Or. Admin. Code § 410-122-0710

Current through Register Vol. 63, No. 12, December 1, 2024

Section 410-122-0710 - Special Needs Car Seats

(1) Special needs car seats are used to provide safe transportation to individuals of all ages with health care needs such as orthopedic or medical needs that cannot be met using conventional car seats for safe travel in a vehicle.

(2) A special needs car seat may be covered by the Division when a conventional car seat cannot be used by a client because the client has a significant physical, neurological, or orthopedic condition including one or more of the following (list not all-inclusive):

(a) Inability to maintain an unsupported sitting position independently;

(b) Significant head and trunk instability;

(c) Significant hypotonicity, hypertonicity, spasticity or muscle spasm which result in uncontrollable movement and position changes;

(d) Orthopedic disease processes resulting in significant bony fragility;

(e) Significant contractures that would result in an inability to perform postural corrections due to vehicle motion;

(f) Severe seizure activity that results in uncontrollable movement and position change; or

(g) Orthopedic condition, such as a curvature of the spine, which interferes with proper positioning;

(3) Prior Authorization is required. The DMEPOS provider's request for prior authorization must include the following documentation:

(a) The prescribing practitioner's clinical documentation supporting that the special needs car seat requested is medically appropriate and the least costly alternative that will meet the client's current medical needs. The prescribing practitioner's documented assessment of the client's medical needs must be within 30 days before the date the PA request is submitted to the Division;

(b) A signed and dated evaluation by a physical therapist or occupational therapist which includes detailed documentation of all of the following:

(i) The medical condition for which the special needs car seat is needed and why a conventional car seat will not meet the current medical needs of the client;

(ii) Description of what equipment is currently being used to transport the individual in a vehicle and why it no longer meets the medical needs of the client;

(iii) Other interventions that have been tried and why those interventions were not successful (e.g., conventional car seats, vests, harnesses);

(iv) Less costly car seats that were considered and why they were ruled out; and

(v) A signed, dated, attestation from the prescribing practitioner supporting the requested special needs car seat;

(c) Client's current height and weight, and the weight capacity and growth potential of the special needs car seat model requested;

(d) Brand name and model number of the special needs car seat requested; and

(e) Manufacturer's suggested retail price (MSRP) for the brand and model number of the special needs care seat requested.

(4) The prescribing practitioner's order, medical records, and all documentation submitted with the prior authorization request in (3) shall be kept on file by the DMEPOS provider;

(5) Special needs car seats do not require PDAC coding verification;

(6) HCPCS code E1399 shall be used for billing special needs car seats.

Or. Admin. Code § 410-122-0710

DMAP 101-2023, adopt filed 12/29/2023, effective 1/1/2024

Statutory/Other Authority: ORS 413.042 & ORS 414.065

Statutes/Other Implemented: ORS 414.065