Ohio Admin. Code 5160-10-02 - DMEPOS: repair
(A)
Definitions.
(1)
"Major repair" is a repair for which the combined
medicaid allowed amounts for materials and labor exceed one hundred twenty
dollars for an orthotic or prosthetic device or one hundred dollars for any
other item.
(2)
"Minor repair" is a repair for which the combined
medicaid allowed amounts for materials and labor do not exceed one hundred
twenty dollars for an orthotic or prosthetic device or one hundred dollars for
any other item. Reporting a major repair on a claim as a series of minor
repairs is not permitted.
(B)
Coverage.
(1)
Provisions
governing the repair of wheelchairs are set forth in rule
5160-10-16 of
the Administrative Code.
(2)
Need verification is required before payment can be
made for the following repairs made to a particular item:
(a)
The initial
repair made to an item that was not purchased by the
department;
(b)
Major repairs; and
(c)
Minor repairs in
excess of one per one hundred twenty days.
(3)
If no other form
or format is specified, a request for need verification must be submitted on
form ODM 01904, "Request for Need Verification: Repair of Durable Medical
Equipment (Other Than Wheelchairs), Prostheses, or Orthotic Devices" (rev.
7/2018), and must include the following information:
(a)
Specification of
the item, including manufacturer, model, and serial number (if
applicable);
(b)
The date on which the item was originally purchased or
dispensed or, if the date is not known, the approximate age of the
item;
(c)
Any warranty period and the type of warranty
(manufacturer or dealer);
(d)
A full description of the wear, damage, or
malfunction;
(e)
A full description of the repair;
(f)
A description,
with dates, of previous repairs (both major and minor);
(g)
A complete
itemization of parts; and (h) An estimate of labor time needed.
(4)
Providers should advise the department when, in their
professional opinion, replacement of an item would be more cost-effective than
repair.
(5)
No separate payment will be made for the following
items or services:
(a)
Temporary replacement ("loaner") equipment provided
while an individual's own equipment is being repaired; and
(b)
Repair of an item
if within the preceding twelve months the department has paid for the repair of
a duplicate or conflicting item currently in the recipient's possession,
regardless of payment or supply source.
Replaces: 5160-10-08
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 04/07/1977, 12/21/1977, 01/01/1980, 03/01/1984, 10/01/1988, 05/15/1989, 05/01/1990, 12/10/1993, 01/01/1995, 09/01/2002, 10/01/2004, 01/13/2006, 04/09/2009, 07/31/2009 (Emer), 10/29/2009, 12/31/13
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