• Schedule an appointment with your loved one’s doctor.
• Before your visit, print the Prescription and Written Order Form in the Required Documents Packet.  If you do not have access to a printer, ask the provider to print it for you at the appointment.
• Discuss the medical need for a Cubby Bed during your visit and ask the doctor to fill out the printed Prescription and Written Order Form. 
• Obtain a Letter of Medical Necessity (LMN). It is highly recommended that it be written by an Occupational Therapist (OT) or Physical Therapist (PT). If you do not have access to an OT or PT, consult with your chosen Medical Supplier (see next step), or if necessary, a physician can write the LMN. Use our Safety Needs and Concerns Worksheet to write down your child’s safety concerns and any other solutions you’ve tried that didn’t work. The level of detail you provide is crucial to ensure your medical documents fully capture your loved one's need for a Cubby Bed.
• Locate a Medical Supplier that carries Cubby Beds and accepts your insurance. 
• Follow up with the medical supplier: Confirm they’ve received all the necessary documents and ensure they’ve submitted your request to Medicaid.
• For more information on how to get a Cubby Bed, visit our website.

• Complete the Prescription and Written Order Form, which is included in the Required Documents Packet.
• Provide chart notes from the most recent face-to-face visit that clearly explain why the patient was seen and the medical necessity of the Cubby Bed.
• Once your patient has partnered with a medical supplier, please send this document directly to that supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process, such as the State of California Certificate of Medical Necessity form, or for appealing a denial.

• Work with the family to write a Letter of Medical Necessity (LMN). Use the guidance provided in the Required Documents Packet for the details that need to be included. Ask the family to share their completed Safety Needs and Concerns Worksheet with you, which will help you write a detailed letter.
• Once your patient has partnered with a medical supplier, please send the LMN directly to that supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• California requires the DHCS 6181 Certificate of Medical Necessity in addition to the prescription and letter of medical necessity.
• Communicate regularly with the family and providers to improve the chance of approval. 

• Schedule an appointment with your loved one’s doctor.
• Before your visit, print the Prescription and Written Order Form in the Required Documents Packet. If you do not have access to a printer, ask the provider to print it for you at the appointment.
• Discuss the medical need for a Cubby Bed during your visit and ask the doctor to fill out the printed Prescription and Written Order Form. 
• Locate a Medical Supplier that carries Cubby Beds and accepts your insurance. The supplier will help guide you through the insurance process and assist in gathering the required documents. They will also need to be present during an evaluation performed by an OT or PT in order to receive a Letter of Medical Necessity (outlined in the next step).
• Obtain a Letter of Medical Necessity (LMN) from an Occupational Therapist (OT) or Physical Therapist (PT). An LMN written by a physician will NOT be accepted. If you do not have access to an OT or PT, consult with your chosen Medical Supplier. Use our Safety Needs and Concerns Worksheet to write down your child’s safety concerns and any other solutions you’ve tried that didn’t work. The level of detail you provide is crucial to ensure your medical documents fully capture your loved one's need for a Cubby Bed. The Medical Supplier will need to be present at the evaluation by the OT or PT, so make sure you are connected with a supplier before requesting the LMN.
• Follow up with the medical supplier: Confirm they’ve received all the necessary documents and ensure they’ve submitted your request to Medicaid.

For more information on how to get a Cubby Bed, visit our website.

• Complete the Prescription and Written Order Form, which is included in the Required Documents Packet. 
• Explain the significance of a Letter of Medical Necessity (LMN) to the patient, so they have a plan to obtain one. Georgia Medicaid requires the letter to be written by an OT or PT, and will NOT be accepted by a physician.
• Once your patient has partnered with a medical supplier, please send the Prescription and Written Order Form directly to the supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• Work with the family to write a Letter of Medical Necessity (LMN). Use the guidance provided in the Required Documents Packet for the details that need to be included. Ask the family to share their completed Safety Needs and Concerns Worksheet with you, which will help you write a detailed letter.  In addition to the recommended guidance in the above packet, be sure to address the following:
• Patients with severe behavioral disorders need to have a documented plan for behavioral management.
• Where is the member currently sleeping and why is it no longer working?
• What are the specific features of the requested safe bed that are medically necessary for this member? 
• Provide your written plan for monitoring the member that has been approved by the ordering physician describing when the bed will be used, how the member will be monitored, how all the member’s needs will be met while enclosed in the bed (toileting, eating, hydration, skin care and general safety), and an explanation of how any documented medical conditions (e.g., seizures) will be managed while the bed is in use. 
• Must provide safety, cognitive, behavioral and boundary concerns. Evaluation should specify the need for a safe bed, including how the requested bed was chosen over other options. 
• Any requests for a built-in technology hub, or any other specific features or components, should include specific documentation on the need for the features. 
• Once your patient has partnered with a medical supplier, please send the LMN directly to that supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• Georgia requires the Certification of Medical Necessity for Custom Durable Medical Equipment form signed by the ordering physician, in addition to the OT/PT.
• An ATP will need to be present during the evaluation by the OT or PT.
• Communicate regularly with the family and providers to improve the chance of approval.

