Waiver Consulting Group — Start any program. In any state.

New York - Medical Supply Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New York State Department of Health (NYS DOH) enrolls Medical Supply Service providers under Category of Service (COS) 0321 for Durable Medical Equipment (DME) Appliances or Supplies and Footwear, and COS 0323 for Oxygen Related Equipment. These providers furnish, fit, and service durable medical equipment and disposable supplies for Medicaid waiver participants and fee-for-service members.

Applicants must secure active Medicare enrollment as a DMEPOS supplier before the NYS Medicaid Provider Services Portal (PSP) will accept a Medicaid enrollment application. The state also mandates a $750 application fee and a verified site visit conducted within the past 12 months by Medicare, another state's Medicaid program, or a state licensing agency.

1. Service Definition and Scope

Medical Supply Services in New York encompass the provision of durable medical equipment, medical/surgical supplies, enteral and parenteral therapy, orthopedic footwear, and oxygen-related equipment. Providers supply these items to Medicaid members, including those enrolled in Home and Community-Based Services (HCBS) waivers.

The service requires providers to maintain a physical business location that matches the address approved by Medicare. Providers must dispense items directly to the member and handle necessary fitting, servicing, and warranty fulfillment.

2. Regulatory and Oversight Agencies

The New York State Department of Health (NYS DOH) serves as the primary regulatory authority for Medicaid provider enrollment and policy. The fiscal agent, eMedNY, manages the Provider Services Portal (PSP) and processes claims and enrollment applications.

The Office of the Medicaid Inspector General (OMIG) oversees provider compliance programs and conducts audits to ensure adherence to state regulations.

3. Gatekeeping Prerequisites: Who Can Even Apply

New York imposes strict structural preconditions for DME and Medical Supply providers. The state requires active Medicare enrollment as a prerequisite; a Medicaid application will be rejected without proof of this status.

Additionally, applicants must pass a site visit and pay a substantial application fee before their enrollment is processed.

4. Licensure and Certification Requirements

New York does not issue a distinct state-level "DME License" for general medical supplies, relying instead on Medicare DMEPOS certification and local business licensing. However, specific services like pharmacy-dispensed supplies or respiratory care may require distinct professional licenses.

Providers must submit proof of current business registration and any applicable professional licenses for specialized staff.

5. Medicaid Provider Enrollment

Enrollment is conducted entirely online through the NYS Medicaid Provider Services Portal (PSP). Providers must select their specific Category of Service (0321 or 0323) and submit a comprehensive packet of forms.

Key forms include the ETIN Certification Statement and the Electronic Funds Transfer (EFT) Authorization, which are mandatory for billing providers.

6. Staffing, Training and Background Checks

General medical supply providers do not have universal staff certification requirements in New York. However, specialized equipment provision triggers specific credentialing mandates.

All applicants must complete a Prior Conduct Questionnaire to disclose any past exclusions, and OMIG screens all owners and managing employees.

7. Documentation, Policies and Records

New York requires Medicaid providers to implement a formal compliance program if they meet certain billing thresholds. This is governed by New York State Social Services Law section 363-d.

Providers must maintain records of all dispensed supplies, valid prescriptions, and proof of delivery to the Medicaid member.

8. Billing, Rates and Claims

DME providers bill New York Medicaid fee-for-service using the ePACES system or via clearinghouses using their Electronic Transmitter Identification Number (ETIN).

Many high-cost or custom items require Prior Approval (PA) before dispensing. Effective September 1, 2026, NYS updated its PA change request process to comply with CMS interoperability rules.

9. Approval Sequence and Timeline

The approval sequence begins with obtaining an NPI and securing Medicare DMEPOS enrollment. Only after Medicare approval can the provider submit the NYS Medicaid application via the PSP.

NYS DOH staff review the application, verify the site visit, and process the $750 fee. A written determination containing the MMIS Provider ID is sent upon approval.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to missing prerequisites, particularly the failure to secure Medicare enrollment prior to applying.

Clerical errors on financial forms also cause significant delays, as eMedNY requires exact matches between IRS documents and application fields.

11. Key Contacts and Resources

Providers should utilize the eMedNY Call Center for enrollment and billing technical assistance. The NYS DOH website hosts the official provider manuals and monthly Medicaid Update newsletters.

For compliance program questions, providers must refer to the Office of the Medicaid Inspector General (OMIG).

See all New York services · New York Medicaid consulting · book a consultation.