(a) Specialized equipment shall be functionally necessary and meet at least two of the following criteria: - (i) Be necessary to increase ability to perform activities of daily living or to perceive, control, or communicate with the environment in which the person lives;
- (ii) Be necessary to enable the participant to function with greater independence and without which the person would require institutionalization; and
- (iii) Be necessary to ensure the person's health, welfare, and safety.
(b) The individualized plan of care shall reflect the need for equipment, how the equipment addresses health, safety, or accessibility needs of the participant, or allows them to function with greater independence, and include specific information on how often the equipment is used and where it is used. - (i) The Case Manager shall inquire with Medicaid, Medicare, or a participant's other insurance carrier to see if the requested equipment is covered under their plans.
- (ii) The Medicaid Waiver is a payer of last resort, and shall not pay for specialized equipment that can be paid through another source.
(c) Specialized equipment may include but is not limited to: - (i) Devices, controls, or appliances, specified in the plan of care, that enable participants to increase their ability to perform activities of daily living;
- (ii) Devices, controls, or appliances that enable the participant to perceive, control or communicate with the environment in which they live;
- (iii) Items necessary for life support or to address physical conditions along with the ancillary supplies and equipment necessary to the proper functioning of such items;
- (iv) Such other durable and non-durable medical equipment not available under the Medicaid state plan that is necessary to address participant functional limitations; and
- (v) Necessary medical supplies not available under the Medicaid state plan or other insurance held by the participant.
- (A) Items reimbursed with waiver funds are in addition to any medical equipment and supplies furnished under the state plan and exclude those items that are not of direct medical or remedial benefit to the participant. All items shall meet applicable standards of manufacture, design and installation.
(d) Specialized equipment shall not include the following, even if prescribed by a licensed health care professional: - (i) Items paid for under the Medicaid state plan or under Early Periodic Screening, Diagnosis, and Treatment (EPSDT);
- (ii) Educational or therapy items that are an extension of services provided by the Department of Education;
- (iii) Items of general use that are not specific to a disability, or that would normally be available to any child or adult, including but not limited to furniture, recliners, desks, shelving, appliances, bedding, bean bag chairs, crayons, coloring books, other books, games, toys, videotapes, CD players, radios, cassette players, tape recorders, television, VCRs, DVD players, electronic games, cameras, film, swing sets, other indoor and outdoor play equipment, trampolines, strollers, play houses, bike helmets, bike trailers, bicycles, health club memberships, merry-go-rounds, golf carts, four wheelers, go-carts, scooters, vehicles, automotive parts, and motor homes;
- (iv) Pools, spas, hot tubs or modifications to install pools, spas, or hot tubs;
- (v) Computers and computer equipment, including the CPU, hard drive, and printers, except for situations pursuant to (c) of this Section;
- (vi) Items that are not proven interventions through either professional peer reviews or evidence based studies; and
- (vii) Communication items such as telephones, pagers, pre-paid minute cards and monthly services.
(e) Repairs on specialized equipment shall be completed by the manufacturer, if a warranty is in place.
(f) Requests for repairs on specialized equipment not covered by warranty may be submitted to the Division for approval.
(g) Sale of specialized equipment shall not profit the participant or family.
048-44 Wyo. Code R. § 44-7