416 Designated exceptional durable medical equipment

DEPARTMENT OF
PUBLIC WELFARE

Designated Exceptional Durable Medical Equipment

[31 Pa.B. 1422]

   On October 30, 1999, the Department of Public Welfare (Department) announced its intention to make changes to its methods and standards for payment of Medical Assistance (MA) nursing facility services to authorize additional payment for nursing facility services involving the purchase or rental of certain medically necessary Exceptional Durable Medical Equipment (DME), (See 29 Pa.B. 5637).

   Exceptional DME is defined as DME that has an acquisition cost of $5,000 or more and is either Specially Adapted DME or such other DME that is designated as Exceptional DME by the Department annually by notice in the Pennsylvania Bulletin.

   Specially Adapted DME is DME that is uniquely constructed or substantially adapted or modified in accordance with the written orders of a physician for the particular use of one resident, making its contemporaneous use by another resident unsuitable.

   The list of Exceptional DME that has been designated by the Department is as follows.

(1)  Air fluidized beds

   The pressure relief provided by this therapy uses a high rate of airflow to fluidize fine particulate material (for example, beads or sand) to produce a support medium that has characteristics similar to liquid. May have a Gortex cover.

(2)  Powered air flotation bed (low air loss therapy)

   A semi-electric or total electric bed with a fully integrated powered pressure reducing mattress which is characterized by all of the following:

   (a)  An air pump or blower with a series of interconnected woven fabric air pillows which provides sequential inflation and deflation of the air cells or a low interface pressure throughout the mattress allowing some air to escape through the support surface to the resident. May have a Gortex cover;

   (b)  Inflated cell height of the air cells through which air is being circulated is 5 inches or greater;

   (c)  Height of the air chambers, proximity of the air chambers to one another, frequency of air cycling (for alternating pressure mattresses), and air pressure provide adequate patient lift, reducing pressure and prevent bottoming out;

   (d)  A surface designed to reduce friction and shear;

   (e)  May be placed directly on a hospital bed frame; and

   (f)  Automatically re-adjusts inflation pressures with change in position of bed (for example, head elevation and the like).

(3)  Augmentative communication devices

   Used by residents who are unable to use natural oral speech as a primary means of communication. The specific device requested must be appropriate for use by the resident and the resident must demonstrate the abilities or potential abilities to use the device selected. Portable devices need to supplement, aid or serve as an alternative to natural speech for residents with severe expressive communication disorders. Non-portable devices may be covered only if required for visual enhancement or physical access needs that cannot be accommodated by a portable device.

(4)  Ventilators and related supplies

   Used by residents 21 years of age and older who require full ventilator support for a minimum of 8 hours per day in order to sustain life.

   Interested persons are invited to submit written comments regarding this notice to the Department within 30 days of publication in the Pennsylvania Bulletin. Public comments may be sent to: Tom Jayson, Long Term Care Policy Section, Department of Public Welfare, Division of Long Term Care Client Services, P. O. Box 2675, Harrisburg, Pennsylvania 17105.

   Persons with a disability may use the AT&T Relay Service by calling [phone] (TDD users) or [phone] (voice users). Persons who require another alternative format, contact Thomas Vracarich in the Office of Legal Counsel at [phone].

FEATHER O. HOUSTOUN,   
Secretary

[Pa.B. Doc. No. 01-416. Filed for public inspection March 9, 2001, 9:00 a.m.]