DME and related supplies, complex rehabilitation technology, prosthetics, orthotics, medical supplies and related services—Rental or purchase.
(1) The medicaid agency 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 agency for the rental or purchase of equipment supplied to the provider at no cost by suppliers/manufacturers.
(3) The agency purchases new DME equipment and complex rehabilitation technology (CRT) only.
(a) A new DME item that is placed with a client initially as a rental item is considered a new item by the agency 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 agency.
(4) The agency 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 agency's minimum rental period for covered DME is one day.
(6) The agency authorizes rental equipment for a specific period of time. The provider must request authorization from the agency for any extension of the rental period.
(7) The agency'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 agency considers rented equipment to be purchased after twelve months' rental unless the equipment is restricted as rental only.
(9) DME and related supplies, CRT, prosthetics, and orthotics purchased by the agency for a client are the client's property.
(10) The agency 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 agency stops paying for any rented equipment effective the date of a client's death. The agency prorates monthly rentals as appropriate.
(12) For a client who is eligible for both medicare and medicaid, the agency pays only the client's coinsurance and deductibles. The agency 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 agency does not obtain or pay for insurance coverage against liability, loss and/or damage to rental equipment that a provider supplies to a client.
[Statutory Authority: RCW 41.05.021
and 2013 c 178. WSR 14-08-035, § 182-543-2250, filed 3/25/14, effective 4/25/14. WSR 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. WSR 11-14-052, § 388-543-2250, filed 6/29/11, effective 8/1/11.]