Section 16.03.09.752 - DURABLE MEDICAL EQUIPMENT AND SUPPLIES: COVERAGE AND LIMITATIONSThe Department will purchase or rent, when medically necessary, reasonable and cost-effective, durable medical equipment (DME) and medical supplies that are suitable for use in any setting in which normal life activities take place. Medical supplies, equipment, and appliances provided by a home health agency under a home health plan of care must meet the requirements found in Sections 750 through 779 of these rules and the requirements found in Sections 720 through 729 of these rules.
01.Medical Necessity Criteria -- Equipment and Supplies. Department standards for medical necessity are those national standards set by Centers for Medicare and Medicaid Services (CMS) in the CMS/Medicare DME coverage manual. Exceptions to Medicare coverage are described in the Idaho Medicaid Provider Handbook available at: www.idmedicaid.com. Items for convenience, comfort, or cosmetic reasons are not covered.02.Prior Authorization -- Equipment and Supplies.a. The Department will specify in the Idaho Medicaid Provider Handbook, which durable medical equipment and medical supplies require prior authorization by the Department.b. Each request for prior authorization must include all medical necessity documentation required under Section 753 of these rules.03.Coverage Conditions -- Equipment and Supplies.a. Medical equipment and supplies are subject to coverage limitations in the CMS/Medicare DME coverage manual. Exceptions to these coverage conditions and coverage conditions for medically necessary items not included in that manual are described in the Idaho Medicaid Provider Handbook available at: www.idmedicaid.com. Exceptions must be established using evidence-based or best clinical practice standards as determined by the Department.b. The Department will purchase no more than three (3) months of necessary medical supplies in a three (3) month period for the treatment or amelioration of a medical condition identified by the attending physician or non-physician practitioner. Supplies in excess of coverage limitations must be prior authorized by the Department.Idaho Admin. Code r. 16.03.09.752