• Schedule an appointment with your loved one’s doctor.
• Before your visit, print the Prescription and Written Order Form in the Required Documents Packet. If you do not have access to a printer, ask the provider to print it for you at the appointment.
• Discuss the medical need for a Cubby Bed during your visit and ask the doctor to fill out the printed Prescription and Written Order Form. 
• Obtain a Letter of Medical Necessity (LMN). It is highly recommended that it be written by an Occupational Therapist (OT) or Physical Therapist (PT). If you do not have access to an OT or PT, consult with your chosen Medical Supplier (see next step), or if necessary, a physician can write the LMN.  Use our Safety Needs and Concerns Worksheet to write down your child’s safety concerns and any other solutions you’ve tried that didn’t work. The level of detail you provide is crucial to ensure your medical documents fully capture your loved one's need for a Cubby Bed. 
• Locate a Medical Supplier that carries Cubby Beds and accepts your insurance. 
• Follow up with the medical supplier: Confirm they’ve received all the necessary documents and ensure they’ve submitted your request to Medicaid.
• For more information on how to get a Cubby Bed, visit our website. 

• Complete the Prescription and Written Order Form, which is included in the Required Documents Packet. 
• Once your patient has partnered with a medical supplier, please send these documents directly to that supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• Work with the family to write a Letter of Medical Necessity (LMN). Use the guidance provided in the Required Documents Packet for the details that need to be included. Ask the family to share their completed Safety Needs and Concerns Worksheet with you, which will help you write a detailed letter.
• Once your patient has partnered with a medical supplier, please send the LMN directly to that supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• Communicate regularly with the family and providers to improve the chance of approval.

• Schedule an appointment with your loved one’s doctor.
• Before your visit, print the Prescription and Written Order Form in the Required Documents Packet. If you do not have access to a printer, ask the provider to print it for you at the appointment.
• Discuss the medical need for a Cubby Bed during your visit and ask the doctor to fill out the printed Prescription and Written Order Form. 
• Obtain a Letter of Medical Necessity (LMN). It is highly recommended that it be written by an Occupational Therapist (OT) or Physical Therapist (PT). If you do not have access to an OT or PT, consult with your chosen Medical Supplier (see next step), or if necessary, a physician can write the LMN.  Use our Safety Needs and Concerns Worksheet to write down your child’s safety concerns and any other solutions you’ve tried that didn’t work. The level of detail you provide is crucial to ensure your medical documents fully capture your loved one's need for a Cubby Bed. 
• Locate a Medical Supplier that carries Cubby Beds and accepts your insurance. 
• Follow up with the medical supplier: Confirm they’ve received all the necessary documents and ensure they’ve submitted your request to Medicaid.
• For more information on how to get a Cubby Bed, visit our website. 

• Complete the Prescription and Written Order Form, which is included in the Required Documents Packet. 
• Once your patient has partnered with a medical supplier, please send this document directly to that supplier.  You may need to work with the supplier to provide your signature on the MassHealth Medical Necessity Review Form. You may also be asked for revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• Work with the family to write a Letter of Medical Necessity (LMN). Use the guidance provided in the Required Documents Packet for the details that need to be included. Ask the family to share their completed Safety Needs and Concerns Worksheet with you, which will help you write a detailed letter.
• Once your patient has partnered with a medical supplier, please send the LMN directly to that supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• MassHealth requires the Medical Necessity Review Form to be submitted with the prior authorization.
• The supplier must submit the request for prior authorization to the MassHealth agency no later than 90 calendar days from the date of the prescription. Failure to submit the request within the 90-day period will result in a denial of the prior authorization request.
• Communicate regularly with the family and providers to improve the chance of approval. 

