Rule 23-209-1.28 - Hospital BedsA. The Division of Medicaid defines a hospital bed as a medical device with: 1. An articulating frame allowing adjustment of the head and foot of the bed,B. The Division of Medicaid covers hospital beds when medically necessary, prior authorized by the Utilization Management/Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity and ordered by a physician for purchase or rental up to the purchase amount. 1. The Division of Medicaid defines a manual fixed-height hospital bed as one with manual head and leg elevation adjustments but no height adjustment and is covered when a beneficiary meets one (1) of the following: a) Requires positioning of the body in ways not feasible with a non-hospital bed in order to alleviate pain,b) Requires the head of the bed to be elevated thirty (30) degrees or more due to a medical condition including, but not limited to, congestive heart failure, chronic pulmonary disease, or risk of aspiration,c) Has failed to achieve the desired clinical outcome, with pillows or wedges,d) Requires equipment that can only be attached to a hospital bed,e) Has a disease, injury, or condition causing paralysis, immobility, or severe malaise and weakness requiring the performance of bathing, bodily functions, and other treatment or care while in bed, orf) Is semi-comatose or comatose.2. The Division of Medicaid defines a manual variable-height hospital bed as one with manual height, head and leg elevation adjustments and is covered when a beneficiary: a) Meets one (1) of the criteria listed in Miss. Admin. Code Part 209, Rule 1.28.B.1., andb) Requires a bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair or standing position.3. The Division of Medicaid defines a semi-electric hospital bed as one with manual height adjustment and with electric head and leg elevation adjustments and is covered when a beneficiary: a) Meets one (1) of the criteria in Miss. Admin. Code Part 209, Rule 1.28.B.1.a) through e) and B.2.b),b) Is able to operate the hospital bed controls, andc) Lives alone or with assistance of a caregiver, but without continuous twenty-four (24) hours per day caregiver support.4. The Division of Medicaid defines bariatric hospital beds as heavy duty extra-wide and extra-heavy duty extra wide hospital beds used for beneficiaries whose weight and/or body measurements exceed the manufacturer's limit for size or weight of a standard hospital bed and is covered when: a) The beneficiary meets one (1) of the criteria listed in Miss. Admin. Code Part 209, Rule 1.28.B.1., and b) Documentation includes current weight and body measurements that exceed the manufacturer's limit for size and weight of a standard hospital bed which is obtained within thirty (30) days of request.C. The Division of Medicaid covers total electric hospital beds when medically necessary, prior authorized by the Utilization Management/Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity and when the following criteria are met: 1. An orthopedist, neurologist, physiatrist, or a physician with expertise in treating beneficiaries with disabilities and/or special needs orders the hospital bed and documents the following: a) Medical necessity detailing the clinical rationale for the hospital bed, b) The number of hours and times of the day the beneficiary is expected to be in the hospital bed, and c) The reason a lower cost hospital bed does not meet the needs of the beneficiary.2. A Mississippi licensed occupational or physical therapist conducts an on-site evaluation of the location where the hospital bed is to be used includes certification of the following: a) The hospital bed is for the exclusive use of the beneficiary,b) The hospital bed can be installed without structural or electrical modifications to the environment, andc) The beneficiary and/or caregiver are trained in the use, cleaning and care of the hospital bed.3. The hospital bed has a full two (2) year warranty.4. The beneficiary has not received a total electric hospital bed within the last five (5) years.23 Miss. Code. R. 209-1.28
42 U.S.C. § 1395(m); Miss. Code Ann. §§ 43-13-117, 43-13-121.