Ala. Admin. Code r. 560-X-13-.19

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-13-.19 - Warranty, Maintenance, And Replacement

(1) All standard DME, appliances, and POP must have a warranty for a minimum of one year; this may include the manufacturer's warranty. If the provider supplies items that are not covered under a warranty, the provider is responsible for repairs, replacements and maintenance for the first year.

(a) The warranty begins on the date of delivery (date of service) to the recipient. A statement of the warranty must be given to the recipient and the provider must keep a copy of the warranty for audit review by Medicaid. Medicaid may request a copy of the warranty.

(b) In the event the supplying provider does not honor or provide the mandatory one year warranty and does not repair the items when needed, Medicaid may impose penalties, to include but not limited to deducting the total cost of the repairs from a check write of the supplying provider, recoupment of reimbursement paid to the provider for the equipment, or termination of the provider's contract.

(2) Medicaid covers repair and replacement of DME, supplies, appliances and POP. These services, in most cases, must be prior approved by Medicaid. The request for repair or replacement and appropriate documentation (includes PA when applicable) justifying the need for replacement must be submitted electronically to Medicaid's fiscal agent and kept in the recipient's file.

(3) Requests for replacement or repair of items that are covered by Medicaid which are outside the normal benefit limits, due to damage beyond repair or other extenuating circumstances, must be submitted to the DME Unit for review and consideration. Request for repair or replacement due to extenuating circumstances should be mailed to, Alabama Medicaid Agency, 501 Dexter Ave., DME Unit, Montgomery, AL 36103.

(4) Medicaid will not repair or replace items that are lost, destroyed, or damaged as a result of misuse, neglect, loss, or wrongful disposition of equipment by the recipient, the recipient's caregiver(s), or the provider. Requests for repair or replacement will be denied if such circumstances are confirmed. Payment for repair or replacement of items denied by Medicaid is the responsibility of the recipient. At a minimum, examples of misuse, neglect, loss or wrongful disposition by the recipient, recipient's caregiver, or the provider include, but are not limited to the following:

(a) Loss of item or related parts

(b) Selling or loaning item or related parts

(c) Damage due to weather

(d) Failure to store the items in a secure and covered area when not in use

(e) Loss, destruction or damage caused by the malicious, intentional or negligent acts

(5) Alabama Medicaid covers replacement items due to loss by disasters, fire, theft, etc. The provider must submit the appropriate documentation (fire report, police report, etc.) with the PA (if PA is required), and keep all related documentation in the recipient's file per Agency record retention policy. The date of the report must be within 30 days of the date of the loss or event.

Ala. Admin. Code r. 560-X-13-.19

Adopted by Alabama Administrative Monthly Volume XXXIV, Issue No. 04, January 29, 2016, eff. 2/25/2016.

Author: Kelli Littlejohn Newman, PharmD, Director, Clinical Services

Statutory Authority: State Plan; 42 CFR Section 440.70; and Title XIX, Social Security Act.