SPECIALIZED MEDICAL EQUIPMENT SERVICES PROVIDER IN TENNESSEE

Fatumata Kaba
3d
3 min read

SUPPLYING CUSTOMIZED MEDICAL EQUIPMENT AND SUPPORTIVE TECHNOLOGIES TO PROMOTE HEALTH, MOBILITY, AND INDEPENDENCE

Specialized Medical Equipment (SME) Services in Tennessee provide individuals with disabilities or complex medical needs access to essential devices and assistive technologies that support daily functioning, health maintenance, and safety. These services are available under TennCare’s State Plan Medicaid, Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and the Katie Beckett Program.

1. GOVERNING AGENCIES

Agency: TennCare (Tennessee Medicaid)

Role: Oversees State Plan Durable Medical Equipment (DME) and waiver-based Specialized Medical Equipment services.

Agency: Tennessee Department of Intellectual and Developmental Disabilities (DIDD)

Role: Monitors and certifies providers under 1915(c) and ECF CHOICES Waivers for SME delivery and training.

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

Role: Establishes federal rules and medical necessity criteria for SME and DME coverage.

2. SPECIALIZED MEDICAL EQUIPMENT SERVICES OVERVIEW

Specialized Medical Equipment refers to medically necessary devices, adaptations, and equipment that:

Are not available through standard DME coverage
Improve functional capabilities, independence, or health outcomes
Are used in the home or community and not solely for recreation

Covered items may include:

Adaptive Seating and Wheelchairs
Portable Ramps or Lifts
Specialized Beds or Pressure-Relief Mattresses
Communication Devices (AAC)
Adaptive Utensils, Toileting Equipment, or Bath Aids
Medical Alert and Safety Monitoring Devices
Environmental Controls (e.g., voice-activated switches, remote lighting)
Custom Prosthetics or Orthotics (non-standard)

Services may also include delivery, setup, maintenance, and participant training.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply to TennCare as a DME/SME provider OR enroll via DIDD for waiver programs
Secure a DME License (if dispensing medical devices under State Plan Medicaid)
Maintain insurance (liability, equipment coverage, workers’ comp)
Develop a Specialized Medical Equipment Policy & Procedure Manual

4. TENNESSEE PROVIDER ENROLLMENT PROCESS

Step 1: Form legal entity and acquire EIN/NPI

Step 2: Apply as a TennCare DME/SME Provider or DIDD-certified Waiver SME Provider

Step 3: Submit catalog of equipment, medical necessity criteria, and order procedures

Step 4: Verify delivery protocols and return/replacement policies

Step 5: Receive referrals based on ISP/physician orders and begin delivery

5. REQUIRED DOCUMENTATION

Articles of Incorporation, EIN, NPI
TennCare or DIDD provider approval
Product list and manufacturer certifications
SME Policy & Procedure Manual including:
- Medical necessity review and documentation process
- Delivery, setup, and participant training protocols
- Maintenance and warranty tracking
- Participant education and safe use materials
- HIPAA compliance and incident response procedures
- Billing templates and prior authorization forms

6. STAFFING REQUIREMENTS

Role: SME Delivery Technician

Requirements: Background check, product-specific training, CPR/First Aid recommended

Role: Equipment Specialist or ATP (Assistive Technology Professional)**

Requirements: ATP Certification or relevant clinical background (e.g., OT/PT) preferred for complex devices

Role: Program Coordinator or Billing Specialist

Requirements: Knowledge of TennCare claims and HCBS documentation

All staff must complete:

HIPAA and privacy training
Product-specific operation and safety protocols
Documentation and incident reporting procedures
Infection control (for equipment entering homes)

7. MEDICAID WAIVER PROGRAMS

Specialized Medical Equipment is available under:

TennCare State Plan (as Durable Medical Equipment) – For items meeting standard DME definitions with physician orders
ECF CHOICES (Group 4, 5, 6) – Includes SME as part of the Individual Support Plan
1915(c) Waivers – For children or adults with I/DD and specific assistive device needs
Katie Beckett Program – For medically complex children not eligible for Medicaid through income alone
EPSDT (under 21) – Covers medically necessary equipment for children under physician recommendation

8. TIMELINE TO LAUNCH

Phase: Business Registration & Licensing

Timeline: 1–2 months

Phase: TennCare/DIDD Enrollment & Product Documentation

Timeline: 2–3 months

Phase: Vendor Agreements & Staff Training

Timeline: 1–2 months

Phase: Begin Referrals & Equipment Delivery

Timeline: Upon approval and receipt of ISP/doctor’s orders

9. CONTACT INFORMATION

TennCare (Tennessee Medicaid Program)

Website: https://www.tn.gov/tenncare

Tennessee Department of Intellectual and Developmental Disabilities (DIDD)

Website: https://www.tn.gov/didd

Tennessee Department of Health – Health Licensure

Website: https://www.tn.gov/health

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

SPECIALIZED MEDICAL EQUIPMENT PROVIDER IN TENNESSEE

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

WCG helps equipment suppliers and assistive technology startups enroll with Medicaid and waivers to deliver meaningful, personalized SME services across Tennessee.

Scope of Work: