Current through Register Vol. 50, No. 9, September 20, 2024
A. Assistive
technology and specialized medical equipment and supplies (AT/SMES) service
includes providing specialized devices, controls, or appliances which enable a
beneficiary to increase his/her ability to perform activities of daily living,
ensure safety, and/or to perceive, control, and communicate within his/her
environment.
1. This service also includes
items that meet at least one of the following criteria:
a. items that are necessary for life
support;
b. items that are
necessary to address physical conditions, along with ancillary
supplies;
c. address physical
conditions;
d. items that will
increase, maintain, or improve ability of the beneficiary to function more
independently in the home and/or community; and
e. equipment necessary to the proper
functioning of such items.
2. This service also includes medically
necessary durable and non-durable equipment not available under the Medicaid
State Plan and repairs to such items and equipment necessary to
increase/maintain the independence and wellbeing of the beneficiary.
a. All equipment, accessories and supplies
must meet all applicable manufacture, design and installation
requirements.
b. The services under
the Residential Options Waiver are limited to additional services not otherwise
covered under the Medicaid State Plan.
3. The services are limited to additional
services not otherwise covered under the state plan, including EPSDT, but
consistent with waiver objectives of avoiding institutionalization.
B. AT/SMES services provided
through the ROW include the following services:
1. the evaluation of assistive technology
needs of a beneficiary including a functional evaluation of the impact of the
provision of appropriate assistive technology and appropriate services to the
beneficiary in the customary environment of the beneficiary;
2. services consisting of selecting,
designing, fitting, customizing, adapting, applying, maintaining, repairing, or
replacing assistive technology devices;
3. coordination of necessary therapies,
interventions or services with assistive technology devices;
4. training or technical assistance on the
use and maintenance of the equipment or device for the beneficiary or, where
appropriate, his/her family members, legal guardian or responsible
representative;
5. training or
technical assistance, on the use for the beneficiary, or where appropriate,
family members, guardians, advocates, authorized representatives of the
beneficiary, professionals, or others;
6. all service contracts and warranties
included in the purchase of the item by the manufacturer;
7. equipment or device repair and replacement
of batteries and other items that contribute to ongoing maintenance of the
equipment or device;
a. separate payment will
be made for repairs after expiration of the warranty only when it is determined
to be cost effective; and
8. services consisting of purchasing,
leasing, or otherwise providing for the acquisition of assistive technology
devices for beneficiaries.
C. Approval of AT/SMES services through ROW
is contingent upon the denial of a prior authorization request for the item as
a Medicaid State Plan service and demonstration of the direct medical,
habilitative, or remedial benefit of the item to the beneficiary.
1. Items reimbursed in the ROW may be in
addition to any medical equipment and supplies furnished under the Medicaid
State Plan.
D. All
assistive technology items must meet applicable manufacture, design and
installation requirements.
E.
Service Exclusions
1. Assistive technology
devices and specialized equipment and supplies that are of general utility or
maintenance and items that are not of direct medical or remedial benefit to the
beneficiary are excluded from coverage.
2. Any equipment, device, appliance or supply
that is covered and has been approved under the Medicaid State Plan is excluded
from coverage.
3. For adults over
the age of 20 years, specialized chairs, whether mobile or travel are not
covered.
F. Provider
Participation Requirements. Providers of AT/SMES services must meet the
following participation requirements. The provider must:
1. be enrolled in the Medicaid
Program;
2. provide documentation
on manufacturer's letterhead that the agency listed on the Louisiana Medicaid
Enrollment Form and Addendum (PE-50) is:
a.
authorized to sell and install assistive technology, specialized medical
equipment and supplies, or devices for assistance with activities of daily
living; and
b. has training and
experience with the application, use fitting and repair of the equipment or
devices they propose to sell or repair; and
3. Upon completion of the work and prior to
payment, the provider shall give the beneficiary a certificate of warranty for
all labor and installation and all warranty certificates.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
