Appendix 144-101-II-A - SUPPLIES AND EQUIPMENT WHICH ARE PROVIDED AS PART OF THE ICF-MR REGULAR RATE OF REIMBURSEMENTThe following supplies and equipment must be provided to a member by an ICF-MR as part of the facility's regular rate of reimbursement, when items are required by the member.
Facilities that serve a special group of disabled members are expected to furnish that equipment which is normally used in their care (e.g. children's wheelchairs) as a part of their reimbursement rate.
Neither the facility nor the supplier may bill for the following items:
1. Alcohol, swabs and rubbing2. Analgesics, non-prescription including: aspirin: plain, buffered and coated, suppositories; acetaminophen: tablets, liquids and suppositories.3. Antacids, non-prescription including: Aluminum/magnesium hydroxide (ex. Maalox); Aluminum/magnesium hydroxide with simethicone (ex. Mylanta, Maalox Plus); Calcium carbonate tablets (ex. Tums); Calcium carbonate/ magnesium hydroxide tablets (ex. Rolaids)4. Alternating pressure pads, air mattresses, "Egg Crate" mattresses, gel mattresses9. Beds (standard hospital type, not therapy beds)12. Blood pressure equipment15. Calcium supplements, non-prescription (ex. Tums, Oscal)17. Catheter trays (disposable)18. Chairs (standard and geriatric)23. Cough syrup and expectorants, all non-prescription brands25. Cushions (e.g., comfort rings)28. Douch trays (disposable)31. Enteral feeding, supplies and equipment33. Gauze bandages (sterile or non-sterile)34. General services such as administration of oxygen and related medications, hand feeding, incontinency care, tray service, and enemas36. Gloves (sterile and unsterile)38 Hemorrhoidal preparations40. Incontinency supplies (full brief- all sizes; bedpad; undergarment liners, disposable or reusable; underpads)43. Laundry services, personal (including supplies and equipment)44. Laxatives, non-prescription including: Stool softeners (ex. Docusate sodium liquid or capsule); Bulk: (ex. Psyllium); Stimulants: (ex. Bisacodyl tablets and suppositories; docusate casanthranol, liquid and/or capsule); Enemas: (ex. Saline, phosphate types-except Fleets); oil retention; Misc.: milk of magnesia; glycerin suppositories; lactulose and analogs (when used as a laxative); mineral oil.46. Lubricants (skin, bath oil)49. Ointments and creams (available over the counter), including petroleum jelly and hydrocortisone 0.5%50. Ophthalmic lubricants: tears, ointments51. Oxygen, for emergency and prn use only, including portable oxygen and equipment52. Parenteral solutions, supplies and equipment55. Powders (medicated and baby)57. Restraints (posey, thorasic chest supports, wedge pillows, etc.)58. Sand and water tables59. Sensory stimulation materials60. Shampoo, regular; medicated; no tears baby shampoo63. Soap: including hypoallergenic64. Special dietary supplements66. Sterile I.V. or irrigation solution69. Supplies necessary for treatment of decubiti (non-prescription)71. Swabs, medicated or unmedicated74. Testing materials to be used by staff of facility, not to include material normally included in psychometric testing84. Tubes (gavage, lavage, etc.)87. Urinary drainage equipment and supplies (disposable)90. Vitamins, non-prescription, all brands92. Wheelchairs - Standard: Chairs with removable arms and leg rests; wheelchairs with elevators; pediatric wheelchairs; "hemi" wheelchairs; reclining wheelchairs93. Wipes, rectal medicated94. Routine personal hygiene and grooming items to include, but not be limited to items for shaving, shampooing, bathing, nail clipping (unless specified as a covered service when performed by a podiatrist as covered under the MaineCare Benefits Manual), haircutting or the services of a barber when requested and paid for by the member.95. Routine transportation of members or laboratory specimens to hospital or doctor's offices C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-50, app 144-101-II-A