States Listed: [32]

Federal Medicaid Regulations:

Home Health Care Services are defined in the federal Medicaid regulations as follows:

(a) Home health services means the services in paragraph (b) of this section that are provided to a recipient -

(1) at his place of residence, as specified in paragraph (c); and

(2) On his physician's orders as part of a written plan of care that they physician reviews every 60 days.

(b) Home health services include the following services and items. Those listed in paragraphs (b)(1), (2) and (3) are required services; those in paragraph (b)(4) are optional.

(1) nursing services, as defined in the state nurse practice act, that is provided on a part time or intermittent basis by a home health agency

(2) home health aide service provided by a health agency.

(3) medical supplies and equipment, and appliances suitable for use in the home; and

(4) physical therapy, occupational therapy or speech pathology and audiology services provided by a home health agency or by a facility licensed by the State to provide medical rehabilitative services. . . .

42 C.F.R. Section 440.70.

Alaska Definition of Durable Medical Equipment

Equipment which can:

• withstand repeated use;
• primarily and customarily serves a medical purpose;
• generally is not useful to a person in the absence of illness or injury; and
• is appropriate for use in the home.

Alaska Medicaid Manual, ' 5940.13(c).

7 AAC 43.1980 (5) (2005)

Durable medical equipment means sturdy, long lasting items and appliances that can withstand repeated use, are designed primarily to serve a medical purpose and are not generally useful to a person in the absence of a medical condition, illness or injury.

OMD Policy Manual, ' 310.16, at 3-31 (effective October 1, 1994)

Equipment which (1) can withstand repeated use and (2) isused to serve a medical purpose. Examples include a wheelchair or hospital bed.

Arkansas Medicaid Manual, Glossary, at p. IV-4 (April 1, 1991)

Equipment that

• can withstand repeated use;
• is used to serve a medical purpose
• is not useful to anindividual in the absence of illness, injury, functional impairment,or congenital anomaly; and
• is appropriate for use in or out of the patient’s home.

Cal. Code, Reg. Title 22 § 51160, cited in Blue v. Bonta, 121 Cal.Rptr. 483 (Cal. App. 2002)

Equipment which is suitable for use outside of a medical facility, which can withstand repeated use, which has a medical purpose, and which would not be useful to the client in the absence of illness, injury or disability.

Section 8.591.02(E), 10 Code Colo. Regs. 2505-10, cited in T.L. v. COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING, 42 P.3d 63 (Colo. App. 2001).

Colorado Medicaid web page: list of covered services: http://www.chcpf.state.co.us/HCPF/refmat/fy03-exa.asp.

Connecticut Durable Medical Equipment

• Can withstand repeated use
• Is primarily and customarily used to serve a medical purpose
• Generally is not useful to a person in the absence of an illness or injury
• Excludes items that are disposable.

Conn. MAP Manual, ' 189.E.B.

reprinted in Desario v. Thomas, No. 3:96 CV 646 (JBA) (D.Conn. Slip Op. at 6 Jan. 10, 1997)(ruling granting preliminary injunction).

Durable medical equipment is defined as equipment that:

• can withstand use;
• is primarily and customarily used to serve a medical purpose;
• generally is not useful to a person in the absence of an illness or injury; and
• is needed to maintain the client in the home (equipment will NOT be purchased or rented for use in a nursing facility or in any inpatient or outpatient treatment setting).

DME Provider Specific Policy at p. 2 (October 1, 1993).

A medically necessary item which can withstand repeated use (i.e., could normally be rented and used by successive patients);

• is primarily and customarily used to serve a medical purpose
• generally is not useful in the absence of illness or injury; and
• is appropriate for use in the patient's home.

Florida Administrative Code (F.A.C.) ' 59G-4.080(2)(c).

Georgia DME Definition:

• 902.1 The equipment must be appropriate for home use.
• 902.2 The equipment must be able to withstand repeated use.
• 902.3 The equipment must be medically necessary.
• 902.4 The equipment must have a warranty.

GA Dept of Medical Assistance, Policies & Procedures For Durable Medical Equipment Services

Equipment which:

• Can withstand repeated use
• Is primarily and customarily used to serve a medical purpose
• Generally is not useful to an individual in the absence of illness or injury; and
• Is appropriate for use in the home.

http://www.dpaillinois.com/assets/041703dme.pdf at p. 15 of 50.

Durable medical equipment (DME) is equipment that:

• Can withstand repeated use,
• Is primarily and customarily used to serve a medical purpose,
• Is generally not useful to a person in the absence of an illness or injury, and
• Is appropriate for use in the home.

