23 Miss. Code. R. 209-1.52 - Pressure Reducing Support Surface
A. Medicaid defines
pressure reducing support surfaces as surfaces designed for beneficiaries with
limited or no mobility who are bed confined most or all of the day and prone to
developing pressure ulcers.
B.
Medicaid covers pressure reducing support surfaces for all eligible
beneficiaries when ordered by a physician, medically necessary and prior
authorized by the Utilization Management and Quality Improvement Organization
(UM/QIO), the Division of Medicaid or designated entity for rental up to
purchase amount or purchase.
C.
Beneficiaries requiring pressure reducing support surfaces must have a care
plan, established by the beneficiary's physician or home care nurse, documented
in the beneficiary's medical record, which includes all of the following:
1. Education of the beneficiary and caregiver
on the prevention and/or management of pressure ulcers.
2. Regular assessment by a nurse, physician,
or other licensed health care practitioner.
3. Appropriate turning and
positioning.
4. Appropriate wound
care for a stage II, III or IV ulcer.
5. Appropriate management of
moisture/incontinence.
6.
Nutritional assessment and intervention consistent with the overall plan of
care.
D. Medicaid defines
a pressure pad for a mattress as a non-powered pressure reducing mattress
overlay designed to be placed on top of a standard hospital or home mattress
which includes a gel mattress overlay, an air mattress overlay, a water
mattress overlay and a foam mattress overlay with a waterproof cover.
1. Medicaid covers a pressure pad when one
(1) or more of the following apply:
a) The
beneficiary is completely immobile and cannot make changes in body position
without assistance.
b) The
beneficiary has limited mobility and cannot independently make changes in body
position significant enough to alleviate pressure.
c) The beneficiary has any stage of a
pressure ulcer on the trunk or pelvis.
d) The beneficiary is essentially bedbound
with an impaired nutritional status, fecal or urinary incontinence, altered
sensory perception, or compromised circulatory status.
2. A replacement pad for use with a medically
necessary power alternating pressure device owned by the beneficiary is covered
if the beneficiary meets one (1) or more of the criteria in Rule 1.52,
D.l.a-d.
3. A foam overlay or
mattress, such as an egg crate without a waterproof cover, is not considered
durable and is not covered under the DME program.
E. Powered Pressure Reducing Overlays and
Mattresses
1. Medicaid defines a powered
pressure reducing overlay as a low air loss, powered flotation device without
low air loss, or alternating pressure with an air pump or blower providing
either sequential inflation or deflation of the air cells or a low interface
pressure throughout the overlay designed to reduce friction and shear and are
to be placed on top of a standard hospital or home mattress.
2. Medicaid defines a powered pressure
reducing mattress as a mattress with alternating pressure, low air loss, or
powered flotation without low air loss. An air pump or blower provides both
sequential inflation and deflation of the air cells or a low interface pressure
throughout the mattress. The surface is designed to reduce friction and shear
and can be placed directly on a hospital bed frame.
3. Powered pressure reducing overlays and
mattresses are covered when one (1) or more of the following applies:
a) The beneficiary has multiple stage II
pressure ulcers, defined as partial thickness skin loss involving epidermis
and/or dermis, on the truck or pelvis.
b) The beneficiary has been on a
comprehensive ulcer treatment program and the ulcers have worsened or remained
the same for one (1) month.
c)
Large or multiple stage III pressure ulcers, defined as full thickness skin
loss involving damage or necrosis of subcutaneous tissue that may extend down
to, but not through, underlying fascia, or stage IV pressure ulcers, defined as
full thickness skin loss with extensive destruction, tissue necrosis or damage
to muscle, bone or supporting structures, on the trunk or pelvis.
d) Myocutaneous flap or skin graft for a
pressure ulcer on the trunk or pelvis within the previous sixty (60)
days.
Notes
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No prior version found.