DMEPOS licensing and registration requirements often depend on the state and the products/services offered.
Some states have a very specific and regulated DME license program with routine inspections and extra requirements. Other states have less formalized license programs which may include fewer formalized inspections, but they still have rules governing DME sales based upon the types of products being sold (e.g., walkers vs. oxygen) and the method in which the products are delivered (e.g., delivery via mail versus face-to-face).
Also, a state may require a “No DME License” for the sale of walkers and/or wheelchairs, but wil say a “License is Required” for the sale of oxygen and/or other prescription-only categories.
Here are some examples that demonstrate why you should always cross-check by product type prior to enrolling with payers:
➜ In Wisconsin, many basic DME suppliers do not need a special state DME license just to sell items like walkers or wheelchairs, but if you provide medical oxygen, Wisconsin requires a Home Medical Oxygen Provider license through the state’s licensing system tied to the Pharmacy Examining Board.
➜ In South Carolina, a supplier that dispenses medical gases like oxygen or legend devices on a practitioner’s order needs a Medical Gases and Legend Devices Permit through the South Carolina Board of Pharmacy, even though a basic DME-only supplier might not trigger that permit.
➜ In Washington State, the Department of Health clearly says no license is required for wholesale distribution of medical devices as long as no pharmaceuticals are involved, but once pharmaceuticals enter the picture, you can move into pharmaceutical wholesaler licensing rules.
“Best Practice: Prior to enrolling with Medicare, Medicaid or commercial payers, verify the DME/HME License requirement by state and product category, since the products in your catalog determine your licensing.“
Which States Require DME Provider Licensing for Durable Medical Equipment?
The majority of states do not have a singular “DME License” that covers all medical supplies. State requirements can be specific to either the product or service being delivered. Also, the type of operation will determine whether there are any changes in licensing requirements.
- License types vary from state-to-state, product to product, and service to service. Some states do not require any form of licensure for basic DME products.
- Examples of common areas where licensure would be triggered are Oxygen/Medical Gases, Prescription-Only Devices, and Patient Setup/Fitting/Training.
- Some states look at the location of the business physically within their state, while other states will require registration if you deliver/shipping your products/services into their state.
Below is a list of each state where DME-related licensing is most likely to occur, along with examples of what will usually trigger licensure.
1). Alabama
Alabama is a licensing state. If you provide home medical equipment services within Alabama, you will likely need a Home Medical Equipment Services Provider License. This license is granted by the Alabama Board of Home Medical Equipment Services Providers. To simplify, Alabama requires DME suppliers to be officially licensed before servicing patients, and this license is tied to where you operate; therefore, if you have multiple locations within Alabama, you may need more than one license.
2). Alaska
Alaska is easier than it seems. If you only sell or rent medical equipment or medical devices such as wheelchairs, walkers, etc., and typical DME, Alaska does not normally require you to register with the Alaska Board of Pharmacy just for doing this. A significant change occurs if you also handle prescription medications (not devices). If you transport or ship prescription medications to Alaska, pharmacy regulations may apply to you.
3). Arizona
Arizona is a state where oxygen and medical gases are the primary licensing trigger for most DME distributors. If you provide medical oxygen or similar prescription medical gases, you may need a permit from the Arizona State Board of Pharmacy. If you only provide typical DME such as walkers, wheelchairs, hospital beds, and commodes, your licensing requirements are typically less stringent; however, you should always check to see if a special rule applies to the products you offer.
4). Arkansas
Arkansas tends to become more restrictive when your products are prescription-only devices or medical gases. If your DME business provides these types of products, you may need a permit from the Arkansas Board of Pharmacy. A basic way to avoid errors is to review your product listing and ask: “Do we sell oxygen? Do we sell CPAP-type respiratory products? Do we sell prescription-only devices?” If you answered yes to any of these questions, you are more likely to need a Board of Pharmacy permit.
5). California
California is a very strict state. If you operate out of California and sell or rent DME or prescription medical devices for home use, you will normally need a Home Medical Device Retailer (HMDR) license from the California Department of Public Health (CDPH), Food and Drug Branch. Additionally, if you sell prescription devices, California may require a qualified manager for daily operations at your facility, which may be either a Pharmacist in Charge or an approved Exempt Manager (Exemptee). Also, if you ship prescription devices into California from another state, you may need to obtain an Out-of-State HMDR registration.
