State Regulations: Where to Look

When I was a kid—maybe 6^th or 7^th grade—I had a friend that could name all the states in alphabetical order. He also could name each state capital. Half a century later, after a career spent traveling the United States, I think I might be able to list them all if I could start with Maine and work geographically south and west visualizing a map. My friend was a pretty smart individual and is finishing up a stellar career as a cardiothoracic surgeon. I often wonder if he can still list the states like that in between heart valve replacement surgeries and repairing aortic aneurisms. And because that special talent so impressed me back in the day, I think about him and his high-intelligence parlor trick every time I see a map of the United States with the outline of states and the Crayola crayon rainbow of colors for each place.

I also think of him when I access the Palmetto GBA website to check state regulations. Like my friend’s parlor trick naming all the states, it would be pretty impressive (and nearly impossible) to be able to recite from memory which states require what kind of state license and what the requirements for each state dictate for a DME. Fortunately, there’s a pretty good website which puts all that information together into an accessible and easy-to-search database, which is available to one and all.

Check out: https://dominoapps.palmettogba.com/palmetto/npewest.nsf/DID/P4LF7PNQM8?Open

Palmetto GBA is a very large provider of high-volume claims processing, contract operations, and technical services for the federal government (and by “the federal government”, I mean Medicare). They have been providing governmental healthcare administration for many years and have a longstanding relationship with Centers for Medicare Services (CMS). The “take home” message from this is that they are credible when it comes to offering advice regarding regulations, law, and compliance.

One of the helpful tools Palmetto GBA offers is the map that is accessed in the link above. The link will take you to a map of the United States, complete with state names. Move your cursor over the map and you’ll see that each state is a hyperlink. The hyperlinks take you to a database of law and regulation for the individual state.

Why are these links useful?

Navigating the law and regulation that comes with state DME licensure is complex and sometimes confusing. Rules and regulation have changed a lot over the last ten years, so the rules today might not be the same rules tomorrow. States have their own definition of what constitutes “home medical equipment”. TENS units might be considered DME in one state but not DME in an adjacent state. Thus, simply determining that a state requires a license to provide DME isn’t enough. You need to drill down and see if the equipment and supplies you are providing are considered DME.

The next level of confusion is that states also have different interpretations of licensure for “out of state” providers. If you operate a business close to a state border, and plan to provide equipment services in that neighboring state, you need to first determine if that state has a state DME license. Next, you have to figure out if the equipment you plan to provide is something that requires that DME license in that state. Finally, you have to check their rules for out of state providers, reciprocity, and the need for a license.

The last piece of this complex puzzle is adding accreditation to the equation. Some states may require it. Some states have different “types” of licenses for accredited companies and non-accredited companies. Ohio, for instance, has a DME “license” and a DME “registration” through the Pharmacy Board. One is for accredited organizations and one is for non-accredited companies. While they are similar in terms of conveying the right to provide DME in the state, the biggest difference is that non-accredited companies must submit to an inspection by the board (presumably because they have not been inspected by an approved accrediting board).

The good news in all this is that the Palmetto GBA link above will answer all your questions and solve this complex puzzle. The database can be sorted by equipment codes/types for each or any state. So, if you are a national provider of wheelchairs, you can check each state for licensure requirements. If you are a provider of several or many equipment lines in one state, you can check that particular state for requirements for all products.

The site will not only tell you that you need a license, it will also give you a department name, address, phone number, website, and email for the government entity you’ll need to work with to obtain the state license. In most cases, there’s even a handy hyperlink so you can jump directly from the Palmetto website right to the website for the place you need the license from.

One last word of caution: if in doubt, pick up the phone or send an email to get clarification. If something is unclear, or you aren’t sure what category a given supply or piece of equipment falls into, call the state agency directly and have them explain and clarify.

The Palmetto GBA website is something that all DME organizations should bookmark as a “favorite place”. You won’t be able to recite the rules and requirements from memory, but you’ll know where to look for the answer.