NOTICES
DEPARTMENT OF
HUMAN SERVICES
Designated Exceptional Durable Medical Equipment
[52 Pa.B. 3724]
[Saturday, July 2, 2022]In accordance with the Department of Human Services' (Department) currently approved State Plan, the Department is required to publish an annual list of exceptional Durable Medical Equipment (DME) by notice in the Pennsylvania Bulletin in July of each year for nursing facilities Statewide. Interested persons may petition the Department to consider additions to the exceptional DME list by submitting a written request to the Department. Requests received on or before December 31 will be considered in developing the list for the following July.
During calendar year 2021, the Department received one written request for an addition to the list of exceptional DME. The request was to add negative pressure wound therapy (NPWT) pumps and supplies to the list of exceptional DME. According to the Department's Medical Assistance fee schedule rates, the cost of a NPWT pump and supplies, in aggregate, is approximately $2,000 (procedure codes HCPCS E2402 (NPWT pump), A6550 (NPWT dressing sets) and A7000 (disposable canisters for pump)).
Upon review, the Department determined that NPWT pumps and supplies would not meet the acquisition cost of $5,000 or more necessary to qualify as an item of exceptional DME. In addition, the Department determined that NPWT pumps and supplies do not meet the criteria to qualify as an item of ''Specially Adapted DME'' since the pump and supplies are not substantially adapted or modified in a way to meet the needs of a specific resident and, therefore, is suitable for the contemporaneous use by numerous other persons. Accordingly, this notice makes no changes in either the acquisition cost or the list of qualifying DME.
''Exceptional DME'' is defined as DME that has an acquisition cost of $5,000 or more and is either Specially Adapted DME or other DME that is designated as exceptional DME by the Department annually by notice in the Pennsylvania Bulletin.
''Specially Adapted DME'' is DME that is uniquely constructed or substantially adapted or modified in accordance with the written orders of a physician for the particular use of one resident, making its contemporaneous use by another resident unsuitable.
The list of exceptional DME that has been designated by the Department is as follows:
(1) Air fluidized beds. The pressure relief provided by this therapy uses a high rate of airflow to fluidize fine particulate material (for example, beads or sand) to produce a support medium that has characteristics similar to liquid. It may have a Gore-Tex cover.
(2) Powered air flotation bed (low air loss therapy). A semielectric or total electric bed with a fully integrated powered pressure-reducing mattress, which is characterized by all of the following:
(a) An air pump or blower with a series of interconnected woven fabric air pillows which provides 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. It may have a Gore-Tex cover.
(b) Inflated cell height of the air cells through which air is being circulated is 5 inches or greater.
(c) Height of the air chambers, proximity of the air chambers to one another, frequency of air cycling (for alternating pressure mattresses) and air pressure provide adequate patient lift, reducing pressure and prevent bottoming out.
(d) A surface designed to reduce friction and shear.
(e) May be placed directly on a hospital bed frame.
(f) Automatically readjusts inflation pressures with change in position of bed (for example, head elevation).
(3) Augmentative communication devices. Used by residents who are unable to use natural oral speech as a primary means of communication. The specific device requested must be appropriate for use by the resident and the resident must demonstrate the abilities or potential abilities to use the device selected. Portable devices need to supplement, aid or serve as an alternative to natural speech for residents with severe expressive communication disorders. Nonportable devices may be covered only if required 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 Comment
Interested persons are invited to submit petitions for the Department to consider additions to the exceptional DME list or written comments regarding these designated DME items to the Department of Human Services, Office of Long-Term Living, Bureau of Policy Development and Communications Management, Attention: Robyn Kokus, P.O. Box 8025, Harrisburg, PA 17105-8025 or at RA-WOLTLNFPUBLICCOM@pa.gov. Comments received within 30 days will be reviewed and considered.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
MEG SNEAD,
Acting SecretaryFiscal Note: 14-NOT-1512. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 22-982. Filed for public inspection July 1, 2022, 9:00 a.m.]
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