Lawriter - OAC - 173-39-02.7 Home medical equipment and supplies.

173-39-02.7 Home medical equipment and supplies.

(A) Home medical equipment and supplies (HME) is a service designed to promote functional independence and safe, effective, in-home care through the provision of health-related equipment and supplies. The equipment items and/or supplies eligible to be purchased, installed and/or rented through this service are those items that enable the consumer to function with greater independence in the home and help prevent the consumer's placement in a nursing facility.

(B) HME items are limited to only those medicaid items in rule 5101:3-10-03 of the Administrative Code, other items and repairs as applicable in rules 5101:3-10-02 to 5101:3-10-26 of the Administrative Code, and miscellaneous items that include, but are not limited to: walker baskets or trays; room monitors; eating, dressing and vision assistive devices; incontinent bath wipes; and medication dispensers. HME items are also limited to those items that and are not covered by other payers (third-party payers, medicare, state plan medicaid, etc.). A HME provider must have documentation that items to be purchased cannot be paid for by medicare, state plan medicaid, or other sources prior to authorization by ODA's designee.

(C) HME items must be approved and authorized by the case manager and must be included in the consumer's service plan.

(D) A unit of HME service is the item purchased or rented, and the unit rate is the purchase, installation and/or rental price authorized for the item by ODA's designee.

(1) The provider must furnish professional, ongoing assistance when needed to evaluate and adjust products delivered and/or to instruct the consumer or the consumer's caregiver in the use of an item furnished.

(2) The provider must have the prior approval of the case manager for any HME item(s) purchased and delivered.

(E) The provider must assume liability for equipment warranties and must install, maintain, and/or replace any defective parts or items specified in those warranties. Replacement items or parts for HME are not reimbursable as rental equipment.

(F) The provider must, in collaboration with the case manager, ascertain and recoup any third-party resource(s) available to the consumer prior to billing ODA or its designee. ODA or its designee will then pay any unpaid balance up to the lesser of the provider's billed charge or the maximum allowable reimbursement set forth in division-level designation 5101:3 of the Administrative Code.

(G) The provider must submit the price for an item to be purchased or rented within two business days of the case manager's request. The provider must purchase, deliver and install (as appropriate) the authorized item(s) prior to submitting a bill to ODA's designee. The billed amount for each item may not exceed the preauthorized amount.

(H) The provider must maintain a record for each consumer. The record must document the delivery, installation of the item(s) purchased or rented, any education and/or instructions for the use of equipment and/or supplies provided to the consumer, and must include documentation of delivery of item(s) to the consumer. The documentation must consist of:

(1) The consumer's signature, the signature of the consumer's caregiver or electronic verification of delivery; and,

(2) The date on which the equipment and/or supplies were delivered.

R.C. 119.032 review dates: 11/18/2010 and 11/16/2015
Promulgated Under: 119.03
Statutory Authority: 173.02, 173.391
Rule Amplifies: 173.39 , 173.391 , 173.431
Prior Effective Dates: 03/31/2006