6). Colorado
Colorado is also a licensing state. If you conduct DME business in Colorado, you will generally need a Durable Medical Equipment Supplier license from the Colorado Secretary of State. Colorado requires DME suppliers to be licensed and to post their license at each location where they operate. Therefore, if you have a storefront or office in Colorado, you will need to obtain the state license for that operation.
7). Connecticut
Connecticut requires you to register with the state when you distribute DME based on a doctor’s order. If your facility receives prescriptions or medical orders and then distributes DME to consumers, Connecticut requires you to register as a wholesaler of drugs, medical devices, and/or cosmetics through the Connecticut Department of Consumer Protection (DCP), Drug Control Division.
8). Delaware
Delaware is most strict regarding oxygen and medical gases. If you dispense medical gas (oxygen) to patients, Delaware requires you to have a Medical Gas Dispenser License from the Delaware Board of Pharmacy. If you do not sell oxygen or medical gas to patients, this license may not apply to your DME business.
9). Florida
Florida requires most DME suppliers to hold a Home Medical Equipment (HME) Provider License issued by the Florida Agency for Health Care Administration (AHCA). Florida also states that it is illegal to operate a home medical equipment business without a valid and current license, and AHCA requires timely renewal so the license does not lapse.
10). Georgia
Georgia requires a Durable Medical Equipment (DME) Supplier License from the Georgia State Board of Pharmacy. One of the major requirements for this license is that the Board will only grant it if you have an approved Designated Representative. The Designated Representative must be a competent individual responsible for overseeing your DME business and ensuring compliance with all applicable laws and regulations.
11). Hawaii
In Hawaii, DME distributors are required to obtain a medical equipment distribution license from the Hawaii Department of Health, Office of Health Care Assurance. It is illegal in Hawaii to engage in DME supply business activities unless you possess such a license.
12). Idaho
Idaho considers many DMEPOS suppliers as being licensed facilities. Therefore, if you are conducting DME business in Idaho, you will likely need to register with the Idaho Board of Pharmacy as a Durable Medical Equipment Outlet. The Idaho Board of Pharmacy provides very detailed application procedures for registering DME Outlets, including the fee for the DME outlet registration. Therefore, it is a formal State Registration requirement for any Idaho operations.
13). Illinois
In Illinois, you will need to apply for a Home Medical Equipment and Services Provider license with the Illinois Department of Financial and Professional Regulation (IDFPR). Illinois describes this as licensure for businesses that offer home medical equipment and associated services. The application packet for the Illinois Home Medical Equipment and Services Provider License includes basic information regarding the business and insurance documentation.
14). Indiana
Indiana licenses DME services through the Indiana Professional Licensing Agency (PLA) which oversees pharmacies. To work as a DME vendor in Indiana, you will need to obtain a Home Medical Equipment Service Provider license from the PLA. The requirements include having a physical location and complying with all applicable state compliance rules.
15). Iowa
Iowa is more about the product type and how it is provided. If you are distributing medical gases or other products subject to a prescription as regulated items, then you will likely need to obtain a distributor-type license from Iowa’s pharmacy licensing system.
16). Kansas
If you want to operate as a DME supply vendor, Kansas requires a Durable Medical Equipment registration from the Kansas Board of Pharmacy. Once you submit a complete application, the Board reviews it and then schedules any required inspection through its inspection staff before final approval.
17). Kentucky
Kentucky requires a state-issued Home Medical Equipment Supplier License. This license is issued by the Kentucky Board of Durable Medical Equipment Suppliers.
Note: Kentucky often links its DME licensing process to accreditation. This means that providers may need to first complete accreditation with a recognized third-party accrediting body before submitting the accreditation certificate as part of their state license application. In layman’s words, Kentucky may not approve your DME license until you can demonstrate that your company meets certain accrediting standards.
18). Louisiana
Louisiana requires a Durable Medical Equipment (DME) Permit from the Louisiana Board of Pharmacy prior to offering DME services in the state. Louisiana’s regulations clarify that a DME permit allows you to deliver “legend” devices to patients/end users. However, it does not allow you to deliver prescription medications. A DME permit is only issued to a registered agent at a real street address.
