1. GOVERNING AGENCIES

Agency: Kansas Department of Health and Environment (KDHE) — Division of Health Care Finance
Role: Administers Medicaid benefits and oversees provider enrollment and reimbursement for durable medical equipment (DME) and SME.

Agency: Kansas Department for Aging and Disability Services (KDADS)
Role: Establishes service standards for SME within HCBS waivers, including definitions of covered equipment and clinical criteria.

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures federal guidelines are met for reimbursement and medical necessity of equipment under Medicaid.

Agency: Managed Care Organizations (MCOs) under KanCare
Role: Approve service authorizations, facilitate claims processing, and monitor care outcomes for participants receiving SME.

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2. SERVICE OVERVIEW

Specialized Medical Equipment includes items not typically covered under standard DME, designed to meet specific participant needs.

Approved providers may supply:

• Adaptive devices to promote self-care and independence
• Environmental controls and alert systems (e.g., voice-activated lights, emergency call systems)
• Mobility and transfer aids (e.g., customized wheelchairs, hoyer lifts)
• Specialized communication equipment
• Assistive technology tailored to the individual’s disability
• Modifications to equipment to accommodate the participant’s environment or needs

All equipment must be listed in the participant’s Individualized Service Plan (ISP) and justified with supporting clinical documentation and a physician’s order.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Kansas Secretary of State
• Obtain IRS EIN and Type 2 NPI
• Enroll with Kansas Medicaid via the Kansas Medical Assistance Program (KMAP)
• Secure general liability and product liability insurance
• Submit equipment pricing and procurement policies
• Employ or contract with licensed professionals (e.g., Assistive Technology Professionals, Occupational or Physical Therapists, as needed for assessments)
• Ensure HIPAA compliance and develop protocols for equipment delivery, maintenance, and documentation

4. KANSAS PROVIDER ENROLLMENT PROCESS

Step 1: Medicaid Enrollment

• Apply through KMAP as a provider of Specialized Medical Equipment/Durable Medical Equipment
• Complete credentialing with each KanCare MCO

Step 2: Documentation Submission

• Provide proof of business registration, insurance, product sourcing, and maintenance capabilities
• Submit staff credentials and equipment-related policy manual

Step 3: Authorization & Service Delivery

• Obtain physician’s order and clinical documentation
• Coordinate assessment (if required) for participant’s equipment needs
• Submit service request to MCO for approval
• Deliver, install, and train participant on equipment use
• Submit claims using appropriate HCPCS or CPT codes

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5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Kansas business license
• IRS EIN verification
• NPI registration confirmation
• Proof of insurance coverage (liability/product liability)
• Vendor agreements or product catalogs

SME Provider Policies & Procedures Manual, including:

• Equipment delivery and maintenance policies
• Intake and equipment assessment forms
• Informed consent and training documentation
• Recordkeeping and claims protocols
• Critical incident response and equipment malfunction protocols
• Staff qualifications and HIPAA compliance policies

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6. STAFFING REQUIREMENTS

Role: Equipment Technician / Delivery Specialist
Requirements: Experience in medical equipment installation, maintenance, and participant training; background check clearance

Role (optional): Assistive Technology Specialist or Therapist
Requirements: Certified ATP, OT, or PT for assessments and clinical justification, licensed in Kansas

All staff must complete:

• HIPAA training
• Infection control and equipment sanitization procedures
• Emergency response and participant safety training
• Annual training on new technologies and Medicaid updates

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7. MEDICAID PROGRAMS & HCBS WAIVERS

SME is covered under:

• Kansas Medicaid State Plan (DME coverage)
• KanCare MCO contracts

HCBS Waivers (with ISP documentation):

• Intellectual/Developmental Disability (IDD) Waiver
• Physical Disability (PD) Waiver
• Frail Elderly (FE) Waiver
• Technology Assisted (TA) Waiver
• Brain Injury (BI) Waiver
• Autism Waiver

Delivery settings may include:

• Participant homes
• Adult day programs
• Residential care settings
• Virtual consultations for tech support or training

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8. TIMELINE TO LAUNCH

Phase: Business Registration and Manual Development
Timeline: 1–2 months

Phase: KMAP Enrollment and MCO Credentialing
Timeline: 2–3 months

Phase: Staff Onboarding and Service Workflow Setup
Timeline: 1 month

Phase: Equipment Procurement and Services Launch
Timeline: 30–60 days

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9. CONTACT INFORMATION

Kansas Department of Health and Environment (KDHE)
Website: https://www.kdhe.ks.gov

Kansas Department for Aging and Disability Services (KDADS)
Website: https://kdads.ks.gov

Kansas Medical Assistance Program (KMAP)
Website: https://www.kmap-state-ks.us

KanCare MCOs:

Sunflower Health Plan: https://www.sunflowerhealthplan.com

UnitedHealthcare Community Plan: https://www.uhccommunityplan.com/ks

Aetna Better Health of Kansas: https://www.aetnabetterhealth.com/kansas

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10. SCOPE OF WORK

• Business formation and KMAP enrollment
• MCO credentialing and SME policy manual development
• Staff hiring templates, equipment sourcing protocols, and maintenance tracking tools
• Medicaid coding, billing setup, and audit documentation preparation
• Branding, website development, and referral outreach
• Care coordination tools and outcomes tracking systems

Waiver Consulting Group supports DME suppliers, home health agencies, and tech-based providers in establishing compliant SME services under Medicaid and HCBS waivers across Kansas.