(1) The department bases its decision to rent or purchase durable medical equipment (DME) on the length of time the client needs the equipment.
(2) A provider must not bill the department for the rental or purchase of equipment supplied to the provider at no cost by suppliers/manufacturers.
(3) The department purchases new DME equipment only.
(a) A new DME item that is placed with a client initially as a rental item is considered a new item by the department at the time of purchase.
(b) A used DME item that is placed with a client initially as a rental item must be replaced by the supplier with a new item prior to purchase by the department.
(4) The department requires a dispensing provider to ensure the DME rented to a client is:
(a) In good working order; and
(b) Comparable to equipment the provider rents to individuals with similar medical equipment needs who are either private pay or who have other third-party coverage.
(5) The department's minimum rental period for covered DME is one day.
(6) The department authorizes rental equipment for a specific period of time. The provider must request authorization from the department for any extension of the rental period.
(7) The department's reimbursement amount for rented DME includes all of the following:
(a) Delivery to the client;
(b) Fitting, set-up, and adjustments;
(c) Maintenance, repair and/or replacement of the equipment; and
(d) Return pickup by the provider.
(8) The department considers rented equipment to be purchased after twelve months' rental unless the equipment is restricted as rental only.
(9) DME and related supplies, prosthetics, and orthotics purchased by the department for a client are the client's property.
(10) The department rents, but does not purchase, certain DME for clients. This includes, but is not limited to, the following:
(a) Bilirubin lights for newborns at home with jaundice; and
(b) Electric hospital-grade breast pumps.
(11) The department stops paying for any rented equipment effective the date of a client's death. The department prorates monthly rentals as appropriate.
(12) For a client who is eligible for both medicare and medicaid, the department pays only the client's coinsurance and deductibles. The department discontinues paying client's coinsurance and deductibles for rental equipment when either of the following applies:
(a) The reimbursement amount reaches medicare's reimbursement cap for the equipment; or
(b) Medicare considers the equipment purchased.
(13) The department does not obtain or pay for insurance coverage against liability, loss and/or damage to rental equipment that a provider supplies to a client.
[11-14-075, recodified as § 182-543-2250, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.04.050. 11-14-052, § 388-543-2250, filed 6/29/11, effective 8/1/11.]