19). Maine
Maine most commonly triggers licensing when you distribute oxygen. If you are selling/dispensing medical oxygen, Maine requires a Retail Supplier of Medical Oxygen and Oxygen Devices license from the Maine Board of Pharmacy. This license is typically required for each DME location. Maine commonly permits a pharmacy that is licensed in the state to sell medical oxygen without needing to have a separate oxygen supplier license.
20). Maryland
Maryland can feel confusing because the state does not view DME licensing as a single “DME supplier” type of license. More than likely, the state will direct DME suppliers to go through an agency type of license by way of the Maryland Department of Health. Therefore, based upon what type of durable medical goods you are providing, and how you plan to deliver them to your patients, you could have to be licensed as a Residential Service Agency (RSA), or, if you do not meet the criteria for RSA status, you may be required to register in a category such as “Other Durable Medical Goods”.
The important point is that in Maryland, the license to provide DME is often determined by the Department of Health’s agency licensing process rather than simply a basic DME storefront license.
Example:
A company located in Baltimore provides hospital beds, walkers, oxygen equipment and other DME to its customers at their home. In addition, the company has staff members that visit the customer’s home to install the equipment, educate the customer on safe usage of the equipment and perform follow-up visits to check on the condition of the equipment. In Maryland, this type of “in-home service” delivery model would most likely place the DME company into the Residential Service Agency (RSA) type of licensure from the Maryland Department of Health, as opposed to a basic retail DME license.
On the other hand, a small medical supply store that only sells DME products from behind a counter (i.e., canes, braces, and shower chairs) and performs no in-home services, might be classified as falling under another, possibly less restrictive, type of licensure or registration requirement.
21). Massachusetts
Typically, there is no single statewide DME store license for most suppliers in Massachusetts. However, the initial step for most companies is to enroll as a DME provider with MassHealth (the primary payer), since that enables them to submit claims and get paid. MassHealth will then assess whether your business meets its standards for providing DME services, including having a physical storefront where services are performed, having regular posted hours of operation, and ensuring staff are present during typical business hours. Companies that sell high-risk items such as oxygen or prescription related products, should also check if pharmacy-type regulations apply to those types of sales.
22). Michigan
Michigan typically does not require a single statewide DMEPOS supplier license for basic equipment items (e.g., walkers, wheelchairs, etc.). Most DME suppliers focus on enrolling with the payers they submit claims to, primarily Medicaid. Licensing becomes important when a company starts conducting wholesale distributions of prescription regulated products. In that situation, a Wholesale Distributor License needs to be issued through the state’s licensing agency.
23). Minnesota
The key factor driving licensure in Minnesota is the enrollment and regulatory compliance associated with the Minnesota Health Care Programs. To continue submitting claims as a medical supplier, companies must follow the provider enrollment process with the programs and maintain compliance with the programs’ ongoing requirements. Some suppliers that receive Medicaid payments may be required to obtain and maintain a surety bond, which would also be an additional compliance item to consider. For most companies, maintaining enrollment and compliance with the various programs will allow for continued success with DME billing.
24). Mississippi
Mississippi is a relatively straightforward licensure state. Any company supplying home medical equipment, prescription-only devices or medical gases generally needs to obtain a Medical Equipment Suppliers Permit from the Mississippi Board of Pharmacy. Typically each location will require a separate permit. A missing or expired permit could result in denied claims, due to the fact that the company was not properly authorized at the time the supplies were delivered.
25). Missouri
For many suppliers in Missouri, the first step is to enroll with payers (particularly MO HealthNet for billing purposes of Missouri Medicaid). As a supplier begins to make regulated drug distributions, licensing becomes a larger issue since the Missouri Board of Pharmacy issues licenses to perform certain regulated distribution functions under state law. Standard DME suppliers will normally first enroll with payers. However, if a company’s business model includes regulated distribution, they should also confirm if a state license is required.
26). Montana
Montana is largely dependent upon what is being sold, particularly when selling medical gases and oxygen. When delivering medical gases to patients, unless a company is operating as a pharmacy, it is likely that a registration will be needed through the state’s pharmacy-related licensing path as a Medical Gas Supplier or similar category. If a company is only selling the usual DME (walkers, wheel chairs, etc.) then these requirements will likely not be applicable. When medical gases and oxygen begin to appear in a company’s offerings, then licensing becomes a much larger compliance requirement.
