Ohio Admin. Code 5160-10-22 - DMEPOS: ventilators
(A)
Provider
requirement. A provider of ventilators for use in the home must make
Condition of provider participation. A
provider of in-home use ventilators needs to have available a licensed
respiratory care professional (LRCP) twenty-four hours a day to provide
respiratory care, technical support, and clinical ventilator services and to
perform emergency servicing of equipment on two-hour notice.
(B) Coverage.
(1) Separate payment may be made for a
ventilator furnished to a resident of a longterm care facility
(LTCF).
(2) Payment may be made for
a ventilator on a rental basis only. The default certificate of medical
necessity (CMN) form is the ODM 01902, "Certificate of Medical Necessity:
Ventilators" (rev. 7/2018
7/2021).
(3) For the rental of a primary ventilator,
the CMN must include
a CMN includes the following information:
(a) Diagnosis;
(b) Specification of the condition or
conditions for which ventilatory support is needed;
(c) An estimated length of need;
(d) The continuity of ventilatory support
required
needed (e.g.,
constant, during the day, at night, for sleep only);
(e) The ventilator type, mode, and settings
or parameters;
(f) A list of other
respiratory equipment in use; and
(g) If applicable, documentation showing that
the individual is being weaned.
(4) For the rental of a secondary or back-up
ventilator, the CMN must include
includes appropriate attestation to at least one
of the following statements:
(a) The
individual cannot maintain spontaneous respiration for at least four
hours;
(b) Because of regular
activities outside the home (e.g.,
such as school,
or outpatient
therapy), the individual needs a second ventilator with a suitable power
source; or
(c) The average
emergency medical team response time to the individual's address is estimated
to be more than two hours.
(5)
A multi-function
ventilator is an all-in-one device that also has the capability to perform the
functions of other respiratory equipment such as an oxygen concentrator, a
nebulizer, a suction device, or a cough-assist device. A device that may serve
either as a ventilator or as a positive airway pressure device but not as both
simultaneously is not a multi-function ventilator.
(a)
Payment may be
made for a multi-function ventilator only if at least one additional function
("ventilator plus one") is used.
(b)
For each
additional function, whether included when the unit is first dispensed or
activated later, the appropriate CMN applies. A prescription is sufficient when
no CMN is specified for a particular function.
(C)
Requirements, constraints,
Constraints and and limitations.
(1) A ventilator with an invasive interface
must include
is
covered only if it includes backup power capability and alarms indicating
disconnection, high pressure, low pressure, and power loss.
(2) Rental of a ventilator includes the
following items and services:(b)
(c) A humidifier, either heated or unheated;
(c)
(d)
Humidifier bacteria filters;
(d)
(e) Tubing to connect
the humidifier to the ventilator;
(e)
(f) Evaluation of the
individual's residence to ensure compatibility with the equipment and to
forestall problems with its use; and
(f)
(g) Visits made at an
appropriate frequency determined by a LRCP in consultation with the
individual's prescribing practitioner, at least one visit during the first
week, not less often than once per month for the first six months, and not less
often than every sixty days thereafter.
(a) Ventilator
accessories, including inlet ventilator filters, permanent or reusable
ventilator circuits, whisper swivels, exhalation ports, tracheostomy tube
elbows, and circuit extensions and adapters;
(b)
Accessories
necessary for the oxygen and ventilator functions of a multifunction
ventilator;
(3) No separate payment is made to a provider
for keeping a LRCP on call or for performing emergency servicing of
equipment.
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02, 5165.47
Prior Effective Dates: 12/30/1991, 07/01/1993, 07/01/1994, 01/01/1995, 08/01/1998, 10/01/2004, 01/01/2008, 07/16/2018
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