MedicaidDocumentationMedium impact
MAB 09-16-09 Procedure for Obtaining an 1150 Administrative Waiver for Durable Medical Equipment, Medical Supplies or Prosthetics and Orthotics
Pennsylvania Medicaid (DHS)·PA · Orthopedics, PM&R (Physical Medicine & Rehab), Physical Therapy +4 more·Provider Bulletin
Effective date
May 9, 2016
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires specific documentation including Manufacturer's Suggested Retail Price (MSRP) and adjusted acquisition cost for all 1150 Administrative Waiver requests for durable medical equipment, medical supplies, prosthetics and orthotics starting May 9, 2016. Providers must submit detailed invoices or cost quotes on letterhead with 14-17 specific data elements, and approved quotes require final invoice submission within 30 days of purchase.
Action Required
For PA Medicaid 1150 Administrative Waiver requests submitted after May 9, 2016: Billing team must obtain and submit MSRP documentation and adjusted acquisition cost with all DME, medical supplies, prosthetics and orthotics waiver requests. Ensure all invoices/quotes are on supplier letterhead and include all 14-17 required elements (supplier info, product details, unit costs, shipping/labor costs separately identified). For approved cost quotes, submit final paid invoice to PA DHS Bureau of Fiscal Management within 30 days of purchase. Requests without proper documentation will not be processed.