• Schedule an appointment with your loved one’s doctor.
• Before your visit, print the Prescription and Written Order Form in the Required Documents Packet. If you do not have access to a printer, ask the provider to print it for you at the appointment.
• Discuss the medical need for a Cubby Bed during your visit and ask the doctor to fill out the printed Prescription and Written Order Form. 
• Obtain a Letter of Medical Necessity (LMN). It is highly recommended that it be written by an Occupational Therapist (OT) or Physical Therapist (PT). If you do not have access to an OT or PT, consult with your chosen Medical Supplier (see next step), or if necessary, a physician can write the LMN.  Use our Safety Needs and Concerns Worksheet to write down your child’s safety concerns and any other solutions you’ve tried that didn’t work. The level of detail you provide is crucial to ensure your medical documents fully capture your loved one's need for a Cubby Bed. 
• Medicaid policy states that enclosed bed systems are not covered when the purpose is to restrain the beneficiary due to behavioral conditions, caregiver need or convenience.
• Locate a Medical Supplier that carries Cubby Beds and accepts your insurance. 
• Follow up with the medical supplier: Confirm they’ve received all the necessary documents and ensure they’ve submitted your request to Medicaid.

For more information on how to get a Cubby Bed, visit our website.

• Complete the Prescription and Written Order Form, which is included in the Required Documents Packet.
• If writing the LMN, since Michigan Medicaid’s policy states that enclosed bed systems are not covered when the purpose is to restrain the beneficiary due to behavioral conditions, caregiver need or convenience, the following must be shown:
• If applicable, documentation to substantiate the need for the bed should include:
• Evidence that the patient is at risk of falls, has impaired motor skills, poor executive function, sensory outbursts, wandering, and/or elopement; or
• If the patient is diagnosed with a motor and/or behavioral disorder that leads to a heightened risk of injury to themself, others, and/or property and is at an increased risk of morbidity or mortality.
• Documentation must show the caregiver has tried solutions such as:
• Side rails, placing the mattress on the floor, medications to address seizures or behaviors, behavior modification strategies, a helmet for headbanging, removing safety hazards from the member’s bedroom, etc.
• Detail indicating why those other solutions did not address the patient’s sleep safety needs.
• Documentation should address if the patient would be at risk for injury, harm, or putting themselves or others in danger without the bed.
• Once your patient has partnered with a medical supplier, please send this document directly to that supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• Work with the family to write a Letter of Medical Necessity (LMN). Use the guidance provided in the Required Documents Packet for the details that need to be included. Ask the family to share their completed Safety Needs and Concerns Worksheet with you, which will help you write a detailed letter.
• Since Michigan Medicaid’s policy states that enclosed bed systems are not covered when the purpose is to restrain the beneficiary due to behavioral conditions, caregiver need or convenience:
• If applicable, documentation should include:
• Evidence that the patient is at risk of falls, has impaired motor skills, poor executive function, sensory outbursts, wandering, and/or elopement; or
• If the patient is diagnosed with a motor and/or behavioral disorder that leads to a heightened risk of injury to themself, others, and/or property and is at an increased risk of morbidity or mortality.
• Documentation should include if  the caregiver has tried solutions such as:
• Side rails, placing the mattress on the floor, medications to address seizures or behaviors, behavior modification strategies, a helmet for headbanging, removing safety hazards from the member’s bedroom, etc.
• Detail indicating why those other solutions did not address the patient’s sleep safety needs.
• Documentation should address if the patient would be at risk for injury, harm, or putting themselves or others in danger without the bed.
• Once your patient has partnered with a medical supplier, please send the LMN directly to that supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• The MSA-1653-B Prior Approval-Request/Authorization form must be submitted.
• Communicate regularly with the family and providers to improve the chance of approval.