27). Nebraska
Nebraska does not treat basic DME as a single category of licensure, but it does regulate medical gas distribution and some wholesale distribution activities. When a company delivers medical gases (like oxygen), they may need a medical gas distributor type license through the correct state path. Nebraska Medicaid also expects providers to be properly licensed whenever a license applies. Therefore, the safest approach is to verify the requirements for your exact product offering.
28). Nevada
When a company provides prescription medical products directly to consumers, Nevada is more restrictive. Generally, when furnishing medical devices, equipment or gases to consumers, a Medical Devices, Equipment & Gases license is required from the Nevada State Board of Pharmacy. If a company sells to other businesses (such as clinics or pharmacies), the state may classify that activity as wholesale, and a different type of license may be required. In Nevada, both what you sell and to whom you sell can change what you need.
29). New Hampshire
Licensing is most relevant in New Hampshire when distributing regulated products. When a company operates as a wholesale distributor of prescription drugs or certain prescription regulated devices, a wholesale distributor license may be required by the New Hampshire Board of Pharmacy. Medical gas products may also require special considerations. While basic suppliers may only need to enroll with payers, adding oxygen or other regulated categories will cause licensing to become a component of your compliance checklist.
30). New Jersey
New Jersey is very clear regarding registration for businesses that distribute medical devices. Companies are required to register through the New Jersey Department of Health’s Drug and Medical Device Registration. New Jersey Medicaid also has extensive rules for medical suppliers to participate in their programs. Regardless of whether a company primarily bills commercial plans, this registration is normally considered a major compliance step since it establishes a company as a legitimate supplier in the state.
31). New Mexico
Many standard medical supply vendors in New Mexico do not require a state DME license. However, if your business is a wholesaler of prescription regulated products, a license will be required by the New Mexico Board of Pharmacy. One approach to this is to consider two types of DME: the type that is standard DME and the type that is prescription regulated product (which would be a wholesale distributor), and then determine into which category your workflow fits.
32). New York
In New York, DMEPOS providers must enroll in New York’s DMEPOS provider enrollment system to bill Medicaid. As one of the most stringent states regarding DMEPOS rules and regulations, New York expects DME vendors to operate with a storefront style presence, meet the day-to-day standards of a business and maintain good standing. Most payers review compliance indicators similarly to Medicaid. Therefore, even if your intention is to bill commercial insurance, enrolling as a DMEPOS provider and adhering to the DMEPOS rules and regulations of New York will minimize delays or blocks on claims.
33). North Carolina
North Carolina is considered a permitting state for many DME suppliers. The North Carolina Board of Pharmacy requires all places of business that deliver medical equipment to users in North Carolina to obtain a Medical Equipment Permit, except for suppliers that are permitted in another manner through the Board. There are exceptions, such as businesses that already hold certain other Board permits, so what you already have in place can affect whether you need an additional permit.
34). North Dakota
North Dakota has a strong track record of licensing DME and medical gas suppliers. The North Dakota Board of Pharmacy is responsible for issuing licenses to durable medical equipment and medical gas suppliers, and payers often require evidence of licensure prior to completing their enrollment process. It is essential to keep your license active and ensure that your legal name and address are consistent with what you report to payers to avoid unnecessary issues related to enrollment.
35). Ohio
If you provide any level of service beyond simply delivering medical equipment in Ohio, you will likely need to obtain a Home Medical Equipment Services Provider license from the Ohio Board of Pharmacy. If your business provides any level of service including setup, patient instruction, repairs or other forms of support, Ohio may classify these services as home medical equipment services and thus require a license. Payers use licensure status as a compliance indicator and failure to maintain an active or valid license can cause delays in DME billing.
36). Oklahoma
Oklahoma clearly licenses DME suppliers. The Oklahoma State Board of Pharmacy issues a license, and there are other options available for suppliers who provide medical gases, such as oxygen. Oklahoma may conduct an inspection as part of the approval process for obtaining a license. Therefore, it is safer to treat licensing as a first step before completing payer enrollment and billing processes.
