Update to Durable Medical Equipment (DME) and Medical Supplies for Healthy Montana Kids (HMK)

Mar. 01, 2017

Effective March 1, 2017, for HMK, prior authorization is required for DME and medical supplies that cost more than $500. HMK will pay for the most economical equipment or supplies that are Medically Necessary to treat a problem or physical condition; and must be appropriate for use in the Member's home, residence, school, or workplace.

DME does not include equipment or supplies that are useful or convenient, but are Medically Necessary. DME includes things like oxygen equipment, wheelchairs, prosthetic limbs, and orthotics.

Diabetic equipment and supplies include things like; insulin, syringes, injection aids, devices for self-monitoring of glucose levels, test strips, visual reading and urine test strips, one insulin pump for the warranty period, and accessories to insulin pumps.

This also includes an infusion pump, or diabetic pump that is authorized. The supplies will also need an authorization completed separately and specific to these services if they are going to be billed with a claim line total of over $500.00.