053-10 Wyo. Code R. §§ 10-8 - Durable Medical Equipment (DME)

The limitations in this section are in addition to any other limitation or restrictions that may apply to the Division's rental or purchase of any physical items or apparatus as a benefit under the Act.

(a) The Division will not rent or purchase or provide reimbursement for any physical item or apparatus for use by an injured worker unless there is proof that the item:

(i) Is medically necessary for the documented compensable work injury;

(ii) Is prescribed by a health care provider;

(iii) Is the most cost-effective method of meeting the medical need;

(iv) Is not considered to be experimental or investigational;

(v) Is designed to withstand repeated use in the home;

(vi) Generally is not useful to a person in the absence of an illness or injury;

(vii) Has primary purpose other than enhancing the personal comfort of the injured worker or providing convenience for the injured worker or caregiver;

(viii) Is the type of item that is suitable and commonly provided for home use or mobility under employer provided health insurance coverage, Medicare or Medicaid; and,

(ix) Generally has an expected lifetime of at least three (3) years.

(b) The Division may choose to rent or purchase any physical item or apparatus depending on its assessment as to which option is most reasonable and cost effective.

(c) DME Repair or Replacement. Requests for repair or replacement of equipment purchased by the Division shall be reviewed on an individual case-by-case basis. Approval will be dependent upon evidence the equipment was used in a safe and appropriate manner and, due to normal wear and tear, needs to be repaired or replaced. Evidence of improper use or abuse of equipment may warrant denial of the repair or replacement of the equipment.

(d) An injured worker shall be responsible for reasonable care and maintenance of any physical item or apparatus provided.

(i) The Division may cover needed repairs and maintenance when a professional is required and the services are not covered under warranty within the warranty period.

(ii) Providers shall not bill for equipment, parts, or services covered under manufacturer warranty within the warranty period.

(iii) The Division may require a copy of the warranty from the provider to be submitted upon request.

Notes

053-10 Wyo. Code R. §§ 10-8

Amended, Eff. 8/24/2017. Amended, Eff. 6/7/2019. Amended, Eff. 4/16/2020. Amended, Eff. 10/26/2020. Amended, Eff. 2/7/2023. Amended, Eff. 7/5/2023. Amended, Eff. 7/22/2024. Amended, Eff. 1/18/2025.