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Durable Medical Equipment/Medical Supply Dealers

Durable medical equipment suppliers may be enrolled as Bureau for Children with Medical Handicaps (BCMH) providers in accordance with Ohio Administrative Code Rule 3701-43-05.  All services authorized by BCMH, including durable medical equipment and medical supplies, must be directly related to the client’s BCMH-eligible condition.  BCMH requires prior authorization (PA) for selected equipment to ensure that the service is medically necessary and appropriate.

Major services are specific services which may be included in “service packages” for selected diagnoses or individually requested by the child’s managing physician.  Examples include:

  • Medical/Surgical Supplies: Includes items such as catheters, needles/syringes, alcohol wipes, urine and blood testing supplies, etc.
  • Medical Equipment: Includes items such as wheelchairs, orthotics, percussors, IV or feeding pumps, oxygen, etc.
  • Special Prescription Shoes: Shoes prescribed by a physiatrist or orthopedic surgeon.
  • Special Formula: Oral or enteral formula necessary to promote normal growth and development for a child needing nutritional support, as determined by BCMH policy. Also includes modular components such as MCT Oil and Polycose.

Does not include milk-based formula. A BCMH Nutrition Support Request form and current growth chart must be submitted to BCMH by the managing physician.

Note: BCMH does not require a Prior Authorization Form be submitted; however, this is a requirement of Medicaid

  • Ear Molds: Additional molds required due to growth of the child
  • Maintenance and Repair: Authorized for medical equipment. A PA form is required for repairs greater than $150

Approval of selected BCMH services requires the provider to submit a Prior Authorization Form and include a prescription from an appropriate BCMH-prescribing physician, along with a letter of medical necessity to: Ohio Department of Health, BCMH, PO Box 1603, Columbus, OH  43216-1603.  Please do not submit packet to the Ohio Department of Job and Family Services.

Services Requiring Submission of a Prior Authorization Form

  • Peritoneal dialysis
  • Durable medical equipment
  • Major maintenance and repair
  • Orthotics
  • Prosthetics
  • Wigs

Prior Authorization Requirements for Approval of Services

  • Active BCMH Treatment case
  • BCMH-eligible diagnosis
  • The eligible services must relate to a BCMH medically eligible diagnosis
  • A recent medical report and signed prescription from an appropriate BCMH physician provider (e.g. orthopedist, physiatrist, developmental pediatrician or neurologist for wheelchair or orthotics request).

Completion of the Prior Authorization Form

The following information must be provided:

  • Provider number
  • Provider name, address and telephone number
  • Name of person completing form
  • Date form completed
  • Client’s case number
  • Client’s name, address and telephone number
  • Quantity, proper Healthcare Common Procedural Coding System (HCPCS) code and usual and customary charge.  A copy of the invoice reflecting the acquisition cost must be attached using code E1399
  • Description of service
  • Information related to rental cost (if applicable)
  • Dispensing date (Indicate “pending” if not yet dispensed)
  • Attach prescription for the service, signed by the appropriate BCMH physician provider and a letter of medical necessity

For more information, contact the BCMH prior authorization nurse at BCMH central office (614) 466-1700.

 

Last Updated: 6/29/2017