All elements of this definition of durable medical equipment must be satisfied in order for the equipment to be covered under Medicaid. Durable medical equipment is not provided in a hospital, nursing facility, or intermediate care facility for the mentally retarded.

Kansas durable medical equipment

Equipment which:

• Can withstand repeated use
• Is primarily & customarily used to serve a medical purpose
• Is appropriate for use in the recipient's home; and
• Generally is not useful to a person in the absence of illness or injury

The definition of durable medical equipment is equipment which:

• can withstand repeated use;
• is primarily and customarily used to serve a medical purpose;
• generally is not useful to a person in the absence of illness or injury; and
• is appropriate for use in the home

All requirements of the definition must be met before an item is considered to be durable medical equipment.

Maryland Durable Medical Equipment

equipment which:

• can withstand repeated use;
• is used to serve a medical purpose;
• is appropriate for use in the home.

COMAR, § 10.09.12.01(3)

DME is defined at Minn. Reg. 9505.0175(10) as:

a device or equipment that can withstand repeated use, is provided to correct or accommodate a physiological disorder or physical condition, and is suitable for use in the home.

(4) Definition for Durable Medical Equipment.:

DME is equipment that

• can withstand repeated use,
• is primarily and customarily used to serve a medical purpose,
• generally is not useful to a person in the absence of an illness or injury, and
• is appropriate for use in the home.

All requirements of the definition must be met in order for the equipment to be covered by Medicaid.

13 CSR 70-60.010 Durable Medical Equipment Program

Durable Medical Equipment is equipment which –

• withstands repeated use;
• is primarily and customarily used to serve a medical purpose;
• generally is not useful to a person in the absence of an illness or injury; and
• is appropriate for use in the home.

471 NAC 7-004 (NE Dept. of Social Services Manual, Manual Letter # 17-96, 3/18/96).

Durable medical equipment is defined as equipment which can withstand repeated use, and is primarily and customarily used to serve a medical purpose, and generally is not useful to a person in the absence of illness or injury and is appropriate for use in the home.

NV Medicaid Services Manual, DME, 1302.4

New Hampshire Durable Medical Equipment

Durable Medical Equipment means an apparatus which is used to treat a specific illness, injury, disease or disability and is either rented or purchased. Durable medical equipment includes but is not limited to: wheelchairs, hospital beds, walkers and/or oxygen regulators.

NH Medicaid Rules, HE-W ' 504.30(a)(1).

Covered services: rental, repair and purchase of DME, when PA. ' 504.30(d)(4).

Limitations: any item not specifically listed . . . shall be given an independent determination by the Office of Medical Services using Medicare guidelines listed in HCFA Publication No. 6: "Medicare Coverage Issues." ' 504.30(d)(5) & (e)(7).

(2004)

A. Medicaid covers durable medical equipment (DME) that meet the definition of DME, the medical necessity criteria and the prior authorization requirements. Medicaid covers repairs, maintenance, delivery of durable medical equipment and disposable and non-reusable items essential for use of the equipment, subject to the limitations specified in this section. All items purchased or rented must be ordered by providers who are currently enrolled in medicaid.

(1) "Durable medical equipment" is defined as equipment that can withstand repeated use, is primarily and customarily used to serve a medical purpose, is not useful to individuals in the absence of an illness or injury and is appropriate for use at home.

(2) Equipment used in a recipient’s residence must be used exclusively by the recipient for whom it was approved.

(3) To meet the medical necessity criterion, durable medical equipment must be necessary for the treatment of an illness or injury or to improve the functioning of a body part.

(4) Replacement of equipment is limited to one item every three years for adults, unless there are changes in medical necessity or are otherwise indicated in policy.

Taken from: http://www.nmcpr.state.nm.us/nmac/parts/title08/08.324.0005.htm

Medicaid covers durable medical equipment (DME) which meet the definition of DME, the medical necessity criteria and the prior approval requirements. Medicaid covers repairs, maintenance, delivery of durable medical equipment and disposable and non-reusable items essential for use of the equipment, subject to the limitations specified in this section. All items purchased or rented must be ordered by providers who are eligible to participate in Medicaid.

1. "Durable medical equipment" is defined as equipment which can withstand repeated use, is primarily used to serve a medical purpose, is not useful to individuals in the absence of an illness or injury and is appropriate for use at home.
2. Equipment used in a recipient's residence must be used exclusively by the recipient for whom it was approved.
3. To meet the medical necessity criterion, durable medical equipment must be necessary for the treatment of an illness or injury or to improve the functioning of a body part.

