32 Miss. Code. R. 1-16.9
Specialized medical equipment and supplies include devices, controls or appliances that will enhance the client's ability to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live. This service also includes equipment and supplies necessary for life support, supplies and equipment necessary for the proper functioning of such items, and durable and nondurable medical equipment not available under the Medicaid State Plan. The need for/use of such items must be documented in the assessment/case file and approved on the plan of care.
Items reimbursed with waiver funds are in addition to medical equipment and supplies furnished under the Medicaid State Plan. Items not of direct medical or remedial benefit to the client are excluded.
Medicaid waiver funds are utilized as the payor of last resort. The Counselor must request payment from other sources (i.e., Medicare, private insurance, etc.) prior to submitting claims for reimbursement to the Division of Medicaid.
The maximum dollar amount of all approved services on the plan of care is limited to the latest CMS 372-372 Lag Report cost neutrality comparison threshold, i.e. annualized nursing home cost. In an attempt to ensure the client's plan of care does not exceed the annual nursing home cost, a list of medical supplies and a fee schedule is developed to indicate the maximum amount of supplies. See SMS Fee Schedule at end of section for a complete list of medical supplies and the maximum allowed by MDRS/OSDP.
Maximum Units
If a client is requesting supplies that exceed the maximum units, prior approval must be requested with accompanying documentation as to why the additional supplies are being requested.
A letter from the attending physician must be submitted to the District Manager to determine medical necessity. The letter must address the client's diagnosis, the effects of the condition, the period of time for which the approval is being requested and why the excessive number is medically necessary.
Catheters/Catheter Kits
* Intermittent Catheters are for urinary retention
* Foley Catheters are for urinary incontinence and retention
* Catheter Kits may be approved for a maximum of three months at a time. Chronic UTI's must be documented for intermittent kits to be covered.
| Supply Name | Supply Code | Beginning Date | End Date | Maximum Units |
| Disposables | ||||
| Briefs, Diapers, Pullups: (all sizes) | Not Covered | 04/01/2010 | 12/31/9999 | 200/month Or 2 boxes |
| Under Pads | ||||
| Blue Pads/disposal All sizes | Not covered | 04/01/2010 | 12/31/9999 | 200/month Or 2 cases |
| Catheters | ||||
| Catheters: Condom External (all sizes) | A4349 | 04/01/2010 | 12/31/9999 | 35/month |
| Catheter, Intermittent | A4351 | 04/01/2010 | 12/31/9999 | 200/month |
| Collection device | A4327 | 04/01/2010 | 12/31/9999 | 2/month |
| Collection pouch | A4328 | 04/01/2010 | 12/31/9999 | 2/month |
| Catheter-Urethral Foley | A4352 | 04/01/2010 | 12/31/9999 | 200/month |
| Leg strap Foley | A4334 | 04/01/2010 | 12/31/9999 | 1/month |
| Catheter Kit closed system | A4353 | 04/01/2010 | 12/31/9999 | 200/quarterly |
| Urinary Drainage leg bag | A4357 | 04/01/2010 | 12/31/9999 | 1/month |
| * Vinyl | A4358 | 04/01/2010 | 12/31/9999 | 1/moth |
| * Latex | A5112 | 04/01/2010 | 12/31/9999 | 1/month |
| Urinary Bed bag | 04/01/2010 | 12/31/9999 | ||
| Irrigation tubing set | A4355 | 04/01/2010 | 12/31/9999 | 3/month |
| Bedside Drainage Bottle | A5102 | 04/01/2010 | 12/31/9999 | 1 quarterly |
| Extension drainage tubing | A4331 | 04/01/2010 | 12/31/9999 | 5/month |
| Adhesive Catheter Anchoring Device | A4333 | 04/01/2010 | 12/31/9999 | 35/month |
| Gloves | ||||
| * Non Sterile | A4927 | 04/01/2010 | 12/31/9999 | 2 boxes/50 pairs |
| * Sterile | A4930 | 04/01/2010 | 12/31/9999 | 2 boxes/50 pairs |
| Skin Sealants | ||||
| Lantiseptic, Calmoseptine, Medisurge Cream | A6250 | 04/01/2010 | 12/31/9999 | 50 tubes |
| Gauze | ||||
| Non impregnated, sterile pad 4x4 w/o adhesive border | A6216 A6402, etc. | 04/01/2010 | 12/31/9999 | 200/pads |
| Tubes | ||||
| Gastrostomy-Feeding Tubes, 14Fr-24Fr | B4087 B4088 | 04/01/2010 | 12/31/9999 | 1/month 1/month |
| Syringe | ||||
| Syringes, 60cc pole bag | A4213 | 04/01/2010 | 12/31/9999 | 120/month |
| Skin cleaners | ||||
| Alcohol prep pads | A4245 | 04/01/2010 | 12/31/9999 | 2 boxes/month |
| Irrigation Solutions | ||||
| KY Jelly Lubricant | A4332 | 04/01/2010 | 12/31/9999 | 35/month |
| Tape | ||||
| 18 square inches Waterproof | A4450 | 04/01/2010 | 12/31/9999 | 2/month |
| 18 square inches Non water proof | A4453 | 04/01/2010 | 12/31/9999 | 2/month |
Ostomy Supplies
Ostomy Supplies can be requested if needed. The table below contains a few items on the list.
| Supply name | SupplyCodeQuantity | Beginning Date | End Date | MDRS Cost |
| *Skin Barrier, solid | A4362 | 04/01/2010 | 12/31/9999 | 20/month |
| Adhesive liquid | A4364 | 04/01/2010 | 12/31/9999 | 4/month |
| Ostomy Belt | A4367 | 04/01/2010 | 12/31/9999 | 1/month |
| Ostomy Skin Barrier, liquid | A4369 | 04/01/2010 | 12/31/9999 | 1/month |
32 Miss. Code. R. 1-16.9