MAB2026071601

Effective July 16, 2026: (1) Billing/clinical staff must implement prior authorization requirement for ALL stander prescriptions (purchase or rental >3 months). (2) Update billing system and EMR templates to require submission of the following documentation with EVERY stander prior auth request: diagnoses, physical examination findings, beneficiary functional assessment, specific equipment style with cost justification, written plan of care with therapeutic goals, and home evaluation report. For replacement standers, also require: date of purchase, serial number, warranty information, and repair history. (3) Establish internal checklist ensuring all eight medical necessity criteria are documented before submission (neuromuscular diagnosis, expected therapeutic benefit, failure of conservative methods, caregiver availability, 30-minute tolerance trial, residual strength assessment, and multi-positional tolerance if applicable). (4) Train providers and DME suppliers that requests meeting all clinical guidelines will be auto-approved; those not meeting guidelines will be escalated to physician review. (5) Inform patients and referral sources that stander claims without prior authorization will be denied. (6) Reference MA Bulletin 01-26-55, 08-26-55, 09-26-55, 10-26-12, 24-26-54, 25-26-11, 31-26-56 when communicating with payers. Contact PA Fee-for-Service Provider Service Center at 1-800-537-8862 with questions.