NY Medicaid Definition of DME:

• can withstand repeated use for a protracted period of time
• are primarily and customarily used for medical purposes
• are generally not useful to a person in the absence of illness or injury; and
• are usually not fitted, designed, or fashioned for a particular individual's use. Where equipment is intended for use by only one patient, it may be either custom made, or customized.

18 NYCRR § 505.5(a)(1)

Durable Medical Equipment (instruments and appliances) includes items which (1) are primarily and customarily used for a medical purpose and withstand repeated use; or (2) are ordinarily not useful in the absence of illness or injury. Orthotics and prosthetics are included in this category.

The purpose of renting and/or purchasing durable medical equipment and/or supplies for Medicaid eligible recipients is: to assist in the medical treatment of an illness, disease or injury; to promote healing; to restore to as near normal body functioning as is reasonably possible; or to prevent further deterioration and/or debilitation or injury.

ND Dept. of Human Services, Medical Assistance Program, DME & Supplies Guidelines (May, 1989).

Ohio Administrative Code (OAC) 5101:3 -1-49 Definitions

For the purpose of rules in Chapters 5101:3 -1 and 5101:3 -3 of the Administrative Code, the following definitions shall apply.

(H) "Durable medical equipment" is equipment which can stand repeated use, is primarily and customarily used to serve a medical purpose, and is generally not useful to a person in the absence of an illness or injury.

Pennsylvania Medicaid DME:

DME is an item or device

• listed in the Medical Assistance program fee schedule
• that can withstand repeated use
• which are used primarily and customarily to serve a medical purpose
• are customarily not useful to a person in the absence of illness or injury
• and which are appropriate in the home.

55 PA Code ' 1123.2

Durable medical equipment definition:

• Durable medical equipment is equipment which can withstand repeated use,
• is primarily and customarily used to serve a medical purpose,
• generally is not useful to a person in the absence of illness or injury, and
• is appropriate for use in the home.

SC Medicaid Home Health Services Manual, at p. 2-1.

DME is "equipment that can withstand repeated use and is primarily and customarily used for medical purposes."

Texas Medicaid Providers Procedures Manual, p. 323, quoted in Fred C. v. Texas Health & Human Services Commission, 924 F. Supp. 788, 791 (W.D.Tex. 1996)

Utah DME Definition

DME is equipment which:

• Can withstand repeated use;
• is primarily and customarily used to serve a medical purpose
• generally is not useful to a person in the absence of illness or injury; and
• is appropriate for use in the home.

all requirements must be met to satisfy definition.

use must be required by doctor's order, and included in plan of care.

Home Health Provider Manual, ' 2.730, at p. 2-25 & 26 (1/1/93)

DME is equipment which:

• can withstand repeated use;
• is primarily & customarily used to serve a medical purpose;
• is generally not useful to a person in the absence of illness or injury; and
• is appropriate for use in the home.

Vermont Medicaid Provider Manual, ' M 840.

DME means equipment that:

• Can withstand repeated use;
• Is primarily and customarily used to serve a medical purpose;
• Generally is not useful to a personintheabsence of illness or injury; and
• Is appropriate for use in the home.

WAC 388-543-1000, cited in Burnham v. State of Wash., DSHS , 63 P.2d 816 (Wash App. 2003).

Medical equipment means an item, article, or apparatus which as the following characteristics:

• Is primarily and customarily used to serve a medical purpose;
• Is generally not useful to a person in the absence of illness or injury;
• Is capable of withstanding repeated use (durable and non-expendable, e.g., hospital bed, wheelchair, suction equipment, etc.); and
• Is prescribed by a physician.

Source: W.VA. Medicaid Program Regulations, Durable Medical Equipment Supply Services, Chapter 515.1

DME ordered for patients in a medical institution are considered part of the institution's cost and cannot be billed directly to the Medicaid program by the supplier.

DME must be taken care of by the patient, his family and others in the home. Harsh treatment, damage and destruction of the equipment will result in removal from the home. DME should last as long as needed by the patient; therefore, replacement of DME would not be considered with the exception of wheelchairs. Wheelchairs are to be replaced no more frequently than 3 years unless necessitated by an extreme change in medical condition as justified by the physician at the time of order for the replacement.

Source: W.VA. Medicaid Program Regulations, Durable Medical Equipment Supply Services, Chapter 515.1

Wisconsin

• Equipment which can withstand repeated use,
• is primarily used for medical purposes,
• is generally not useful to a person in the absence of illness or injury
• and is appropriate for use in the home.

HSS 101.03((50).

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