Okla. Admin. Code § 317:40-5-104

Current through Vol. 42, No. 4, November 1, 2024

Section 317:40-5-104 - Medical supplies, equipment, and appliances

(a)Applicability. This section applies to medical supplies, equipment, and appliances provided through home and community-based waiver services (HCBS) operated by the Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services (DDS).

(b)General information. Medical supplies, equipment, and appliances include supplies specified in the plan of care that enable the member to increase his or her ability to perform activities of daily living. Medical supplies, equipment, and appliances include the purchase of additional supplies not available through SoonerCare.

(1) Medical supplies, equipment, and appliances are included in the member's plan, when prescribed by a physician with a SoonerCare contract, and arrangements for this service must be made through the member's case manager. Items reimbursed with HCBS funds are in addition to supplies furnished by SoonerCare.

(2) Medical supplies, equipment, and appliances meet the criteria for service necessity, per Oklahoma Administrative Code (OAC) 340:100-3-33.1.

(3) All items must meet applicable standards of manufacture, design, and installation.

(4) Medical supplies, equipment, and appliance providers must hold a current SoonerCare Durable Medical Equipment (DME) and/or Medical Supplies Provider Agreement with the Oklahoma Health Care Authority, and be registered to do business in Oklahoma or in the state in which they are domiciled. Providers must enter into the agreement giving assurance of ability to provide products and services and agree to the audit and inspection of all records concerning goods and services provided.

(5) Specialized medical supplies, equipment, and appliances include:

(A) Incontinence supplies, per subsection (b) of this Section;

(B) Nutritional supplements;and

(C) Supplies needed for health conditions.

(6) Items that cannot be purchased as medical supplies, equipment, and appliances include:

(A) Over-the-counter medications(s);

(B) Personal hygiene items;

(C) Medicine cups;

(D) Items that are not medically necessary;

(E) Prescription medication(s); and

(F) Incontinence wipes not used in conjunction with incontinence briefs or incontinence underwear/pull-ons.

(7) Medical supplies, equipment, and appliances must be:

(A) Necessary to address a medical condition;

(B) Of direct medical or remedial benefit to the member;

(C) Medical in nature; and

(D) Consistent with accepted health care practice standards and guidelines for the prevention, diagnosis, or treatment of symptoms of illness, disease, or disability.

(c)Limited coverage. Items available in limited quantities through medical supplies, equipment, and appliances include:

(1) Incontinence wipes, three-hundred (300) wipes per month;

(2) Thirty-six hundred (3,600) individual non-sterile gloves, per plan year ;

(3) Sixty (60) disposable underpads per month;

(4) One-hundred eighty (180) disposable incontinence briefs per month (Adult disposable incontinence briefs are purchased only in accordance with the implementation of elimination guidelines developed by the team);

(5) One-hundred fifty (150) disposable incontinence underwear/pull-ons per month (Adult disposable incontinence underwear/pull-ons are purchased only in accordance with the implementation of elimination guidelines developed by the team);

(6) Any combination of disposable incontinence briefs and disposable incontinence underwear/pull-ons that do not exceed one-hundred fifty (150) per month; and

(7) One-hundred fifty (150) disposable liner/shield/guard/pads per month.

(d)Exceptions. Exceptions to the requirements of this section:

(1) When a member's Team determines that the member needs medical supplies that:

(A) Are not available through SoonerCare anda healthcare common procedure code does not exist , the case manageremails pertinent information regarding the member's medical supply need to theSpecialized Medical Supplies programs manager. Theemail includes all pertinent information that supports the need for the supply including; but not limited to, quantity and purpose; or

(B) Exceed the limits stated in subsection(c) of this Section, the case manager documents the need in the individual plan for review and approval, perOAC 340:100-33.

(2) Approval or denial of exception requests is made on a case-by-case basis and does not override the general applicability of this section .

(3) Approval of a medical supplies, equipment, and appliances exception does not exceed one(1) plan of care year.

Okla. Admin. Code § 317:40-5-104

Reserved at 18 Ok Reg 1168, eff 5-11-01; Added at 23 Ok Reg 1396, eff 5-25-06; Amended at 27 Ok Reg 1509, eff 6-11-10

Amended by Oklahoma Register, Volume 37, Issue 23, August 17, 2020, eff. 8/1/2020

Amended by Oklahoma Register, Volume 38, Issue 23, August 16, 2021, eff. 9/1/2021