N.H. Code Admin. R. He-E 801.27 - Specialized Medical Equipment Services

Current through Register Vol. 41, No. 39, September 30, 2021

(a) Specialized medical equipment shall be a covered service when:
(1) A NH Medicaid-enrolled licensed practitioner or physical or occupational therapist has determined the clinical need for one or more of the items in (b) below;
(2) The participant's case manager has requested prior authorization for the item in accordance with (c) below;
(3) BEAS has provided the prior authorization for the item; and
(4) The service is completed by a NH enrolled Medicaid provider.
(b) Covered specialized medical equipment services shall include the following durable medical equipment items:
(1) Raised toilet seats;
(2) Shower/tub seats and benches;
(3) Tub lifts;
(4) Transfer benches;
(5) Bedside commodes;
(6) Dressing aids and grabbers;
(7) Non-slip grippers to pick up and reach items;
(8) Adaptive utensils;
(9) Transport wheelchairs;
(10) Wheelchair cushions;
(11) Walkers;
(12) Hoyer lifts;
(13) Slings;
(14) Semi-electric beds;
(15) Bed rails;
(16) Mattress overlay pads;
(17) Seat lifts, including the chair, or seat lift mechanisms when the following criteria are met:
a. The participant meets the following criteria:
1. Has a severe condition that causes the participant to require assistance to come to a standing position; and
2. Is completely incapable of standing up from a regular armchair or any chair in their home; and
b. The participant's attending physician, or a consulting physician treating the participant for the disease or condition resulting in the need for a seat lift, documents that the seat lift mechanism is a part of the physician's course of treatment to provide support for a condition that is not likely to improve and that may worsen; and
(18) Medication dispensing devices, including training on their use, when the following conditions are met:
a. The participant or caregiver is able to use the device;
b. The participant does not live in a licensed facility;
c. When the use of this service is documented to either:
1. Replace another service of equal or greater cost; or
2. Avoid the addition of another service; and
d. The type of device is determined by the BEAS nurse to be the least costly device that is appropriate for the participant.
(c) The participant's case manager shall submit the following when requesting prior authorization for specialized medical equipment:
(1) A completed Form 3715, "Choices for Independence Prior Authorization Request Form" (4/2011) ;
(2) A copy of the evaluation in (a) (1) above that describes:
a. The medical or functional need for the equipment;
b. The description and any measurements required for the equipment; and
c. The proposed training plan for the client and caregiver to ensure safe use of the equipment;
(3) Proposals from at least 2 enrolled providers, except that one proposal may be submitted with a written explanation of why only one proposal is available or appropriate, including the following, as applicable to the equipment:
a. A list of supplies and materials; and
b. A description, including measurements, of the equipment; and
(4) If a participant prefers one bid over the other(s) , then an explanation of the preference.
(d) Specialized medical equipment services shall not be covered separately for participants receiving residential care services.
(e) Payment for specialized medical equipment shall:
(1) Be for the most cost-effective item, as identified by the department, that would effectively meet the participant's needs; and
(2) Not exceed the participant lifetime limit specified in the HCBC-CFI waiver approved by the Centers for Medicare and Medicaid Services.

Notes

N.H. Code Admin. R. He-E 801.27

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11

Amended by Volume XXXIX Number 32, Filed August 8, 2019, Proposed by #12830, Effective 8/7/2019, Expires 2/3/2020.

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