Section 7 AAC 120.225 - Rental of items; general provisions(a) Service authorization under 7 AAC 120.210 is required for the following rentals of durable medical equipment: (1) rental of items for anticipated short-term use indicated as requiring service authorization on the Alaska Medicaid DMEPOS Fee Schedule, Tables 1-5 through 1-9, adopted by reference in 7 AAC 160.900;(2) capped rental of items indicated as requiring service authorization on the Alaska Medicaid DMEPOS Fee Schedule, Tables 1-5 through 1-9, adopted by reference in 7 AAC 160.900;(3) continuous rental of items indicated as requiring service authorization on the Alaska Medicaid DMEPOS Fee Schedule, Tables 1-5 through 1-9, adopted by reference in 7 AAC 160.900. (b) Regardless of the type of rental under (a) of this section, (1) the department will review the length of need for the item and its cost before authorizing payment for rental or purchase;(2) if the department determines it necessary to purchase the item instead of continuing to rent the item, the department will only pay the remaining portion of the full purchase price, not rental plus the full purchase price; the provisions of this paragraph do not apply to an item that is continuously rented under (a)(3) of this section; (3) the cost of necessary repair, return shipping, or maintenance is included in the rental fee; and(4) when total rental payments reach the purchase price, except for an item that is continuously rented under (a)(3) of this section, repair is covered after 60 days or when the warranty expires, whichever is later. (c) The department will pay a provider by rental period.(d) The department will not pay a provider for a rental item that exceeds 13 months of continuous use or for which 100 percent of the purchase price has been paid, except for an item described in (a)(3) of this section.(e) A provider enrolled under 7 AAC 105.210 as a durable medical equipment provider may request payment for medically necessary used or refurbished durable medical equipment and may be reimbursed at a rate of not more than 75 percent of the rate for new equipment or services established in theAlaska Medicaid DMEPOS Fee Schedule, Tables 1-5 through 1-9, adopted by reference in 7 AAC 160.900, when a specific used rate is not listed, in accordance with 7 AAC 145.420, as long as the following criteria are met: (1) the provider must have the recipient acknowledge in writing, and must maintain the written acknowledgment, that the recipient is receiving used equipment; (2) the provider must bill with the appropriate modifier that distinguishes used or refurbished equipment from new equipment; (3) the provider must submit and maintain the equipment's serial number;(4) the used or refurbished equipment provided must be clean and sanitized; and (5) the used or refurbished equipment provided as rental equipment must (A) meet the current medical needs of the recipient;(C) comply with the manufacturer's suggested specifications for a newly purchased piece of equipment; and (D) be able to withstand at least three years of use; if the equipment supplied does not meet current replacement standards of three years of use and the item needs to be replaced before the standard replacement limit has been met, the provider must replace the item with a new or used piece of equipment at no charge to the department or the recipient.(f) A provider enrolled under 7 AAC 105.210 as a durable medical equipment provider is not obligated to dispense used equipment. However, if a provider dispenses used equipment, the provider may not submit a claim representing that new equipment was dispensed. Otherwise, the department may seek recovery under 7 AAC 105.260 of payment for those items and impose sanctions under 7 AAC 105.400 - 7 AAC 105.490. (g) A provider enrolled under 7 AAC 105.210 as a durable medical equipment provider may not request payment for equipment, options, supplies, and accessories that are considered included in the monthly rental payment. (h) A provider enrolled under 7 AAC 105.210 as a durable medical equipment provider may not request payment for equipment, options, supplies, and accessories that are still considered to be covered by the manufacturer warranty.Eff. 2/1/2010, Register 193; am 6/2/2019, Register 230, May 2019 Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040