37). Oregon
For most basic DME items, Oregon does not require a specific license. However, the regulations get more stringent when you supply oxygen or other medical gases. Generally, you must register your facility under the relevant outlet category with the Oregon Board of Pharmacy if you supply those regulated products. To put it simply, if you intend to sell or rent oxygen or medicinal gases in Oregon, a Board of Pharmacy registration will be one of the processes you must complete before you can bill and operate.
38). Pennsylvania
Pennsylvania generally requires many businesses that provide medical devices to register with the Pennsylvania Department of Health drugs, devices, and cosmetics program. Registration is required unless an exemption exists. Facilities that only sell retail directly to consumers in another state and meet certain criteria may be exempt from registration. Whether you manufacture, distribute, or sell medical devices in Pennsylvania, your physical footprint and method of sale can determine whether you need to register.
39). Rhode Island
While Rhode Island has a number of requirements for DME suppliers, many of them are associated with payer enrollment rather than a single storefront license. To bill Rhode Island Medicaid as a DME supplier, you must enroll as a provider and comply with the program rules. In addition, in many cases, DME suppliers are expected to be Medicare-certified, with exceptions for suppliers who only provide items not covered by Medicare. Regardless of the products your business provides, if you are a wholesale distributor of regulated drugs, you will need to comply with separate licensing requirements for distributors established by Rhode Island. Thus, your product mix continues to matter.
40). South Carolina
South Carolina tends to be more restrictive when supplying oxygen, medical gases, or prescription-only devices. The South Carolina Board of Pharmacy issues a Medical Gases and Legend Devices Permit, and, in many cases, requires the DME business to have a qualified consultant that assists with compliance obligations tied to that permit. If you only provide basic DME such as walkers or wheelchairs, you may not need a permit.
41). South Dakota
Most states don’t require a single license to cover all types of DME. South Dakota is no exception, as long as your workflow stays within the basic DME items. However, when you interact with prescription regulated categories, South Dakota can be a licensing state. The South Dakota Board of Pharmacy will require a Board license if you dispense prescription drugs or if you supply a medical device that contains a prescription (legend) drug. Therefore, the safest approach for billing is to view South Dakota as follows: Basic DME is relatively easy, while prescription regulated products usually require Board of Pharmacy approval.
42). Tennessee
To operate a home medical equipment business in Tennessee, you will likely require a Home Medical Equipment Provider License, which is administered by the Tennessee Health Facilities Commission. The purpose of the license is to ensure the licensed provider meets the state’s standards and maintains an active license. For billing purposes, this is important since many Medicaid and commercial plans consider a state license as a valid indicator of a supplier who is capable of performing DME services for patients.
43). Texas
Texas expects many DME suppliers that distribute medical devices to be properly licensed as a medical device distributor and that this licensing is administered by the Texas Department of State Health Services. Although this is simply a formality, it is worth noting that Medicare and Medicaid enrollment verification often use state licensure to verify whether your Texas location is valid. Therefore, if you have multiple Texas locations, you should treat each location separately, since state licensure and payer enrollment must match your company information and address.
44). Utah
Utah typically connects the licensing of DME facilities to the pharmacy licensing system. Many DMEPOS suppliers are required to obtain a facility license under the structure of the Board of Pharmacy, handled via Utah’s professional licensing agency. Simply stated, Utah wants its DME vendors to meet facility standards such as secure storage, cleanliness, security and written policies, etc., which is why inspections and facility requirements may be part of the process.
45). Vermont
Vermont is typically not about obtaining a separate license for a DME storefront, but rather about proper enrollment and compliance with program rules. However, the type of products you supply still matter. If you supply only standard DME items such as walkers, wheelchairs and hospital beds, Vermont will typically be easier regarding state licensing. If you start supplying pharmacy regulated items, including dispensing prescription drugs or operating in a manner that would subject you to pharmacy facility rules, then both the Vermont Board of Pharmacy and state licensing office will be relevant to you. For billing, do not assume you are exempt if your catalog includes pharmacy regulated items.
46). Virginia
Virginia is very explicit in stating that some medical equipment suppliers will need to obtain a DME permit issued by the Virginia Board of Pharmacy. This permit is designed for those suppliers that dispense prescription medical devices or medical oxygen to consumers and the Board expects there to be a real location with a responsible party associated with that location.
