SPECIALIZED MEDICAL EQUIPMENT SERVICES PROVIDER IN OKLAHOMA

Fatumata Kaba
Sep 8
3 min read

SUPPORTING SAFETY, FUNCTIONALITY, AND INDEPENDENCE THROUGH CUSTOMIZED MEDICAL DEVICES

Specialized Medical Equipment (SME) Services in Oklahoma ensure individuals with disabilities or chronic health needs have access to essential devices and products that promote independence and support health-related outcomes in home and community settings. These services are authorized under Oklahoma Medicaid’s Home and Community-Based Services (HCBS) Waivers, the ADvantage Waiver, and other long-term services and supports programs.

1. GOVERNING AGENCIES

Agency: Oklahoma Health Care Authority (OHCA)

Role: Oversees Medicaid (SoonerCare) enrollment, billing, and coverage criteria for specialized equipment and supplies.

Agency: Oklahoma Department of Human Services (OKDHS)

Role: Manages eligibility and coordination of services under ADvantage, Medically Fragile, and Developmental Disabilities Services (DDS) waivers.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Provides federal oversight ensuring Medicaid-funded SME services meet medical necessity and HCBS quality standards.

2. SPECIALIZED MEDICAL EQUIPMENT SERVICES OVERVIEW

Specialized Medical Equipment services include the assessment, acquisition, customization, and training needed to provide individuals with medically necessary equipment that is not typically covered under standard Medicaid durable medical equipment (DME) benefits.

Approved providers may deliver:

Needs Assessment: Conducting evaluations in collaboration with therapists or case managers.
Equipment Procurement: Sourcing mobility devices, communication aids, and environmental controls.
Installation & Setup: Configuring devices in the home, including basic modifications if required.
Participant Training: Teaching individuals and caregivers how to safely use and maintain equipment.
Repairs & Replacements: Troubleshooting device malfunctions and replacing faulty equipment.
Documentation: Maintaining purchase records, assessments, service logs, and billing documentation for SoonerCare compliance.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business with the Oklahoma Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll with OHCA as a Medicaid provider for Specialized Medical Equipment.
Maintain liability and product insurance.
Partner with licensed OTs, PTs, or SLPs for clinical justification and training (if required).
Develop a Specialized Medical Equipment Policy & Procedure Manual.
Ensure staff are trained in device safety, documentation, and Medicaid compliance.

4. OKLAHOMA PROVIDER ENROLLMENT PROCESS

Step 1: Business Formation

Create a legal entity, secure insurance, and prepare internal policies.

Step 2: Medicaid Enrollment via OHCA

Apply through the SoonerCare Provider Portal and choose "Specialized Medical Equipment" as the service category.

Step 3: Documentation Submission

Submit business license, insurance certificates, staff credentials, policy manual, and vendor agreements.

Step 4: Readiness Review (as required)

OHCA may review policies, equipment tracking systems, and billing capabilities.

Step 5: Service Authorization & Billing Activation

Upon approval, providers may begin accepting referrals and billing Medicaid for approved SME items.

5. REQUIRED DOCUMENTATION

Business license and Articles of Incorporation
IRS EIN and NPI confirmation
Liability and product insurance certificates
Specialized Medical Equipment Policy & Procedure Manual including:
- Equipment sourcing and purchasing policies
- Assessment and participant needs documentation
- Staff training protocols and maintenance tracking
- Delivery, installation, and participant instruction templates
- HIPAA compliance and grievance procedures
- Medicaid billing documentation and audit readiness tools
- Quality assurance and service outcome monitoring

6. STAFFING REQUIREMENTS

Role: Equipment Services Coordinator

Requirements: Experience in equipment logistics, vendor coordination, and Medicaid documentation.

Role: Certified Technician / Installer

Requirements: Training in device safety, setup, and maintenance; background clearance.

Role: Licensed Therapist (OT, PT, or SLP, as needed)**

Requirements: Provides justification, participant training, or device customization support.

All staff must complete:

HIPAA and participant rights training
Device safety, sanitation, and maintenance modules
Annual documentation and billing compliance training
Emergency and recall procedures for equipment issues

7. MEDICAID WAIVER PROGRAMS

Specialized Medical Equipment is reimbursable under:

ADvantage Waiver – for aging adults and individuals with physical disabilities
Medically Fragile Waiver – for individuals requiring high-level care at home
DDS Waivers (IHSW, Community Waiver) – for individuals with intellectual or developmental disabilities
Living Choice Program – supporting transitions from nursing facilities to the community
State Plan EPSDT (for children under 21) – if medically necessary and not otherwise covered

8. TIMELINE TO LAUNCH

Phase: Business Formation & Policy Development

Timeline: 1–2 months

Phase: Staff Hiring & Medicaid Enrollment

Timeline: 2–3 months

Phase: Readiness Review & Approval

Timeline: 60–90 days

Phase: Start Equipment Ordering & Service Delivery

Timeline: 30–45 days

9. CONTACT INFORMATION

Oklahoma Health Care Authority (OHCA)

Website: https://oklahoma.gov/ohca

Oklahoma Department of Human Services (OKDHS)

Website: https://oklahoma.gov/okdhs

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OKLAHOMA SPECIALIZED MEDICAL EQUIPMENT PROVIDER

WCG supports new SME providers in Oklahoma with a comprehensive launch package that includes:

Scope of Work:

Business formation, SoonerCare enrollment, and waiver credentialing
Customized SME Policy & Procedure Manual development
Vendor management and equipment documentation tools
Medicaid billing system setup and audit preparation
Branding, website development, and outreach to case managers and discharge planners
Quality assurance plans and participant satisfaction tracking
Coordination with therapists and home modification providers when needed