Durable Medical Equipment (DME) Changes

Medical supply purchasing changes

Under the 2009-2011 budget approved by the Legislature early this year, the Department of Social and Health Services is implementing a number of changes to the optional medical supply benefit to help DSHS stay within its budget.

Enteral nutrition – a change in purchasing for adults.
Effective July 1, 2009

• Oral enteral nutrition is no longer covered. Providers may submit medical documentation that proves the client is clinically/medically unique from others with a similar condition (diagnosis) as an exception to rule.(WAC 388-501-0160)
• Enteral nutrition will be covered in cases where clients are using it for tube feedings
• Current prior authorizations will be honored through the end date in the authorization letter sent out to the client.
• Expedited prior authorizations are no longer valid for adult clients.
• There is NO CHANGE to enteral nutrition policy for children.

Other medical equipment – changes in purchasing for adults.
Effective August 1, 2009

• Adult bath or shower items, stockings, and auto blood pressure cuffs are non-covered benefits.
• Clients may request an exception to the rule. 
• There is NO CHANGE in purchasing of these items for children.

Other supplies – new limits that apply to both adults and children.
Effective August 1, 2009

• Diabetic supplies (lancets and test strips) will be limited to 100 a month for clients on insulin or to 100 every three months for clients not on insulin.
• Non-sterile gloves will be limited to 200 per month, down from the previous limit of 900 per month.
• Sterile gloves will be limited to 30 a month.

Clients receiving these services may request an exception to the limits if their health-care needs are not met under the limit. WAC 388-501-0169)

Incontinent Supplies
Effective August 1, 2009

• Limited to 200 per month regardless of age. This includes briefs and liners or a combination of pull-ups, briefs and liners.

• All other existing limits on these supplies stay the same.

Clients receiving these services may request an exception to the limits if their health-care needs are not met under the limit. WAC 388-501-0169)

Questions and Answers about DME Changes

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