• Schedule an appointment with your loved one’s doctor.
• Before your visit, print the Prescription and Written Order Form in the Required Documents Packet. If you do not have access to a printer, ask the provider to print it for you at the appointment.
• Discuss the medical need for a Cubby Bed during your visit and ask the doctor to fill out the printed Prescription and Written Order Form. Currently, NY Medicaid has a policy stating non-coverage of the technology hub, so requests for one may be denied.   It may, however, fall under the scope of state or local waiver programs.
• Obtain a Letter of Medical Necessity (LMN). It is highly recommended that it be written by an Occupational Therapist (OT) or Physical Therapist (PT).  If you do not have access to an OT or PT, consult with your chosen Medical Supplier (see next step), or if necessary, a physician can write the LMN.  Use our Safety Needs and Concerns Worksheet to write down your child’s safety concerns and any other solutions you’ve tried that didn’t work. The level of detail you provide is crucial to ensure your medical documents fully capture your loved one's need for a Cubby Bed. 
• Locate a Medical Supplier that carries Cubby Beds and accepts your insurance. 
• Follow up with the medical supplier: Confirm they’ve received all the necessary documents and ensure they’ve submitted your request to Medicaid.

For more information on how to get a Cubby Bed, visit our website.

• Complete the Prescription and Written Order Form, which is included in the Required Documents Packet. 
• Once your patient has partnered with a medical supplier, please send these documents directly to that supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• Work with the family to write a Letter of Medical Necessity (LMN). Use the guidance provided in the Required Documents Packet for the details that need to be included. Ask the family to share their completed Safety Needs and Concerns Worksheet with you, which will help you write a detailed letter.
• In addition to the general LMN guidance in the packet linked above, New York Medicaid requires documentation for the following:
• A behavioral management plan for individuals with a severe behavioral disorder.
• Evidence of mobility that puts the patient at risk for injury, if applicable.
• A written monitoring plan that is approved by the ordering practitioner and describes how the patient will be monitored at specified time intervals. The plan should also describe how the patient’s basic needs will be met while using the bed (including eating, hydration, toileting, etc.)
• How any medical conditions (such as seizures) will be managed while the individual is in the enclosed bed.
• A statement confirming the requested bed will not be used as a restraint.Once your patient has partnered with a medical supplier, please send the LMN directly to that supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• Per New York Medicaid, “Only twin-size beds will be considered. Exceptions for a large sized bed will be reviewed if the manufacturer does not offer a twin-size bed and the cost of the larger bed is comparable to other twin-size beds.” Note: when requesting a bed larger than twin size, be sure to point out the cost and features comparisons amongst the different “special needs beds.”  Compare Cubby Beds with other safety beds in the Cubby Comparison Flyer.
• Communicate regularly with the family and providers to improve the chance of approval.

• Schedule an appointment with your loved one’s doctor.
• Before your visit, print the Prescription and Written Order Form in the Required Documents Packet. If you do not have access to a printer, ask the provider to print it for you at the appointment.
• Discuss the medical need for a Cubby Bed during your visit and ask the doctor to fill out the printed Prescription and Written Order Form. 
• Obtain a Letter of Medical Necessity (LMN). It is highly recommended that it be written by an Occupational Therapist (OT) or Physical Therapist (PT). If you do not have access to an OT or PT, consult with your chosen Medical Supplier (see next step), or if necessary, a physician can write the LMN.  Use our Safety Needs and Concerns Worksheet to write down your child’s safety concerns and any other solutions you’ve tried that didn’t work. The level of detail you provide is crucial to ensure your medical documents fully capture your loved one's need for a Cubby Bed.
• Locate a Medical Supplier that carries Cubby Beds and accepts your insurance. (You should find a supplier shortly after you schedule the doctor’s appointment.)
• Follow up with the medical supplier: Confirm they’ve received all the necessary documents and ensure they’ve submitted your request to Medicaid.
• For more information on how to get a Cubby Bed, visit our website. 

• Complete the Prescription and Written Order Form, which is included in the Required Documents Packet.
• Once your patient has partnered with a medical supplier, please send the Prescription and Written Order Form directly to that supplier.  
• You will be asked to sign the Medicaid Certificate of Medical Necessity (MCMN) by the supplier. You may also need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• Work with the family to write a Letter of Medical Necessity (LMN). Use the guidance provided in the Required Documents Packet for the details that need to be included. Ask the family to share their completed Safety Needs and Concerns Worksheet with you, which will help you write a detailed letter.
• Once your patient has partnered with a medical supplier, please send the LMN directly to that supplier.  You may need to work with the supplier to provide revisions or additional paperwork that insurance requests for the authorization process or for appealing a denial.

• The medical supplier must receive the prescription and Letter of Medical Necessity (LMN) within 90 days of the date they are signed.
• South Carolina requires the Medicaid Certificate of Medical Necessity (MCMN) form to be signed by the ordering physician and supplier.
• Communicate regularly with the family and providers to improve the chance of approval.