• Schedule an appointment with your loved one’s doctor.
• Before your visit, print the Prescription 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 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 loved one’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 Form, which is included in the Required Documents Packet. Make sure the form is filled out completely to avoid delays in submission. 
• Colorado Medicaid requires the prescribing physician to complete and sign Questionnaire #19. Information from the caregiver's Safety Needs and Concerns Worksheet will aid in providing comprehensive responses.
• 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 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.
• Wisconsin Medicaid will not approve coverage for restraint or behavioral management unless there is an imminent risk of harm to the individual. 
• Medical necessity must be clearly and thoroughly documented. Medicaid will only provide coverage in cases where there is a history of daily seizure activity or self-injurious behaviors, such as head banging, that have resulted in documented physical injury.
• 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.

• Colorado Medicaid requires the Questionnaire #19 form to be submitted with the Prior Authorization Request. If the physician has not already completed the form, coordinate with the caregiver to ensure it is completed.
• Communicate regularly with the family and providers to improve the chance of approval.