Ohio Admin. Code 5160-10-21 - DMEPOS: incontinence garments and related supplies
(A)
Coverage.
(1)
The default certificate of medical necessity (CMN) is
the ODM 02912, "Certificate of Medical Necessity: Incontinence Items" (rev.
7/2018). The CMN must include the following elements:
(a)
An indication
that the individual is at least thirty-six months of age;
(b)
The applicable
diagnosis of the specific disease, injury, developmental delay, or
developmental disability causing the incontinence;
(c)
The type of
incontinence; and
(d)
The type and quantity of incontinence garments or
incontinence supplies being prescribed.
(2)
Payment cannot be
made for items related to stress incontinence to which no specific
physiological, psychological, or physiopsychological cause can be
attributed.
(3)
A certification period cannot exceed twelve
months.
(4)
A new certification is required for an increase in the
quantity of an incontinence item already prescribed or for a change in the type
of incontinence item. (No new certification is needed for a decrease in
quantity.)
(B)
Requirements, constraints, and limitations.
(1)
Incontinence
items are dispensed in quantities representing one month's supply. A provider
must not dispense additional incontinence items to an individual who already
has at least a month's supply on hand. Before dispensing additional items,
therefore, providers must make contact, either orally or in writing, with each
individual (or the individual's authorized representative) to verify the
current need. Providers must keep on file a summary of this contact, including
in particular the following information:
(a)
The quantity of
items requested;
(b)
The quantity of items currently on
hand;
(c)
The verification date, which must not be more than
fourteen days before the dispensing date;
(d)
The full name of
the provider's representative who recorded the quantities reported; and
(e)
The
full name of the person (the individual or the individual's
authorizedrepresentative) who reported the quantities.
(2)
Payment will not be made for an incontinence item in excess
of the quantity prescribed.
Replaces: 5160-10-21
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 05/01/1990, 09/01/1998, 10/01/2004, 04/25/2011
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