N.H. Code Admin. R. He-E 801.29

Current through Register No. 25, June 20, 2024

Section He-E 801.29 - Specialized Medical Equipment Services

(a) Specialized medical equipment for non-acute needs shall be a covered service when:

(1) A NH medicaid-enrolled licensed practitioner or physical or occupational therapist has determined the clinical need for one or more of the items in (b) below;

(2) The participant's case manager has requested prior authorization for the item in accordance with (c) below;

(3) The department has provided the prior authorization for the item; and

(4) The service is completed by a NH enrolled medicaid provider.

(b) Covered specialized medical equipment services shall include the following durable medical equipment items:

(1) Raised toilet seats;

(2) Shower/tub seats and benches;

(3) Tub lifts;

(4) Transfer benches;

(5) Bedside commodes;

(6) Dressing aids and grabbers;

(7) Non-slip grippers to pick up and reach items;

(8) Adaptive utensils;

(9) Transport wheelchairs;

(10) Wheelchair cushions;

(11) Walkers;

(12) Patient lifts;

(13) Slings;

(14) Semi-electric beds;

(15) Bed rails;

(16) Mattress overlay pads;

(17) Electronic communication devices;

(18) Seat lifts, including the chair, or seat lift mechanisms when the following criteria are met:

a. The participant has a severe condition that causes the participant to require assistance to come to a standing position;

b. The participant is completely incapable of standing up from a regular armchair or any chair in their home; and

c. The participant's attending physician, or a consulting physician treating the participant for the disease or condition resulting in the need for a seat lift, documents that the seat lift mechanism is a part of the physician's course of treatment to provide support for a condition that is not likely to improve and that may worsen;

(19) Medication dispensing devices, including training on their use, when the following conditions are met:

a. The participant or caregiver is able to use the device;

b. The participant does not live in a licensed facility;

c. When the use of this service is documented to either:

1. Replace another service of equal or greater cost; or

2. Avoid the addition of another service; and

d. The type of device is determined by the department's skilled professional medical personnel to be the least costly device that is appropriate for the participant; and

(20) Other durable medical equipment items that are:

a. Specified in the comprehensive care plan which enable participants to increase their ability to perform activities of daily living;

b. Specified in the comprehensive care plan to help the participant perceive, control, or communicate with the environment in which they live;

c. Necessary for life support or to address physical conditions along with ancillary supplies and equipment necessary to the proper functioning of such items;

d. Not available under the state plan that is necessary to address the participant's functional limitation; or

e. Necessary medical supplies not available under the state plan.

(c) The participant's case manager shall submit the following when requesting prior authorization for specialized medical equipment:

(1) A completed Form 3715, "Choices for Independence Prior Authorization Request Form" (January 2022)

(2) A written copy of the determination in (a)(1) above that describes:

a. The medical or functional need for the equipment;

b. Any specifications necessary to meet the participant's needs; and

c. The proposed training plan for the participant and caregiver to ensure safe use of the equipment;

(3) Proposals from at least 2 medicaid enrolled providers, except that one proposal may be submitted when the equipment costs less than $1,000, already has a set or fixed rate, or with a written explanation of why only one proposal is available or appropriate, including the following, as applicable to the equipment:

a. A list of supplies and materials; and

b. A description of the equipment, including measurements when necessary; and

(4) If a participant prefers one proposal over the other(s), then an explanation of the preference.

(d) Specialized medical equipment services shall not be covered separately for participants receiving residential care facility services if the facility is otherwise required to provide the equipment pursuant to He-P 804, He-P 805, a residential services agreement, or the specialized medical equipment is included in the residential care facility service rate.

(e) Payment for specialized medical equipment shall:

(1) Be for the most cost-effective item, as identified by the department, that would effectively meet the participant's needs; and

(2) Not exceed the participant limit specified in the HCBs-CFI waiver approved by CMS.

(f) If, within 90 days of delivery of the specialized medical equipment:

(1) There is a discrepancy between the proposal and the delivered or installed equipment for a participant, the specialized equipment provider shall replace the equipment; and

(2) The replacement includes a restocking fee that the specialized medical equipment provider will incur as a result, the provider may submit a revised proposal for the replacement equipment at the same cost and add a restocking fee, and the case manager shall submit the revised proposal that includes the restocking fee for authorization to the department.

N.H. Code Admin. R. He-E 801.29

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11

Amended by Volume XXXIX Number 32, Filed August 8, 2019, Proposed by #12830, Effective 8/7/2019, Expires 2/3/2020.

Amended by Volume XLII Number 6, Filed February 10, 2022, Proposed by #13340, Effective 1/29/2022, Expires 1/29/2032 (formerly He-E 801.27).