7 AAC 43.1055. Specialized medical equipment and supplies

(a) The department will reimburse for specialized medical equipment and supplies

(1) that are approved under 7 AAC 43.1030 as part of the recipient's plan of care;

(2) that receive prior authorization; and

(3) for which the department receives written supportive contemporaneous documentation from a licensed physician, occupational therapist, physical therapist, speech therapist or pathologist, or physiatrist that the specific item requested is appropriate for the recipient, consistent with the plan of care, and necessary to avoid placing the recipient at risk of institutionalization.

(b) The department will consider items to be specialized medical equipment and supplies if they are

(1) devices, controls, or appliances that enable a recipient to increase the recipient's ability to perform activities of daily living or to perceive, control, or communicate with the environment in which the recipient lives, or are ancillary supplies and equipment necessary for the proper functioning of those items; and

(2) identified in

(A) Table I-4 of the durable medical equipment (DME) and supplies section of the Alaska Medicaid Provider Billing Manual; the September 1999 revision of Table I-4 of the durable medical equipment (DME) and supplies section of the Alaska Medicaid Provider Billing Manual is adopted by reference; or

(B) the department's Letter DME FY02-004, dated March 13, 2002 and adopted by reference.

(1) the unit cost of equipment must be determined by including the cost of

(A) training in the equipment's proper use; and

(B) routine fitting of and maintenance on the equipment necessary to meet applicable standards of manufacture, design, and installation;

(2) the cost of repair, modification, or adaptation of equipment may be paid as separate units of service, if the department determines that payment as separate units of service is cost-effective;

(3) the department will not reimburse as a home and community-based waiver service the cost of any medical equipment or supplies that is reimbursable under 7 AAC 43.1900 - 7 AAC 43.1980;

(4) specialized medical equipment and supplies must be rented if the equipment is a personal emergency response system or if the department determines that renting the equipment is more cost-effective than purchasing it;

(5) once purchased, specialized medical equipment and supplies become the property of the recipient;

(6) specialized medical equipment may include a portable hydrotherapy tub device, but does not include items listed in (d)(1) of this section;

(7) the department will not give prior authorization to replace specialized medical equipment before the end of that item's expected useful life, unless the department determines that replacing rather than repairing that item is more cost effective.

(d) The department will not reimburse under this section for

(1) hot tubs, spas, saunas, or permanently installed hydrotherapy devices;

(2) developmental toys;

(3) personal computers, other computer hardware, peripherals, computer software, personal data assistants (PDAs), or cellular telephones;

(4) outdoor playground equipment, scissors lifts, bicycles, other pedal-driven devices, or exercise equipment;

(5) lights or other devices used to treat seasonal affective disorder;

(6) vacuum cleaners or household appliances;

(7) devices that receive, record, or play audio or video in any medium, including televisions, compact disc players, MP3 players, videocassette players, and DVD players;

(8) micro cars; or

(9) adaptive clothing.

History: Eff. 5/15/2004, Register 170; am 9/29/2005, Register 175; am 1/11/2006, Register 177

Authority: AS 47.05.010

AS 47.07.030

Editor's note: The specialized medical equipment and supplies part of the durable medical equipment and supplies section of the Alaska Medicaid Provider Billing Manual and Letter DME FY02-004, adopted by reference in 7 AAC 43.1055, may be obtained by contacting the Department of Health and Social Services, Division of Health Care Services, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska 99503-7167.

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