Medicaid Policy on Prior Authorization and Reimbursement for Wheelchairs

Recently UTMED became aware of Medicaid’s recent interpretation regarding policy on prior authorization and reimbursement for wheelchairs. These interpretations of the policy were causing concern throughout the industry, particularly for patients and access to wheelchairs. We met multiple times with members of the industry and the association to address the issue and how we could address this with Medicaid. We met last month with medicaid and voiced our concerns.

Last week we were told that Medicaid would revert to their previous interpretation of the policy. Today we received the following letter outlining that Medicaid is reinstating their previous interpretation of the policy and that they would continue to look at the policy with the industry’s feedback and participation.

This issue is a great example of why the UTMED Association is important and why you should join the association today. Thank you to all those that participated in the process over the last month.

Dear Wheelchair Supply, Nursing Facility and Intermediate Care Facility Providers,  

Earlier this year, as part of its ongoing oversight of Medicaid benefits, Utah Medicaid reviewed its wheelchair coverage and reimbursement policy for individuals residing in Nursing Facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities.  As a result of that review, the agency determined that certain changes to the prior authorization process would bring practices into better compliance with policy. In early September 2018, Utah Medicaid modified its prior authorization process for this benefit. 

In response, providers met with the agency and expressed concern about the impact the new prior authorization process had on several individual cases that were already underway at the time of the change.  The agency would like to address the concerns raised by the providers and has agreed to look at the prior authorizations and policy again.

To decrease confusion while a continued review of this policy takes place, effective immediately, Utah Medicaid is reinstating the prior authorization process that was in place prior to September 2018.  Providers may resubmit authorization requests that were returned as a result of the September 2018 change. 

As Utah Medicaid conducts its review and contemplates updates to policy and operational procedures, the agency will engage providers and solicit stakeholder feedback prior to implementing any changes. 

We appreciate the feedback we received.  We look forward to working with you on this issue going forward.

Thank you. 

Division of Medicaid and Health Financing