Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111

MassHealth
Durable Medical Equipment Bulletin 13
September 1999

TO:      Durable Medical Equipment Providers Participating in MassHealth

FROM:      Mark E. Reynolds, Acting Commissioner

RE:      NEW GENERAL PRESCRIPTION FORM

Background                       The Division has developed a new general prescription form.  This new form will allow prescribers to include all the prescription requirements in the durable medical equipment regulations at 130 CMR 409.407(A) for equipment or supplies.  The General Prescription Form may be used as an alternative to the prescriber’s prescription pad and letterhead, and the DMERC (Durable Medical Equipment Regional Carrier) certificate of medical necessity (CMN).

A copy of the General Prescription Form, which you may photocopy, accompanies this bulletin.  If you need additional copies, please contact Unisys at the attention of Forms Distribution, P.O. Box 9101, Somerville, MA  02145.  Requests must be made in writing.  Include your provider number and the exact title of the form.

130 CMR 409.407 requires DME providers to obtain a written prescription for the rental or purchase of DME and the purchase of medical/surgical supplies.

Acceptable Prescriptions   Effective immediately, the Division will accept any of the following forms of prescription:

•   the MassHealth General Prescription Form;

•   a prescription pad;

•   the prescriber’s letterhead; or

•   the Region A DMERC CMN (to be used only for any of the items listed in the DMERC manual and completed in accordance with the instructions established by the Region A DMERC, in addition to complying with all requirements in 130 CMR 409.407(A)).

MassHealth
Durable Medical
Equipment Bulletin 13
September 1999
Page 2

Recordkeeping                  Durable medical equipment providers must keep the prescriber’s prescription on file for at least four years following the date of service.

Questions                         If you have any questions, please contact the Unisys Provider
Services Unit at (617) 628-4141 or 1-800-325-5231.