Section He-W 571.11 - Payment for Equipment, Devices, and Supplies(a) The department shall determine rates for all DME, prosthetic devices, orthotic devices, and medical supplies in accordance with RSA 161:4, VI(a) .(b) The DME, prosthetic device, orthotic device, and medical supply providers shall submit claims for payment to the department's fiscal agent.(c) Payment for disposable incontinence supplies, including gloves used for this condition, provided to recipients shall be made only for supplies obtained from the exclusive supplier of incontinence products contracted through the department.(d) Billing of and payment for prosthetics, orthotics, DME, medical supplies, and repair parts shall be made at the lesser of: (1) The provider's usual and customary charge to the public, as defined in RSA 126-A:3, III(b);(2) The lowest amount the provider accepts from any other third party payor; or(3) The rate established by the department.(e) Payment for labor costs for repairs shall be at a rate established by the department.(f) Payment shall be denied or recouped if the provider bills for and is paid for disposable incontinence supplies, including gloves used for such condition, which are not obtained from the exclusive supplier of incontinence products contracted through the department.(g) Payment shall be denied if the recipient is not eligible on the date of service, with the exception of (h) below.(h) For the following items only, payment shall be denied if the recipient is not eligible on the date of the order: (1) Customized wheelchairs;(2) Custom fabricated prosthetics;(3) Custom fabricated orthotics; and(4) Frame and seating growths to pediatric and adult wheelchairs.(i) No DME item, prosthetic device, orthotic device, medical supply, or service shall be paid prior to delivery of the DME item, prosthetic device, orthotic device, medical supply, or service to the recipient.(j) In accordance with the payment rates established in (a) above, the rate for wheelchairs shall include the following required provider services: (1) Delivery and assembly of the wheelchair;(2) Training to the recipient and recipient's family and other care giver(s) in the use of the equipment, maintenance care, and equipment diagnostics; and(3) Wheelchair adjustments at the end of the first 30 days(k) Providers shall supply a comparable substitute wheelchair for 2 weeks during the repair of the original wheelchair. For repairs that require move than 2 weeks to complete, the provider shall seek PA for a rental fee.N.H. Admin. Code § He-W 571.11
(See Revision Note at chapter heading He-W 500); ss by #6158, eff 12-29-95, EXPIRED: 12-29-03
New. #8961, eff 8-20-07; ss by #9637, eff 1-16-10; amd by #10139, eff 7-1-12