Md. Code Regs. 10.67.06.13 - Benefits-Disposable Medical Supplies and Durable Medical Equipment
A. An MCO shall provide to its enrollees medically necessary disposable medical supplies, and durable medical equipment including but not limited to:
(1) All supplies and equipment used in the administration or monitoring of prescriptions by the enrollees;
(2) Incontinency pants and disposable underpads for medical conditions associated with prolonged urinary or bowel incontinence if necessary to prevent institutionalization or infection;
(3) Orthotic devices when medically necessary for use in the MCO enrollee's home, school, or place of employment;
(4) Prosthetic devices once annually when medically necessary:
(a) For use in the enrollee's home, school, or place of employment; or
(b) For the purpose of performing physical activities, including running, biking, swimming, strength training, and other activities to maximize the whole-body health and lower or upper limb function of the enrollee;
(5) Annual repairs to prosthetic devices covered under §A(4) of this regulation when:
(a) Medically necessary; and
(b) When the repair's necessity is not due to misuse;
(6) Replacement of prosthetic devices covered under §A(4)of this regulation when medically necessary as follows:
(a) Once annually for devices less than 3 years old if the replacement is necessary for the following reasons:
(i) Because of a change in the physiological condition of the patient;
(ii) Unless necessitated by misuse, because of an irreparable change in the condition of the prosthesis or the component of the prosthetic device; or
(iii) Unless necessitated by misuse, because the condition of the prosthetic device or the component of the prosthetic device requires repairs and the cost of the repairs would be more than 60 percent of the cost of replacing the prosthetic device or the component of the prosthetic device.
(b) For devices more than 3 years old subject to §A(4) and (5) of this regulation.
B. Except as required in §C(1), an MCO shall provide preauthorization within 72 hours for DMS/DME services and supplies that require preauthorization by the MCO.
C. An MCO shall provide its enrollees the disposable medical supplies and durable medical equipment in a timely manner so as to not adversely affect the health of the enrollees, in accordance with the following:
(1) For medical equipment or supplies, or both, when there is an urgent medical need such as to facilitate hospital discharge or when a potential exists for worsening of enrollee's condition, the MCO shall provide needed items within 24 hours of request; and
(2) For all other requests for DMS/DME, the MCO shall provide these items within 7 days from the date of request unless the MCO can document to the Department that justification for additional time is necessary.
D. An MCO is responsible for paying for any durable medical equipment authorized and ordered while the member is active with the MCO if:
(1) The delivery of the item occurs within 90 days after the member's termination date from the MCO; and
(2) The member remains a Medicaid recipient.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
A. An MCO shall provide to its enrollees medically necessary disposable medical supplies and durable medical equipment, including but not limited to:
(1) All supplies and equipment used in the administration or monitoring of prescriptions by the enrollees; and
(2) Incontinency pants and disposable underpads for medical conditions associated with prolonged urinary or bowel incontinence if necessary to prevent institutionalization or infection.
B. Except as required in §C(1), an MCO shall provide preauthorization within 72 hours for DMS/DME services and supplies that require preauthorization by the MCO.
C. An MCO shall provide its enrollees the disposable medical supplies and durable medical equipment in a timely manner so as to not adversely affect the health of the enrollees, in accordance with the following:
(1) For medical equipment or supplies, or both, when there is an urgent medical need such as to facilitate hospital discharge or when a potential exists for worsening of enrollee 's condition, the MCO shall provide needed items within 24 hours of request; and
(2) For all other requests for DMS/DME, the MCO shall provide these items within 7 days from the date of request unless the MCO can document to the Department that justification for additional time is necessary.
D. An MCO is responsible for paying for any durable medical equipment authorized and ordered while the member is active with the MCO if:
(1) The delivery of the item occurs within 90 days after the member's termination date from the MCO; and
(2) The member remains a Medicaid recipient .