Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services
Article 2 - Durable Medical Equipment and Medical Supplies; Related Services
7 AAC 120.399 - Definitions

Universal Citation: 7 AK Admin Code 120.399

Current through November 28, 2024

In 7 AAC 120.200 - 7 AAC 120.399,

(1) "capped rental" means the rental of durable medical equipment for not more than 13 months;

(2) "custom fabricated orthotic" means an orthotic that is individually made for a specific patient and created using measurements or an impression generally by means of plaster or fiber cast, a digital image using computer aided design-computer aided manufacture (CAD-CAM) systems software, or direct form to patient;

(3) "customized or optimally configured durable medical equipment" means durable medical equipment that is uniquely constructed or substantially modified for a specific recipient in accordance with the description and orders of a physician, a physician assistant, or an advanced practice registered nurse, and that is so different from another item used for the same purpose that the two items cannot be grouped together for pricing purposes;

(4) "durable medical equipment" means equipment that

(A) can withstand repeated use;

(B) is primarily and customarily used to serve a medical purpose;

(C) generally is not useful to an individual in the absence of an illness or injury; and

(D) is appropriate for use in the home, school, or community;

(5) "manual wheelchair" means a federally approved, nonmotorized wheelchair that is capable of being independently propelled and fits one of the following categories:

(A) standard, as follows:
(i) usually is not capable of being modified;

(ii) accommodates a person weighing up to 250 pounds; and

(iii) has a warranty period of at least one year;

(B) lightweight, as follows:
(i) composed of lightweight materials;

(ii) cis capable of being modified;

(iii) accommodates a person weighing up to 250 pounds;

(iv) usually has a warranty period of at least three years; and

(v) when applicable, the recliner option has an adjustable, reclining back to facilitate weight shifts and provide support to the upper body and head;

(C) high-strength lightweight, as follows:
(i) is usually made of a composite material;

(ii) is capable of being modified;

(iii) accommodates a person weighing up to 250 pounds;

(iv) has an extended warranty period of over three years;

(v) accommodates the very active person; and

(vi) when applicable, is hemi-configurable with a seat-to-floor height as low as 14.5 inches;

(D) ultra lightweight, as follows:
(i) is usually made of a composite material;

(ii) is capable of being optimally configured;

(iii) accommodates a person weighing up to 250 pounds;

(iv) is available in rigid and folding frames; and

(v) accommodates adjustable rear axle positioning;

(E) pediatric, as follows:
(i) has a narrower seat and shorter depth more suited to pediatric patients;

(ii) is usually adaptable to modifications for a growing child for about three years or growth up to four inches in seating width or depth;

(F) tilt-in-space, that has a positioning system that allows both the seat and back to tilt to a specified angle to reduce shear or allow for unassisted pressure releases;

(G) heavy duty, as follows:
(i) is specifically manufactured to support a person weighing up to 300 pounds; or

(ii) accommodates a seat width of up to 22 inches without custom manufacturing;

(H) extra heavy duty, as follows:
(i) is specifically manufactured to support a person weighing over 300 pounds; or

(ii) accommodates a seat width of over 22 inches without custom manufacturing;

(6) "medical supplies" means supplies that

(A) do not withstand repeated use;

(B) are primarily and customarily used to serve a medical purpose;

(C) generally are not useful to an individual in the absence of an illness or injury; and

(D) are appropriate for use in the home, school, or community;

(7) "minimal self-adjustment" means an adjustment that the beneficiary, caretaker for the beneficiary, or supplier of the device can perform; and that does not require the services of a certified orthotist described in 7 AAC 120.300(a)(2) or an individual who has specialized training;

(8) "miscellaneous" means an item or service listed in the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900, that is

(A) described as "miscellaneous," "not otherwise classified," or "not otherwise specified"; or

(B) without a specific description or identifier;

(9) "orthotic device" or "orthotic" means a corrective or supportive device that

(A) prevents or corrects physical deformity or malfunction; or

(B) supports a weak or deformed portion of the body;

(10) "power wheelchair" means a federally approved, motorized wheelchair that can be independently driven by a client and fits one of the following categories:

(A) custom power wheelchairs that are adaptable to
(i) alternative driving controls; and

(ii) power seating functions; and

(B) non-custom power wheelchairs that do not need special positioning or controls and that have a standard frame;

(11) "prefabricated off-the-shelf orthotic" means an orthotic that

(A) is manufactured in quantity without a specific patient in mind;

(B) requires minimal self-adjustment for appropriate use; and

(C) does not require expertise in trimming, bending, molding, assembling, or customizing to fit a recipient;

(12) "prosthetic device" or "prosthetic" means a preventative, replacement, corrective, or supportive device prescribed by a physician or other licensed practitioner, within the scope of the person's practice under state law;

(13) "reasonable useful lifetime" means the duration of time that a piece of durable medical equipment is expected to perform according to manufacturer specifications without defect, generally three to five years;

(14) "substandard item" means an item that does not function in a manner that meets the prescribed need or specifications;

(15) "used equipment" means equipment that has been gently or lightly used, is in like-new condition, is considered to be as close as possible to the original specifications of the manufacturer, and has an anticipated remaining usable life of about three years;

(16) "warranty period" means a guarantee or assurance, of set duration from the date of purchase, according to the manufacturer's or provider's guidelines.

Definitions applicable to 7 AAC 120.200 - 7 AAC 120.399 were relocated from 7 AAC 120.299 to 7 AAC 120.399. The history note for 7 AAC 120.399 does not reflect the history of the earlier provision.

For the definition of "national drug code," formerly in 7 AAC 120.299, see 7 AAC 160.990.

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040

Disclaimer: These regulations may not be the most recent version. Alaska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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