DME Prior Approval Requests Slow to a Crawl

New York

Since the New York State Health Department closed the Medicaid Manhattan office and transferred the work to the central office in Albany in November, many DME prior approval requests have been drastically delayed, the New York Medical Equipment Providers (NYMEP) association reported.

The slowdown has affected custom mobility and seating, specialized bathroom equipment, specialized rehab equipment and — particularly — certain equipment repairs, according to NYMEP President Gloria Murray, director of operations at Medstar Surgical Supply in Poughkeepsie, N.Y. “We’re definitely talking about the severely handicapped population here,” she said.

William Van Slyke, a spokesman for the state health department, told the New York Times in January that the state is “seeing a higher number of rejections out of the metropolitan area, but we would dispute that it’s virtually all of the requests.” He added that “the most common problem is the lack of documentation citing that the product is medically necessary … We found that the New York City office deviated from established protocols, and we’re trying to apply the rules and regulations uniformly to every part of the state.”

According to Murray, prior approvals “being held up the most are related to repairs. The repairs used to be able to be sent in with a doctor’s order. Now they’re looking for a physical therapy assessment.”

“When you get new windshield wipers for your car, you shouldn’t have to do all the same paperwork as when you bought the car,” Dr. Dara Richardson-Heron, chief medical officer of United Cerebral Palsy of New York City told the Times.

“Right now, we have a crisis on our hands,” Murray said, adding that the state met with providers in December and January to discuss the issue. “The prior approval process is the biggest issue on our chopping block.”