Section 7 AAC 120.215 - Purchase of items(a) The department may authorize the purchase of new or used durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2). The item or service becomes the property of the recipient for whom it is purchased. The enrolled provider shall (1) transfer ownership of the item, including a warranty, if applicable, to the recipient; and(2) assure compliance with (j) of this section if the item was previously used.(b) The department will not authorize the purchase of an item that requires continuous rental under the Alaska Medicaid DMEPOS Fee Schedule, Tables 1-5 through 1-9, adopted by reference in 7 AAC 160.900.(c) The department will not reimburse in a single upfront payment the full cost of an item identified as a capped rental item under the Alaska Medicaid DMEPOS Fee Schedule Tables 1-5 through 1-9, adopted by reference in 7 AAC 160.900, except that medically necessary optimally configured power or ultralight wheelchairs may be considered for direct purchase on a case-by-case basis through the service authorization process under 7 AAC 120.210.(d) Rental of durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2) that are identified as capped rental items on the Alaska Medicaid DMEPOS Fee Schedule, Tables 1-5 through 1-9, adopted by reference in 7 AAC 160.900, are considered purchased in full by the department after 13 months of continuous rental or after 100 percent of the purchase price has been paid, whichever occurs first. Ownership information, including warranties and title, must be transferred to the recipient on the first day after 13 months of continuous rental or the first day after 100 percent of the purchase price has been paid, whichever occurs first.(e) The 13 months of continuous rental begins when the recipient first receives the rental item. The 13 months of continuous rental does not include temporary interruptions of less than 60 consecutive days, including the days remaining in the rental month in which the use stops. Unreimbursed months of temporary interruptions in rental do not count towards the 13 months of continuous rental and also do not begin a new rental period.(f) Interruptions of greater than 60 consecutive days, including the days remaining in the rental month in which the use stops, will begin a new rental period and the provider must get a new prescription order and submit a new service authorization request for the new rental period.(g) Modification of the existing continuous rental equipment due to a change in the recipient's medical needs during a 13-month continuous rental period does not begin a new rental period. If applicable, a new rental period for the added equipment will begin.(h) Continuous rental equipment that is replaced with different, but similar, equipment during the 13-month continuous rental period, and that is billed with the same code under the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900, will not begin a new rental period.(i) A temporary or permanent change in the recipient's residence during the 13-month continuous rental period will not begin a new rental period.(j) A provider enrolled under 7 AAC 105.210 as a durable medical equipment provider may request payment in accordance with 7 AAC 145.420 for the rental or purchase of used or refurbished durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2) at a rate of not more than 75 percent of the rate established in the Alaska Medicaid DMEPOS Fee Schedule, Tables 1-5 through 1-9, adopted by reference in 7 AAC 160.900, as long as the following criteria are met: (1) the provider must have the recipient acknowledge in writing, and must maintain the written acknowledgment, that the recipient is receiving used or refurbished equipment;(2) the provider must bill with the appropriate modifier that distinguishes used or refurbished equipment from new equipment;(3) the used or refurbished equipment provided must be clean and sanitized;(4) the product serial number of the used or refurbished equipment must be retained in the dispensing record and provided to the department upon request; and(5) the used or refurbished equipment provided must meet the current needs of the recipient, must be close to the manufacturer's suggested specifications for a newly purchased piece of equipment, and must be able to withstand at least three years of use; if the equipment supplied does not meet current replacement standards of three years of use and the item needs to be replaced before the standard replacement limit has been met, the provider must replace the item with a new or used piece of equipment at no charge to the department or the recipient except under 7 AAC 120.220.Eff. 2/1/2010, Register 193; am 6/2/2019, Register 230, May 2019Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040