47). Washington
For basic DME, Washington is generally considered to be less burdensome since the state generally does not require a special license to distribute medical devices as long as no pharmaceuticals are involved. Where Washington gets tough is when you distribute prescription drugs or operate in pharmacy regulated lanes, where you may need to obtain a pharmaceutical wholesaler license through the Washington Department of Health.
48). West Virginia
West Virginia has a specific licensing program for home medical equipment services providers. Under state law, a provider must first obtain a license from the West Virginia Board of Home Medical Equipment Services before providing these services, and each in-state location is typically licensed separately. Additionally, if your business also functions as a wholesale drug distributor, West Virginia requires a wholesale drug distributor license through the West Virginia Board of Pharmacy.
49). Wisconsin
In general, Wisconsin doesn’t need an additional special state license for most of the basic DME (with the main exception being medical oxygen). If you are selling or providing oxygen to patients in your care, Wisconsin requires that you have a Home Medical Oxygen Provider license. That license is administered by the pharmacy system within the State of Wisconsin. Simply put, because oxygen is controlled as a higher risk, prescription-type item, the state controls it with more stringent regulations and payers expect you to be licensed if you provide it.
50). Wyoming
Wyoming is typically less burdensome for basic DME, but is strict when it comes to prescription drug distribution activity. If you distribute prescription drugs into or out of Wyoming, you must obtain a wholesale distributor license from the Wyoming State Board of Pharmacy. Therefore, for successful DME billing, while most DME suppliers focus on payer enrollment and compliance, those that interface with prescription drugs must treat Board of Pharmacy licensure as part of being authorized to conduct business.
State-by-State DME Licensing Overview
Here is an easy to read table summarizing DME/HME licensing requirements for each state and some common out of state shipping flags.
How to read this table:
- “Out-of-state shipping” is where many suppliers get burned, so I included it as a separate column.
- “General DME/HME license” means the state commonly licenses the DME supplier or home medical equipment provider as a business location.
- “Product-triggered” means the state is often lighter for basic DME but can require licensing for oxygen/medical gas or prescription regulated categories (often through a Board of Pharmacy or health department).
| # | State | General DME/HME license for an in-state location | Main agency (typical) | Out-of-state shipping can trigger requirements | Most common triggers to re-check |
| 1 | Alabama | Yes | AL Board of Home Medical Equipment Services Providers | Sometimes | HME services, delivery and service model |
| 2 | Alaska | No (often product-triggered) | AK Board of Pharmacy (when drugs) | Sometimes | Prescription drugs (not basic devices) |
| 3 | Arizona | Usually product-triggered | AZ Board of Pharmacy (common for gases) | Sometimes | Oxygen, medical gases |
| 4 | Arkansas | Usually product-triggered | AR Board of Pharmacy | Sometimes | Oxygen, medical gases, prescription-only devices |
| 5 | California | Yes (strict) | CDPH Food and Drug Branch (HMDR) | Yes in some models | Prescription devices, oxygen, respiratory, shipping in |
| 6 | Colorado | Usually no general DME license | Varies by product and payer | Usually no (basic DME) | Oxygen or pharmacy regulated categories |
| 7 | Connecticut | Usually product-triggered | CT Dept of Consumer Protection (Drug Control) | Sometimes | Prescription/order based distribution |
| 8 | Delaware | Product-triggered | DE Board of Pharmacy (medical gas) | Sometimes | Oxygen and medical gases |
| 9 | Florida | Yes (strict) | FL AHCA | Mostly in-state | Home medical equipment operations |
| 10 | Georgia | Yes | GA Board of Pharmacy | Mostly in-state | DME facility licensing |
| 11 | Hawaii | Yes | HI Dept of Health (often) | Mostly in-state | DME supplier operations |
| 12 | Idaho | Often yes (outlet registration) | ID Board of Pharmacy | Sometimes | DME outlet model, oxygen categories |
| 13 | Illinois | Yes | IL IDFPR | Mostly in-state | HME services provider license |
| 14 | Indiana | Yes (commonly) | IN PLA (often with pharmacy board structure) | Mostly in-state | HME services and compliance |
| 15 | Iowa | Usually product-triggered | IA pharmacy licensing pathway | Sometimes | Oxygen, medical gases, Rx workflows |
