Section 16.03.09.753 - DURABLE MEDICAL EQUIPMENT AND SUPPLIES: PROCEDURAL REQUIREMENTS01.Orders. a. All medical supplies, equipment, and appliances must be ordered by a physician or non-physician practitioner acting within the scope of their licensure. Such orders must meet the requirements in the CMS/Medicare DME coverage manual.b. If medical equipment and supplies are required for extended periods, these must be reordered as necessary, but at least annually, for all participants.c. The following information to support the medical necessity of the item(s) must be included in the order and accompany all requests for prior authorization, or be kept on file with the DME provider for items that do not require prior authorization: i. The participant's medical diagnosis, including current information on the medical condition that requires the use of the supplies or medical equipment, or both;ii. An estimate of the time period that the medical equipment or supply item will be necessary and frequency of use. As needed (PRN) orders must include the conditions for use and the expected frequency;iii. For medical equipment, a full description of the equipment needed. All modifications or attachments to the basic equipment must be supported;iv. For medical supplies, the type and quantity of supplies necessary must be identified; andv. Documentation of the participant's medical necessity for the item, that meets coverage criteria.vi. Additional information may be requested by the Department for specific equipment or supplies.02.Face-to-Face Encounter for Home Health Medical Supplies, Equipment, and Appliances. Medical supplies, equipment, and appliances provided under a home health plan of care must comply with requirements in Subsection 723.02 of these rules.03.Plan of Care Requirements for Home Health Medical Supplies, Equipment, and Appliances. Medical supplies, equipment, and appliances provided under a home health plan of care must comply with requirements in Subsection 723.03 of these rules.04.Prior Authorizations. a. Prior authorization means a written, faxed, or electronic approval from the Department that permits payment or coverage of a medical item or service that is covered only by such authorization.i. Medicaid payment will be denied for the medical item or service or portions thereof that were provided prior to the submission of a valid prior authorization request. An exception may be allowed on a case-by-case basis, when events beyond the provider's control prevented the request's submission.ii. The provider may not bill the Medicaid participant for services not reimbursed by Medicaid solely because the authorization was not requested or obtained in a timely manner.b. An item or service will be deemed prior approved where the individual to whom the service was provided was not eligible for Medicaid when the service was provided, but was subsequently found eligible under IDAPA 16.03.05, "Eligibility for Aid to the Aged, Blind, and Disabled," or IDAPA 16.03.01, "Eligibility for Health Care Assistance for Families and Children," and the medical item or service provided is approved by the Department by the same guidance that applies to other prior authorization requests.c. A valid prior authorization request is a written, faxed, or electronic request from a provider for services that contains all information and documentation as required by these rules to justify the medical necessity, amount of and duration for the item or service.05.Notification of Changes to Prior Authorization Requirements. The Department will provide sixty (60) days notice of any substantive changes to requirements for prior authorization in its provider handbook. The Department will provide a method to allow providers to provide input and comment on proposed changes.06.Equipment Rental -- Purchase Procedures. Unless specified by the Department, all equipment must be rented except when it would be more cost effective to purchase it. Rentals are subject to the following guidelines:a. Rental payments, including intermittent payments, are to be automatically applied to the purchase of the equipment.b. The Department may choose to continue to rent certain equipment without purchasing it. Such items include apnea monitors, ventilators, and other respiratory equipment.c. The total monthly rental cost of a DME item must not exceed one-tenth (1/10) of the total purchase price of the item.07.Notice of Decision. A Notice of Decision approving or denying a requested item will be issued to the participant by the Department. The participant has twenty-eight (28) days from the date of the denial to request a fair hearing on the decision. Hearings will be conducted under IDAPA 16.05.03, "Contested Case Proceedings and Declaratory Rulings."Idaho Admin. Code r. 16.03.09.753