La. Admin. Code tit. 50 § XXI-8315

Current through Register Vol. 50, No. 11, November 20, 2024

Section XXI-8315 - Assistive Devices and Medical Supplies

A. Assistive devices and medical supplies are specialized medical equipment and supplies which include:

1. devices, controls, appliances or nutritional supplements that enable participants to increase their ability to perform activities of daily living; or

2. devices, controls, appliances or nutritional supplements that enable participants to perceive, control, or communicate with the environment in which they live or provide emergency response;

3. items, supplies and services necessary for life support, ancillary supplies and equipment necessary to the proper functioning of such items;

4. supplies and services necessary to assure health and welfare;

5. other durable and non-durable medical equipment and medical supplies that are necessary, but not available under the state plan;

6. personal emergency response systems (PERS);

7. other in-home monitoring and medication management devices and technology;

8. routine maintenance or repair of specialized equipment; and

9. batteries, extended warranties, and service contracts that are cost effective and assure health and welfare.

B. This service includes medical equipment, not available under the state plan, that is necessary to address participant functional limitations and necessary medical supplies not available under the state plan.

C. Where applicable, participant must use Medicaid State Plan, Medicare, or other available payers first. The participants preference for a certain brand or supplier is not grounds for declining another payer in order to access waiver services.

D. All services must be based on a verified need of the participant and the service must have a direct or remedial benefit to the participant with specific goals and outcomes. This benefit must be determined by an independent assessment on any items whose cost exceeds the amount identified in the federally-approved waiver document and on all communication devices, mobility devices, and environmental controls. Independent assessments are done by individuals who have no fiduciary relationship with the manufacturer, supplier, or vendor of the item.

E. All items must reduce reliance on other Medicaid State Plan or waiver services.

F. All items must meet applicable standards of manufacture, design, and installation.

G. All items must be prior authorized and no experimental items shall be authorized.

H. Repealed.

La. Admin. Code tit. 50, § XXI-8315

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 37:3521 (December 2011), amended LR 39:321 (February 2013), Amended by the Department of Health, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 441899 (10/1/2018).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.