PM 20-19-02: Prior Approval

WAG 20-19-02.

The Bureau of Comprehensive Health Services handles prior approval. Prior approval is needed, except when:

• the client is eligible for Medicare and Medicare covers the item;
• repair does not cost more than 75% of the item's cost;
• the item is a loaner item;
• an item is replaced within 24 months of purchase and all of the following occur:
  • the item is not under warranty;
  • the item was OK when purchased;
  • HFS purchased the original item for the client;
  • the original item cannot be repaired or it costs more to repair than replace; and
  • the replacement item is new and has the same value as the original.

The following are the requirements and timeframes for specific items.