Capped-Rental DME: 13th-Month Prescription Policy Clarification
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Clarification on when Alaska Medicaid will not require a new prescription solely because a capped-rental durable medical equipment (DME) item reaches its 13th month; affects suppliers billing capped-rental DME to Alaska Medicaid.
No material clinical or coverage changes in this revision.
When a New Prescription Is Required
13th-month prescription applicability
Applicability for suppliers billing capped-rental DME:
ALL of the following must be true for the clarification to apply
ONE of
- The item is a capped-rental durable medical equipment (DME) item that has reached its 13th month of rental under Alaska Medicaid capped-rental policy.
- The supplier is billing Alaska Medicaid for the capped-rental DME item.
- A new prescription will not be required solely because the capped rental has reached the 13th month when the conditions described in the HCS clarification are met (see HCS published clarification).
- Existing capped-rental payment methodologies and billing requirements established in the Alaska Medicaid Payment Methodologies and Billing Guidance for Capped Rental Items and 13-Month Rental Periods remain unchanged.
- Suppliers billing capped-rental DME should review the clarification for applicability to their operations and may contact Provider Inquiry for additional information.
Suppliers should review the full HCS clarification to determine applicability to specific situations and contact Provider Inquiry for questions.
Referenced Provider Type and Codes
| 076 | Medical Supplier |
Supplier Billing Guidance and Actions
Review 13th-month prescription clarification — new Rx not automatically required
Suppliers billing capped-rental DME should review the HCS policy clarification to determine whether it applies to their billed items; HCS will not require a new prescription solely because a capped rental reaches the 13th month when the clarification's conditions are met.
- Review the HCS 13th-month capped-rental DME policy clarification for applicability to your operations.
- Do not assume a new prescription is required solely because a capped-rental item reaches its 13th month if the clarification’s conditions are satisfied.
- Continue to follow existing Alaska Medicaid payment methodologies and billing requirements for capped-rental items.
Key Definitions and Clarifications
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