NOTICES
DEPARTMENT OF PUBLIC WELFARE
Designated Exceptional Durable Medical Equipment; Minimum Acquisition Cost
[33 Pa.B. 5256] The Department of Public Welfare (Department) announces the list of types of durable medical equipment (DME) designated by the Department to be ''exceptional DME'' and the ''minimum acquisition cost'' of an item of exceptional DME for purposes of 55 Pa. Code § 1187.2 (relating to definitions).
The Department pays for nursing facility services under 55 Pa. Code Chapter 1187 (relating to nursing facility services). Among other things, 55 Pa. Code Chapter 1187 provides that a nursing facility enrolled in the Medical Assistance Program as a provider of nursing facility services may obtain ''additional payment'' for nursing facility services that are provided to a specific resident and that involve the use of DME that meets the Department's definition of ''exceptional DME.'' 55 Pa. Code § 1187.151 (relating to definitions).
''Exceptional DME'' is defined to be ''DME that has a minimum acquisition cost that is equal to or greater than an amount specified by the Department by notice in the Pennsylvania Bulletin and is either specially adapted DME or other DME that is designated as exceptional DME by the Department by notice in the Pennsylvania Bulletin.'' 55 Pa. Code § 1187.2. The Department intends that the referenced notice will be published in July of each year and will be effective until the next notice is issued. 32 Pa.B. 734 (February 9, 2002).
The first notice the Department issued was published at 32 Pa.B. 3267 (July 6, 2002). As set forth therein, the minimum acquisition cost is $5,000 and, in addition to DME that qualifies as ''specially adapted DME,'' there are four classes of DME that qualify as exceptional DME: air fluidized beds; powered air flotation beds (low air loss therapy); augmentative communication devices; and ventilators (and related supplies).
The most recent list of exceptional DME was published by the Department at 33 Pa.B. 2133 (April 26, 2003). That notice provides that ventilators and related supplies qualify as exceptional DME if ''used by residents who require full ventilator support for a minimum of 8 hours per day to sustain life.'' This notice supersedes the notices published at 32 Pa.B. 3267 and 33 Pa.B. 2133. This notice amends the provision related to ventilators and related supplies by removing the 8-hour per day minimum time requirement for residents who are 20 years of age and younger. This notice makes no other changes in either the acquisition cost or the list of qualifying DME. Except for establishing the minimum acquisition cost, neither notice affects whether ''specially adapted DME'' qualifies as ''exceptional DME.''
As set forth in the notice announcing the expansion of the Department's exceptional payment policy, persons who wish to have a type of DME considered by the Department for inclusion on or removal from the list must submit a written request to the Department. Requests during a calendar year will be considered by the Department for the list to be issued in the following July. Requests received after December 31 of the calendar year are considered during the next annual review cycle.
During 2002, the Department received one request for a change to the list of exceptional DME. The request was to add a bariatric program, which would cover oversize equipment such as bariatric beds and wheelchairs for extremely tall and/or overweight residents as an additional category of the exceptional DME program. The Department considered the request and has determined that a resident requiring oversized equipment of the type that is designated on the list of exceptional DME would be adequately served by the existing exceptional DME program. Therefore, the Department has decided that the request for the addition of a bariatric program as a separate category of exceptional DME is unwarranted at this time.
Beginning with the effective date of this notice, an item of DME must, in addition to being ''specially adapted'' or within one of the types set forth in the following list, have a minimum acquisition cost of $5,000 to qualify as ''exceptional DME.''
Beginning with the effective date of this notice, if an item of DME is not ''specially adapted'' it cannot qualify as ''exceptional DME'' unless it falls within one of the following designated types:
(1) Air fluidized beds. The Department uses this term to encompass beds that treat or prevent bedsores and treats other conditions such as bone cancer and burns through the use of a high rate of airflow which fluidizes fine particulate matter (such as beads or sand) to produce a support medium that has characteristics similar to liquids.
(2) Powered air flotation bed (low air loss therapy). The Department uses this term to encompass electric or semielectric beds which have a fully integrated powered pressure-reducing mattress that is characterized by all of the following:
a. An air pump or blower with a series of interconnected woven fabric air pillows which provide sequential inflation and deflation of the air cells or a low interface pressure throughout the mattress, allowing some air to escape through the support surface to the resident.
b. The inflated cell height of the air cells must be five inches or greater.
c. The height of the air chambers, the proximity of the air chambers to each other, the frequency of air cycling (for alternating pressure mattresses) and the provided air pressure must provide the patient with sufficient lift to reduce pressure and prevent bottoming out.
d. The surface of the mattress must be designed to reduce skin friction and skin shearing.
(3) Augmentative communication devices. The Department uses this term to encompass devices used by residents who, because of severe expressive communication disorders, are unable to use natural oral speech as a primary means of communication. Portable devices must supplement, aid or serve as an alternative to natural oral speech. Nonportable devices only qualify as augmentative communication devices if they are required by the resident for visual enhancement or physical access needs that cannot be accommodated by a portable device.
(4) Ventilators (and related supplies).
a. Used by residents 21 years of age and older who require full ventilator support for a minimum of 8 hours per day to sustain life.
b. Used by residents 20 years of age and younger who require ventilator support to sustain life (no minimum time requirement).
Effective Date
This notice is effective upon publication in the Pennsylvania Bulletin.
Public Comments
Interested persons are invited to submit written comments regarding this notice to the Department within 30 days of publication of this notice in the Pennsylvania Bulletin to Department of Public Welfare, Division of Long Term Care Client Services, Attention: Gail Weidman, P. O. Box 2675, Harrisburg, PA 17105. Persons with disabilities may use the AT&T Relay Service, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-371. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 03-2035. Filed for public inspection October 17, 2003, 9:00 a.m.]
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