Payment for Durable Medical Equipment

(A) MassHealth pays for DME for eligible members as required by 130 CMR 450.231: General Conditions of Payment and in accordance with the applicable payment methodology and rate schedule established by EOHHS at 101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment. (B) Payments are subject to the conditions, exclusions, and limitations set forth in 130 CMR 409.000 and 130 CMR 450.000: Administrative and Billing Regulations. (C) MassHealth pays for DME only if: (1) medically necessary and, if subject to PA, the MassHealth agency or its designee determines that the DME is medically necessary; (2) the member meets applicable clinical eligibility criteria for the DME; (3) the provider has obtained a prescription or letter of medical necessity for the purchase or rental of DME in accordance with 130 CMR 409.416; and, if necessary, prior authorization for purchase, rental or repair of DME in accordance with the requirements set forth in 130 CMR 409.418; and (4) provider has diligently sought payment from all other liable parties in accordance with 130 CMR 409.418(D) and 130 CMR 450.316: Third-party Liability: Requirements. (D) The MassHealth agency pays for DME provided to MassHealth members in another state by a MassHealth DME provider in accordance with 42 CFR 431.52(b) and 130 CMR 450.109: Out- of-state Services. The DME provider must keep a record for each member in accordance with 130 CMR 409.430, and 130 CMR 450.205: Recordkeeping and Disclosure, and make this record available to MassHealth or its designee upon request.