Delaware Medicaid requires a practitioner's medical necessity letter for supplies and durable medical equipment that need prior authorization. Published as Appendix D of the Supplies and DME Provider Policy Manual, it asks the practitioner to describe diagnosis, prognosis, treatment plan, the reason for the item and its expected therapeutic effect. DMMA's Medical Review Team uses it to decide the supplier's request.
The physician or practitioner completes the whole letter and signs it with printed name, address and phone. The DME supplier attaches it to its prior authorization request.
Download the current version from the source each time; forms change without notice.
Practitioner's Medical Necessity Letter
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Yes. The form states that a separate letter is required for each item requested. Each letter names the item and covers the diagnosis and prognosis, treatment plan, reason for use with estimated duration, and the expected therapeutic effect.
The team applies Medicaid's rule of covering the least costly appropriate alternative that can be provided safely and effectively without duplicating other services. A letter that ties the item to the member's functional limitations, includes test results and explains the expected effect gives the team what it needs; it may ask for more.