California Code of Regulations
Title 22 - Social Security
Division 3 - Health Care Services
Subdivision 1 - California Medical Assistance Program
Chapter 3 - Health Care Services
Article 4 - Scope and Duration of Benefits
Section 51321 - Durable Medical Equipment
Current through Register 2024 Notice Reg. No. 12, March 22, 2024
(a) Durable medical equipment, as defined in Section 51160, is covered in accordance with the standards set forth in section 51303(a) and when provided on the written prescription of licensed practitioners within the scope of their practice as established in California law. Alterations or improvements of real property are not covered except to the extent authorized for the provision of home dialysis services. In addition to the prescribing practitioner's signature, all of the following specific information, at a minimum, shall be clearly provided on, or with the prescription form, or as an attachment to the Treatment Authorization Request:
(b) Prior authorization is required:
(c) All authorization requests shall, at a minimum, include all of the following:
(d) In addition to the documentation requirements specified in (c) above, authorization requests for unlisted durable medical equipment/devices also require copies of catalog pages and medical justification to substantiate why a listed item is insufficient to meet the patient's medical needs.
(e) The following items are not covered by the program:
(f) Authorization shall not be granted for medical equipment when a household or furniture item will adequately serve the patient's medical needs.
(g) Authorization for durable medical equipment shall be limited to the lowest cost item that meets the patient's medical needs.
(h) Authorization for durable medical equipment for skilled nursing facility/Level B or intermediate care facility/Level A inpatients may be approved as follows:
(i) Beneficiaries shall be responsible for appropriate use and care of durable medical equipment purchased for their use under the Medi-Cal program.
(j) Rendering providers of durable medical equipment shall ensure that all devices and equipment are appropriate to meet the beneficiary's medical needs. If a piece of equipment or a device, when in actual use, fails to meet the beneficiary's needs, and the beneficiary's medical condition has not significantly changed since the device/equipment was dispensed, the rendering provider shall adjust or modify the equipment, as necessary, to meet the beneficiary's needs. Any equipment or device that cannot be adjusted or modified, shall be replaced by the rendering provider at no cost to the Medi-Cal program.
(k) In addition to the requirements specified in subsections (a) through (j) above, authorization of the following shall be made in accordance with the criteria contained in the applicable chapter of the Manual of Criteria for Medi-Cal Authorization:
1.
Amendment of subsections (b) and (c) filed 11-4-76; effective thirtieth day
thereafter (Register 76, No. 45). For prior history, see Register 72, No.
31.
2. Amendment of subsection (b) filed 5-25-77; effective
thirtieth day thereafter (Register 77, No. 22).
3. Amendment of
subsection (h) filed 8-8-78; effective thirtieth day thereafter (Register 78,
No. 32).
4. Amendment of subsection (a) filed 9-1-82 as an
emergency; effective upon filing (Register 82, No. 37). A Certificate of
Compliance must be transmitted to OAL within 120 days or emergency language
will be repealed on 12-30-82.
5. Certificate of Compliance
transmitted to OAL 12-28-82 and filed 1-21-83 (Register 83, No.
4).
6. Amendment of subsections (b) and (c) filed 11-7-86; effective
thirtieth day thereafter (Register 86, No. 45).
7. Change without
regulatory effect of NOTE (Register 86, No. 49).
8. Amendment filed
5-25-89; operative 6-24-89 (Register 89, No. 21).
9. Amendment filed
12-10-90 as an emergency; operative 12-10-90 (Register 91, No. 6). A
Certificate of Compliance must be transmitted to OAL by 4-9-91 or emergency
language will be repealed by operation of law on the following
day.
10. Certificate of Compliance as to 12-10-90 order transmitted
to OAL 4-8-91 and filed 5-8-91 (Register 91, No. 24).
11. Amendment
of subsection (b) filed 9-25-92 as an emergency; operative 10-1-92 (Register
92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or
emergency language will be repealed by operation of law on the following
day.
