Specialized Equipment and Supplies 525-05-30-60

(Revised 2/1/22 ML #3663)

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Purpose

Specialized Equipment and Supplies Service includes the purchase of equipment and supplies that will facilitate or promote a recipient's independent functioning within his or her home or family member's home if the recipient resides in the home. The service is not physician driven nor is the allowable equipment and supplies authorized for purchase under this service chapter to primarily serve medical needs, although, the products may indirectly assist with medical needs.

 

Specialized equipment is supplies, safety devices, or assistive technology that enable individuals to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live. Coverage may include the cost of set up, maintenance, and upkeep of equipment, and may also include the cost of training the participant or caregivers in the operation and/or maintenance of the equipment.

 

Assistive technology service means a service that directly assists a participant in the selection, acquisition, or use of an assistive technology device.

 

Assistive technology includes:

  1. The evaluation of the assistive technology needs of a participant, including a functional evaluation of the impact of the provision of appropriate assistive technology and appropriate services to the participant in the customary environment of the participant;
  2. Services consisting of purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices for participants;
  3. Services consisting of selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;
  4. Training or technical assistance for the participant, or, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and
  5. Training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants.

 

Service Eligibility, Criteria for

The individual receiving Specialized Equipment and Supplies Services must meet the following criteria:

  1. Must be eligible for the programs of Medicaid Waiver for Home and Community Services.
  2. The basis of need for the equipment is established through the assessment process and must include an adaptive assessment completed by a professional with expertise in the equipment requested, (e.g. PT/OT, Speech and Hearing). Prior approval is required for the purchase of specialized equipment or supplies.
  1. The equipment purchased is of significant benefit to the applicant/recipient in the performance of personal cares and/or household tasks in the home.
  2. The recipient does not already have access to a product that serves essentially the same purpose.
  3. The need for the equipment is expected to extend indefinitely.
  4. The individual is motivated to use the equipment.
  5. A written bid must be obtained for any specialized equipment and/or supplies funded under this service chapter. If the equipment or supplies are considered durable medical equipment (DME), the bid must include healthcare common procedure coding system (HCPCS) codes.
  6. The equipment is a non-covered item under the Title XIX State Medicaid Plan or unavailable through other funding sources. A list of ND Medicaid DME covered items may be found at http://www.nd.gov/dhs/services/medicalserv/medicaid/provider-fee-schedules.html.
  7. Pre-approval from the Department of Human Services is required before this service can be authorized.

Limits

The costs are limited to what is budgeted per person for Specialized Equipment and Supplies in the federally approved in the Medicaid Waiver(s).

 

Items reimbursed with waiver funds are only for medical equipment and supplies not covered 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 and design.

 

Specialized Equipment and Supplies, Scope of

The products covered under this Service Chapter are ADL/IADL related products that are not covered under the Title XIX Medicaid State Plan. Examples of such specialized equipment and supplies may include but are not limited to the following:

  1. Communication Board
  2. Remote control device to safely operate electronic appliances such as microwave, garbage disposal, blender, toaster, television, etc.
  3. Special designed wheelchair lap tray
  4. Specialized positioning devices(s)
  5. Safety devices and equipment

 

Specialized Equipment and Supplies, Delivery Of

When it has been determined that a specific item(s) (applicable to this service chapter) will be of benefit to the applicant/recipient, the following procedure is followed:

  1. The HCBS Case Manager will contact a supplier of the specialized equipment and/or supplies who are enrolled as a Qualified Service Provider or may be willing to enroll as a Qualified Service Provider.  The purpose of the contact is to authorize purchase of the approved item and to verify the cost.
  2. The supplier will ship/mail the item only upon receipt of the Preliminary Authorization to Provide Medicaid Waiver Service, SFN 410 or Preauth. The Qualified Service Provider will request payment from the Department of Human Services using the QSP payment system.
  3. The supplier is responsible to arrange for or provide any instruction the recipient may need to use the specialized equipment.
  4. One month following delivery, the HCBS Case Manager is to contact the recipient to monitor the effectiveness of the specialized equipment.  The results of this monitoring contact are documented in the case file.  It is at this point that Specialized Equipment and Supplies Service should be deleted from the Person Centered Plan of Care if no further need exists for the reimbursable items of this service chapter.