Section 92-01-02-29.5 - Power mobility devices1. An injured employee must obtain a primary health care provider's order of medical necessity supported by objective medical findings before the purchase of a power mobility device may be approved by the organization. The primary health care provider's order must contain the following: b. Date of patient's face-to-face examination;c. Pertinent diagnosis or conditions that relate to the need for device or modification;d. Description of what is ordered;f. Primary health care provider's signature; and g. Date of primary health care provider's signature.2. There must be clear medical documentation of functional limits of standing and walking with an assistive device. Documentation must support reasons why a cane, walker, or manual wheelchair cannot be used to complete activities of daily living.3. A primary health care provider must make a referral for a mobility assessment and the assessment must be performed by a licensed or certified occupational therapist or physical therapist with specific training and experience in rehabilitation mobility or wheelchair evaluations. The assessment must be completed prior to the approval of a power mobility device.4. When the power mobility device is primarily intended for outdoor use or recreational purposes, the device is not medically necessary.5. Upgrades to a power mobility device are not considered medically necessary if the upgrade is primarily intended for luxury, outdoor, or recreational purposes. Specific items such as power tilt or recline seating will only be approved if the injured employee is at risk of additional medical complications, has issues with transfer, or an upgrade will help manage the injured employee's tone and spasticity.6. An injured employee who has been approved for a power mobility device must independently qualify for a motor vehicle purchase or home modification as provided in subsection 5 of North Dakota Century Code section 65-05-07, section 92-01-02-29.3, and section 92-01-02-29.4.7. If an injured employee does not sustain a catastrophic injury or if exceptional circumstances do not exist as provided in subsection 5 of North Dakota Century Code section 65-05-07, but the injured employee is approved for a power mobility device, the organization, in its sole discretion, may approve a vehicle modification or adaptation for the injured employee, but may not approve a vehicle purchase.8. All initial and replacement requests for power mobility devices must meet the criteria in this section.9. An appeal of a decision made by the organization under this section must be adjudicated pursuant to North Dakota Century Code section 65-02-20.N.D. Admin Code 92-01-02-29.5
Adopted by Administrative Rules Supplement 2017-365, July 2017, effective 7/1/2017.Amended by Administrative Rules Supplement 376, April 2020, effective 4/1/2020.General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-05-07