| 16 | Kansas | Often yes (facility registration) | KS Board of Pharmacy | Sometimes | DME facility registration |
| 17 | Kentucky | Yes | KY Board of DME Suppliers | Mostly in-state | HME license and accreditation expectations |
| 18 | Louisiana | Yes | LA Board of Pharmacy | Mostly in-state | Legend devices, medical gas categories |
| 19 | Maine | Product-triggered | ME Board of Pharmacy (oxygen) | Sometimes | Oxygen |
| 20 | Maryland | Often yes (model-specific) | MD health regulation pathway | Sometimes | Agency-type licensure, certain services |
| 21 | Massachusetts | Often payer-enrollment driven | MassHealth enrollment rules | Sometimes | Oxygen and Rx categories, program rules |
| 22 | Michigan | Often payer-enrollment driven | Medicaid enrollment, some pharmacy licenses | Sometimes | Wholesale or pharmacy regulated categories |
| 23 | Minnesota | Often payer-enrollment driven | MN Medicaid program rules | Sometimes | Surety bond rules, oxygen categories |
| 24 | Mississippi | Yes | MS Board of Pharmacy | Mostly in-state | Equipment supplier permit, gases |
| 25 | Missouri | Often payer-enrollment driven | MO HealthNet, MO Board of Pharmacy for drug lanes | Sometimes | Drug distribution style models |
| 26 | Montana | Product-triggered | MT pharmacy licensing pathway | Sometimes | Medical gases |
| 27 | Nebraska | Product-triggered | NE health/pharmacy licensing pathway | Sometimes | Medical gases |
| 28 | Nevada | Often yes for regulated categories | NV Board of Pharmacy (common) | Sometimes | Devices, equipment, gases by prescription |
| 29 | New Hampshire | Product-triggered | NH Board of Pharmacy | Sometimes | Medical gases, Rx distribution |
| 30 | New Jersey | Often yes (registration) | NJ Dept of Health (device registration) | Sometimes | Device distribution registration |
| 31 | New Mexico | Often no general DME license | NM Board of Pharmacy (drug lanes) | Sometimes | Wholesale or Rx regulated categories |
| 32 | New York | Enrollment-driven (big gate) | NY Medicaid DMEPOS enrollment rules | Sometimes | Medicaid enrollment rules, storefront rules |
| 33 | North Carolina | Yes (permit model common) | NC Board of Pharmacy | Yes in some cases | Delivering into NC, oxygen, Rx categories |
| 34 | North Dakota | Yes | ND Board of Pharmacy | Yes in some cases | DME and medical gas licensing |
| 35 | Ohio | Yes | OH Board of Pharmacy | Mostly in-state | Setup, training, service model |
| 36 | Oklahoma | Yes | OK Board of Pharmacy | Mostly in-state | DME supplier license, medical gas add-on |
| 37 | Oregon | Product-triggered | OR Board of Pharmacy | Sometimes | Oxygen and medical gas outlet categories |
| 38 | Pennsylvania | Yes (registration acts like license) | PA Dept of Health (devices program) | Sometimes | Device retail/distribution registration |
| 39 | Rhode Island | Enrollment-driven | RI Medicaid enrollment rules | Sometimes | Medicare certification and program rules |
| 40 | South Carolina | Product-triggered (strict for gas and legend devices) | SC Board of Pharmacy | Sometimes | Oxygen, medical gases, legend devices |
| 41 | South Dakota | Product-triggered | SD Board of Pharmacy | Sometimes | Prescription regulated distribution |
| 42 | Tennessee | Yes | TN Health Facilities Commission | Mostly in-state | Home medical equipment provider license |
| 43 | Texas | Yes | TX Dept of State Health Services | Mostly in-state | Medical device distribution license |
| 44 | Utah | Often product-triggered | UT DOPL / pharmacy structure | Sometimes | Facility standards, oxygen/Rx categories |
| 45 | Vermont | Often payer-enrollment driven | VT program rules, pharmacy if Rx | Sometimes | Prescription regulated categories |
| 46 | Virginia | Yes (for key categories) | VA Board of Pharmacy | Sometimes | Oxygen and prescription devices |
| 47 | Washington | Often no for devices only | WA Dept of Health (pharma lanes) | Sometimes | Pharmaceuticals trigger licensing |
| 48 | West Virginia | Yes | WV Board of Home Medical Equipment Services | Mostly in-state | Home medical equipment services |
| 49 | Wisconsin | Product-triggered (oxygen is strict) | WI DSPS / Pharmacy Examining Board | Sometimes | Oxygen provider licensing |
| 50 | Wyoming | Product-triggered | WY Board of Pharmacy (drug lanes) | Sometimes | Prescription drug distribution models |
| 51 | Washington, DC | Product-triggered | DC Health | Sometimes | Medical device distribution classification |
| 52 | Puerto Rico | Product-triggered | PR Dept of Health (common) | Sometimes | Prescription regulated categories |
FAQs
Do I need a DME license if I only do online sales and ship to patients, with no storefront?