12. Certificate of Compliance as to 9-25-92 order transmitted
to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
13. Amendment
of subsection (b) and NOTE filed 5-18-94; operative 6-17-94 (Register 94, No.
20).
14. Amendment of subsection (b) filed 8-2-95 as an emergency;
operative 8-2-95 (Register 95, No. 31). A Certificate of Compliance must be
transmitted to OAL by 11-30-95 or emergency language will be repealed by
operation of law on the following day.
15. Certificate of Compliance
as to 8-2-95 order transmitted to OAL 11-22-95 and filed 1-3-96 (Register 96,
No. 1).
16. Amendment of subsection (g) and NOTE filed 4-1-96 as an
emergency; operative 4-1-96 (Register 96, No. 14). A Certificate of Compliance
must be transmitted to OAL by 9-30-96 pursuant to Welfare and Institutions Code
section
14132.22
or emergency language will be repealed by operation of law on the following
day.
17. Editorial correction of HISTORY 16 (Register 96, No.
35).
18. Amendment of subsection (g) and NOTE refiled 8-28-96 as an
emergency; operative 9-30-96 (Register 96, No. 35). A Certificate of Compliance
must be transmitted to OAL by 1-28-97 or emergency language will be repealed by
operation of law on the following day.
19. Certificate of Compliance
as to 8-28-96 order transmitted to OAL 1-23-97 and filed 3-10-97 (Register 97,
No. 11).
20. Amendment filed 6-5-2000 as an emergency; operative
6-5-2000 (Register 2000, No. 23). A Certificate of Compliance must be
transmitted to OAL by 10-3-2000 or emergency language will be repealed by
operation of law on the following day.
21. Amendment refiled
8-21-2000 as an emergency; operative 10-3-2000 (Register 2000, No. 34). A
Certificate of Compliance must be transmitted to OAL by 1-31-2001 or emergency
language will be repealed by operation of law on the following
day.
22. Amendment of subsection (k) and new subsections (k)(1)-(2)
filed 9-22-2000 as an emergency; operative 9-22-2000 (Register 2000, No. 38). A
Certificate of Compliance must be transmitted to OAL by 1-22-2001 or emergency
language will be repealed by operation of law on the following
day.
23. Amendment of subsection (k) and new subsections (k)(1)-(2)
refiled 1-23-2001 as an emergency; operative 1-23-2001 (Register 2001, No. 4).
A Certificate of Compliance must be transmitted to OAL by 5-23-2001 or
emergency language will be repealed by operation of law on the following
day.
24. Certificate of Compliance as to 8-21-2000 order, including
further amendment of subsections (a), (a)(4)(B), (b)(2), (c)(5)(C), (e)(1) and
(h)(2), transmitted to OAL 1-3-2001 and filed 2-5-2001 (Register 2001, No.
6).
25. Certificate of Compliance as to 1-23-2001 order, including
amendment of NOTE, transmitted to OAL 2-7-2001 and filed 3-16-2001 (Register
2001, No. 11).
26. Change without regulatory effect repealing and
adopting new subsection (e)(11), repealing subsection (e)(12) and amending NOTE
filed 5-13-2003 pursuant to section
100, title 1, California Code of
Regulations (Register 2003, No. 20).
27. Change without regulatory
effect amending section and NOTE filed 6-12-2006 pursuant to section
100, title 1, California Code of
Regulations (Register 2006, No. 24).
Note: Authority cited: Sections 14105, 14124.5 and 14126.23, Welfare and Institutions Code; Section 100275, Health and Safety Code; Section 57(c), Chapter 328, Statutes of 1982; and Section 3, Chapter 1381, Statutes of 1990. Reference: Sections 14053, 14132, 14133, 14133.1(c) and 14133.3, Welfare and Institutions Code; Section 447.15, Title 42, Code of Federal Regulations; and Vera Blue, et al., v. Bonta' (2002) 99 Cal. App. 4th 980.