Performance Improvement 2008. How Do States Apply Medicaid Standards to Durable Medical Equipment Providers?


This study identified standards used by States to enroll durable medical equipment (DME) providers in the Medicaid program. The study determined the extent to which providers met the standards, and the extent to which States reenrolled Medicaid DME providers. Each State sets its own standards for the enrollment of Medicaid DME providers. States may verify whether providers meet standards at initial enrollment, and may also review providers after enrollment, to determine whether providers continue to adhere to State standards. Unlike Medicaid, Medicare has provider enrollment standards that are uniform across all States (except licensure requirements that vary from State to State). Researchers collected data from 14 States and the District of Columbia using email and telephone surveys. They also examined States' provider enrollment applications and written documentation about State standards to conduct a selective review of State-reported information. Data collection was completed during September and October 2005.

States reviewed employed a variety of standards for DME provider enrollment. Most were not routinely verifying whether providers met all standards. Four routinely reenrolled DME providers; two reported recent initiatives to reenroll providers.

Report Title: Medicaid Provider Enrollment Standards: Medical Equipment Providers,
Agency Sponsor:
OS-OIG, Office of Inspector General
Federal Contact:
Claire Barnard, 202-205-9523
Performer: Office of Inspector General
PIC ID: 8783

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"PerformanceImprovement2008.pdf" (pdf, 1.29Mb)

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