Section 409.414 - Non-covered ServicesThe MassHealth agency does not pay for the following:
(A) DME that is experimental or investigational in nature;(B) DME that is determined by the MassHealth agency not to be medically necessary pursuant to 130 CMR 409.000, and 130 CMR 450.204: Medical Necessity. This includes, but is not limited to, items that: (1) cannot reasonably be expected to make a meaningful contribution to the treatment of a member's illness, disability, or injury;(2) are more costly than medically appropriate and feasible alternative pieces of equipment; or(3) serve the same purpose as DME already in use by the member, with the exception of the devices described in 130 CMR 409.413(D);(C) the repair of any DME that is not identified as a covered service in Subchapter 6 of the Durable Medical Equipment Manual, the DME and Oxygen Payment and Coverage Guideline Tool or any other guidance issued by the MassHealth agency;(D) the repair of any equipment where the cost of the repair is equal to or more than the cost of purchasing a replacement;(E) routine periodic testing, cleaning, regulating, and checking of DME that is owned by the member;(F) DME that is not of proven quality and dependability, consistent with 130 CMR 409.404(B)(12);(G) DME furnished through a consignment/stock and bill closet (unless permitted by specific MassHealth guidance, pursuant to 130 CMR 409.405(M));(H) DME that has not been approved by the federal Food and Drug Administration (FDA) for community use;(I) evaluation or diagnostic tests conducted by the DME provider to establish the medical need for DME;(J) home or vehicle modifications including, but not limited to, ramps, elevators, or stair lifts;(K) common household and personal hygiene items generally used by the public including, but not limited to, washcloths, wet wipes, and non-sterile swabs;(L) products that are not DME (except for augmentative and alternative communication devices covered pursuant to M.G.L. c. 118E, § 10H under 130 CMR 409.428);(M) certain DME provided to members in facilities in accordance with 130 CMR 409.415; and(N) provider claims for non-covered services under 130 CMR 409.414 for MassHealth members with other insurance, except as otherwise required by law.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.