SPECIALIZED MEDICAL EQUIPMENT SERVICES PROVIDER IN OREGON

DELIVERING ACCESS TO CRITICAL DEVICES THAT SUPPORT INDEPENDENCE, SAFETY, AND QUALITY OF LIFE FOR MEDICAID BENEFICIARIES

Specialized Medical Equipment (SME) Services in Oregon are Medicaid-funded supports that provide individuals with disabilities or chronic medical conditions access to essential devices that support health, mobility, communication, and safety in the home and community. These services include the assessment, purchase, delivery, customization, and repair of equipment such as hospital beds, mobility devices, adaptive aids, and environmental modifications. SME is available under the Oregon Health Plan (OHP) and through HCBS waivers and the K Plan (1915(k)).

1. GOVERNING AGENCIES

Agency: Oregon Health Authority (OHA)

Role: Administers the Oregon Health Plan, oversees Medicaid provider enrollment, and authorizes funding for medical equipment and devices.

Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD), Developmental Disabilities Services (DDS)

Role: Coordinates SME services through local APD offices or Community Developmental Disabilities Programs (CDDPs).

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures Oregon’s Medicaid SME coverage meets federal guidelines under HCBS and State Plan options.

Agency: Oregon Secretary of State (SOS)

Role: Registers businesses operating in Oregon, including Durable Medical Equipment (DME) providers.

Agency: Oregon Board of Pharmacy (if applicable)

Role: License providers dispensing certain medical devices with medical or pharmaceutical components.

2. SPECIALIZED MEDICAL EQUIPMENT SERVICES OVERVIEW

SME Services include the provision of medical and adaptive equipment that is not typically covered under standard Medicaid benefits but is deemed necessary to increase independence or reduce institutional care needs.

Approved providers may deliver:

• Needs Assessment & Device Selection: Reviewing individual support needs and recommending appropriate equipment.

• Procurement & Delivery: Ordering and delivering Medicaid-authorized equipment (e.g., shower chairs, Hoyer lifts, respiratory equipment).

• Installation & Setup: Ensuring devices are functional and safe for use in home environments.

• Customization: Modifying devices to meet individual specifications.

• Training & Instruction: Teaching individuals and caregivers to use equipment correctly.

• Maintenance & Repairs: Replacing worn parts and repairing broken devices.

• Documentation & Billing: Service records, equipment logs, delivery receipts, and Medicaid billing templates.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Oregon Secretary of State.

• Obtain an EIN from the IRS and a Type 2 NPI.

• Enroll with Oregon Medicaid through the OHP Provider Portal as a DME or SME provider.

• If dispensing certain devices, secure licensure with the Oregon Board of Pharmacy.

• Obtain national accreditation (e.g., CHAP, ACHC, or The Compliance Team) if required.

• Carry general liability and workers’ compensation insurance.

• Develop a Specialized Medical Equipment Services Policy & Procedure Manual in line with Medicaid and accreditation standards.

4. OREGON PROVIDER ENROLLMENT PROCESS

Step 1: Register business entity and secure EIN/NPI and insurance.

Step 2: Complete Medicaid provider enrollment through OHA.

Step 3: Apply for DME accreditation (if needed) and Board of Pharmacy licensure.

Step 4: Submit service documentation and equipment inventory processes.

Step 5: Begin accepting referrals and authorizations from APD/DD case managers.

5. REQUIRED DOCUMENTATION

• Business registration and Articles of Incorporation

• EIN and NPI documentation

• Accreditation and/or licensure (Board of Pharmacy, if applicable)

• Insurance certificates

• SME Services Policy & Procedure Manual, including:

  • Equipment procurement, delivery, and installation protocols

  • Client training and instruction procedures

  • Maintenance and repair documentation

  • HIPAA and participant rights safeguards

  • Equipment inventory and tracking logs

  • Incident reporting and recall procedures

  • Medicaid billing and documentation templates

  • Safety and infection control procedures

6. STAFFING REQUIREMENTS

Role: Equipment Technician / Delivery Specialist

Requirements: Background check; trained in device setup, client interaction, and maintenance.

Role: Program Coordinator / Fulfillment Manager

Requirements: Manages orders, vendor relations, scheduling, and Medicaid documentation.

Role: Clinical Consultant (optional)

Requirements: May be an OT, PT, or RN who evaluates equipment needs and trains clients (required for some HCBS services).

All staff must complete:

• HIPAA and safety training

• Equipment-specific handling and infection control

• Documentation and Medicaid compliance education

• Annual performance and protocol reviews

7. MEDICAID WAIVER PROGRAMS

Specialized Medical Equipment Services are available through:

• K Plan (1915(k)) – includes SME necessary to support ADLs/IADLs and independence.

• APD HCBS Waivers – equipment for aging adults or those with physical disabilities.

• Comprehensive & Support Services Waivers (IDD) – includes SME for home and community integration.

• Children’s DD Waiver – adaptive equipment for in-home or school use.

• State Plan DME Benefit (via Prior Authorization) – covers standard medical equipment (wheelchairs, hospital beds, etc.).

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Manual Development

Timeline: 1–2 months

Phase: Medicaid Enrollment & Accreditation

Timeline: 2–4 months (longer if DME accreditation required)

Phase: Equipment Sourcing & Staff Training

Timeline: 30–60 days

Phase: Referral Network Setup & Service Activation

Timeline: Begins once authorizations and contracts are in place

9. CONTACT INFORMATION

Oregon Health Authority (OHA)

Website: https://www.oregon.gov/oha

Oregon Department of Human Services (ODHS)

Website: https://www.oregon.gov/dhs

Oregon Medicaid Provider Portal

Website: https://www.oregon.gov/oha/HSD/OHP/Pages/Providers.aspx

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

Oregon Board of Pharmacy

Website: https://www.oregon.gov/pharmacy

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — OREGON SME PROVIDER

WCG helps DME and SME providers in Oregon develop high-compliance programs that deliver critical medical equipment to Medicaid members across the state.

Scope of Work:

• Business formation, Medicaid enrollment, and equipment licensing support

• SME Policy Manual development and delivery tracking tools

• Equipment request forms, training protocols, and service documentation templates

• Staff credentialing systems and fulfillment workflows

• Accreditation navigation (CHAP, ACHC, TCT)

• Medicaid billing system setup and claim readiness support

• Partnership-building with APD, DD, and hospital discharge teams

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.