Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
Conditions for payment.
To be eligible for payment under the medical assistance
program, medical supplies and equipment must meet the conditions in items A to
C.
A. A purchase of nondurable medical
supplies not requiring prior authorization must not exceed an amount necessary
to provide a one month supply.
B.
The cost of a repair to durable medical equipment that is rented or purchased
by the medical assistance program under a warranty is not eligible for medical
assistance payment if the repair is covered by the warranty.
C. In the case of rental equipment, the sum
of rental payments during the projected period of the recipient's use must not
exceed the purchase price allowed by medical assistance unless the sum of the
projected rental payments in excess of the purchase price receives prior
authorization. All rental payments must apply to purchase of the
equipment.
Subp. 2.
Payment limitation on durable medical equipment in hospitals and
long-term care facilities.
Durable medical equipment is subject to the payment
limitations in items A and C.
A. A
provider who furnishes durable medical equipment for a recipient who is a
resident of a hospital or long-term care facility may submit a separate claim
for medical assistance payment if the equipment has been modified for the
recipient or the item is necessary for the continuous care and exclusive use of
the recipient to meet the recipient's unusual medical need according to the
written order of a physician.
For purposes of this item, "modified" refers to the addition
of an item to a piece of durable medical equipment that cannot be removed
without damaging the equipment or refers to the addition of an item to a piece
of durable medical equipment that permanently alters the equipment. Equipment
purchased through medical assistance on a separate claim for payment becomes
the property of the recipient.
Payment for durable medical equipment that is not for the
continuous care and exclusive use of the recipient is included within the
payment rate made to the hospital under parts
9500.1090 to
9500.1140 and to the long-term
care facility under part
9549.0060.
B. In addition to the types of equipment and
supplies specified in part
9549.0040, subpart 5, item U, the
following durable medical equipment, prosthetics, and medical supplies are
considered to be included in the payment to a hospital or long-term care
facility and are not eligible for medical assistance payment on a separate
claim for payment.
(1) Equipment of the type
required under parts
4655.0090 to
4655.9342.
(2) Equipment used by individual recipients
that is reusable and expected to be necessary for the health care needs of
persons expected to receive health services in the hospital or long-term care
facility. Examples include heat, light, and cold application devices; straight
catheters; walkers, wheelchairs not specified under item A, and other
ambulatory aids; patient lifts; transfer devices; weighing scales; monitoring
equipment, including glucose monitors; trapezes.
(3) Equipment customarily used for treatment
and prevention of skin pressure areas and decubiti. Examples are alternating
pressure mattresses, and foam or gel cushions and pads.
(4) Emergency oxygen.
(5) Beds suitable for recipients having
medically necessary positioning requirements.
C. Any medical equipment encompassed within
the definition of depreciable equipment as defined in part
9549.0020, subpart 17, is not
eligible for medical assistance payment on a separate claim for payment under
parts
9505.0170 to
9505.0475.
Subp. 3.
Payment limitation; prior
authorization.
Prior authorization is a condition of medical assistance
payment for the medical supplies and equipment in items A to C:
A. a nondurable medical supply that costs
more than the performance agreement limit;
B. durable medical equipment, prostheses, and
orthoses if the cost of their purchase, projected cumulative rental for the
period of the recipient's expected use, or repairs exceeds the performance
agreement limit; and
C. maintenance
of durable medical equipment.
For purposes of this subpart, "maintenance" means a service
made at routine intervals based on hours of use or calendar days to ensure that
equipment is in proper working order. "Repair" means service to restore
equipment to proper working order after the equipment's damage, malfunction, or
cessation of function.
Subp.
4.
Excluded medical supplies and equipment.
The medical supplies and equipment in items A to F are not
eligible for medical assistance payments:
A. medical supplies and equipment that are
not covered under Medicare except for raised toilet seats; bathtub chairs and
seats; bath lifts; prosthetic communication devices; and any item that meets
the criteria in part
9505.0210;
B. routine, periodic maintenance on medical
equipment owned by a long-term care facility or hospital when the cost of
maintenance is billed to medical assistance on a separate claim for
payment;
C. durable medical
equipment that will serve the same purpose as equipment already in use by the
recipient;
D. medical supplies or
equipment requiring prior authorization when the prior authorization is not
obtained;
E. dental hygiene
supplies and equipment; and
F.
stock orthopedic shoes as defined in part
9505.0350, subpart 6, item
A.
Statutory Authority: MS s
256B.04
