Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part XXI - Home and Community-Based Services Waivers
Subpart 13 - Residential Options Waiver
Chapter 163 - Covered Services
Section XXI-16301 - Assistive Technology and Specialized Medical Equipment and Supplies

Universal Citation: LA Admin Code XXI-16301

Current through Register Vol. 51, No. 3, March 20, 2025

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 well-being of the beneficiary.
a. All equipment, accessories and supplies must meet all applicable manufacture, design, and installation requirements.

b. The services under the ROW 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.

4. This service includes necessary medical supplies not available under the Medicaid State Plan.

5. Prior to the beneficiary receiving any assistive technology device, a rehabilitation professional (including, but not limited to, an occupational therapist, speech therapist, and/or a physical therapist) must complete an evaluation. The therapist must assess the need and the type of device necessary to address the beneficiary's identified needs, and will make a recommendation for the specific assistive technology device. Assistive technology/specialized medical equipment must be included in the beneficiary's POC.

B. Assistive technology/specialized medical equipment (AT/SME) services provided through the ROW include the following:

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, responsible 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;

8. services consisting of purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for beneficiaries;

9. technology supports with remote features that may include, but are not limited to, mobile emergency response system, medication reminder system, monitoring device, the purchase of emergency response system and other equipment used to support someone remotely; and
a. remote technology service delivery covers monthly response center/remote support monitoring fee and technology upkeep (no internet cost coverage).

b. remote technology consultation is the evaluation of technology support needs for an individual identified in the POC if necessary;

10. incontinence briefs and supplies are available for a beneficiary, 21 years or older, who has a physician's order and requires the use of incontinence briefs and supplies.
a. Service Restrictions
i. This service is for those who are 21 years of age or older.

ii. This service requires a physician's order.

b. Service Limitations
i. The cost cannot exceed $2,500 in a single POC year.

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 and Limitations

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 wheelchairs, whether mobile or travel, are covered under the State Plan durable medical equipment (DME) benefit, at any age, and are, therefore, not covered under the ROW.

4. Incontinence supplies annual maximum cost is $2,500 per POC year, without exception.

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.

Disclaimer: These regulations may not be the most recent version. Louisiana 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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