Section 409.413 - Covered Services(A) MassHealth covers medically necessary DME that can be appropriately used in the member's home or setting in which normal life activities take place, and in certain circumstances described in 130 CMR 409.415 for use in facilities. All DME must be approved for community use by the federal Food and Drug Administration (FDA). DME that is appropriate for use in the member's home may also be used in the community.(B) MassHealth covers the DME listed in Subchapter 6 of the Durable Medical Equipment Manual, the DME and Oxygen Payment and Coverage Guideline Tool, and any successor guidance issued by the MassHealth agency or its designee. Providers may request prior authorization for medically necessary DME if the corresponding service code is not listed in Subchapter 6 or the DME and Oxygen Payment and Coverage Guideline Tool. Covered DME includes, but is not limited to (2) ambulatory equipment, such as crutches and canes;(4) augmentative and alternative communication devices;(5) enteral and parenteral nutrition;(6) nutritional supplements;(7) home infusion equipment and supplies (pharmacy providers with DME specialty only);(8) glucose monitors and diabetic supplies;(9) mobility equipment and seating systems;(10) personal emergency response systems (PERS);(13) hospital beds and accessories;(15) bath and toilet equipment and supplies (including, but not limited to, commodes, grab bars, and tub benches).(C) MassHealth covers the repair of DME, including repairs to medically necessary back-up mobility systems, subject to the requirements of 130 CMR 409.420.(D) The MassHealth agency pays for a manual wheelchair, including any necessary repairs, as a backup to a power mobility system if the member is not residing in a nursing facility, or the member is residing in a nursing facility and has a written discharge plan, and one of the following conditions applies:(1) the level of customization of the member's primary power mobility system would preclude the use of substitute rental equipment if the primary power mobility system were removed for repair;(2) the member requires frequent outings to a destination that is not accessible to a power mobility system (for example, stairs without an elevator); or(3) it is not possible to fit the primary mobility system in any of the vehicles available to the member for transportation.(E) The MassHealth agency pays for the replacement of a member's primary mobility system only when the DME provider has obtained prior authorization and (1) the existing primary mobility system exceeds five years of age or is no longer reliable as a primary mobility system in all settings in which normal life activities take place;(2) the cost of repairing or modifying the existing primary mobility system would exceed the value of that system; or(3) the member's physical condition has changed enough to render the existing mobility system ineffective.Amended by Mass Register Issue 1449, eff. 8/6/2021.Amended by Mass Register Issue 1454, eff. 8/6/2021.Amended by Mass Register Issue 1472, eff. 7/1/2022.