While sometimes no, other times, yes. Depending upon the state, your DME licensure could still be required even though you do not have a storefront located in that state. In fact, some states will require an out-of-state HMDR registration when shipping in categories deemed “higher risk” such as oxygen or prescription only devices. An example of this would be California, which can require an out-of-state HMDR registration for the delivery of certain prescription devices, regardless of whether those deliveries are made from within California’s borders, or from a different state entirely.
If I use a third-party warehouse or fulfillment center, whose license covers the shipment?
Generally speaking, the state only cares about the location from where the product is shipped and who the legal entity supplying the product is. So if the products you ship are coming from a warehouse located in a state that issues DME licenses, that warehouse location itself can create licensing and inspection obligations. This becomes very important in states that are particularly strict with their licenses, such as Florida, Illinois and Georgia. These states issue license based upon the physical address of the warehouse and most importantly, the payer expects that the address used for licensing purposes is the same as the operational address of the warehouse.
If I sell DME on Amazon, eBay, or my Shopify store, am I still considered a DME supplier that needs licensing?
Yes, in many cases. While using a marketplace does not exempt you from the state licensing requirements, if you ship products that are subject to regulation into a state that requires a permit for that category, then you may still need to obtain a state license. In particular, oxygen/medical gas and prescription-only devices are both categories that are commonly regulated through Boards of Pharmacy in states such as South Carolina and Virginia.
Do I need a separate license for each branch location, delivery hub, or repair shop?
Often, yes. In many states, the state license is considered to be a license tied to a specific location (e.g., storefront, branch location, delivery hub), and therefore, if you establish multiple locations in a single state, you will need a separate license for each one. This is particularly true in states that are strict with licensure such as Florida, Illinois, Georgia and California, where licensure is tied to the physical address of the location. Therefore, if you relocate, establish a second site, or establish a warehouse that operates like a location, you will likely need to obtain a new license or have your existing license updated by the state.
If I change my business name, ownership, or address, do I need a new license or just an update?
This varies depending on the state in which you are conducting business, however, you should file an update with the state for any changes to your business information, including a name change, change in ownership, and/or address change. Also, some states treat larger changes in your business as new applications. Address changes are especially sensitive in states like California (HMDR is tied to the licensed premises) and Texas (licensing is tied to your business location). Even if the state allows a simple update, payers may still pause claims if your license name or address does not match your enrollment and claim data.
Does my staff need individual licenses, or is the license only for the business location?
Usually the license is for the facility, however, some states also require a designated individual to be responsible for ensuring compliance at that facility. For example, Georgia requires a Designated Representative for the DME supplier permit, California can require an Exempt Manager (Exemptee) or a Pharmacist-In-Charge for certain prescription device operations, and various Board of Pharmacy states utilize a “Person In Charge” model. Therefore, if that key employee leaves, you may need to notify the state immediately, or appoint a new representative to avoid having your license become inactive, or worse, non-compliant.
Do I need a license if I only provide repairs, maintenance, delivery, setup, or patient training, but I do not sell the equipment?
Sometimes, yes. In addition to providing the sale of DME, some states also regulate “Home Medical Equipment Services”, which can include delivery, set-up, instruction, maintenance, and repair. Ohio is a good example of this type of regulation, as it provides for licensure of “Home Medical Equipment Service Providers”, and various activities including installation, demonstrations and service can trigger licensing. Alabama and Florida are also examples where the licensing framework is focused on “home medical equipment services,” not just retail sales.