California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 3 - Standards for Participation › Section 51224.5 - Durable Medical Equipment and Medical Supply Providers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) As a condition for enrollment, or
					 continued enrollment, in the Medi-Cal program, an applicant or provider of
					 durable medical equipment and medical supplies shall:
(1) Maintain a business address, as defined
					 in Section
					 51000.3, that is accessible to the
					 general public. Each provider shall keep, maintain, and have readily
					 retrievable at their business address those records specified in Section
					 51476.
(2) Maintain a business telephone, as defined
					 in Section
					 51000.4, at the business address.
					 The business telephone number shall be listed under the name of the business
					 and in the business portion of the local telephone company directory.
(3) Maintain comprehensive liability
					 insurance that covers both the applicant's or provider's place of business and
					 any and all customers and employees of the applicant or provider.
(4) Fill orders from its inventory or by
					 contracting with other companies for the purchase of items necessary to fill
					 the order. Items may be fabricated or fitted for sale only from supplies
					 purchased under contract.
(5)
					 Obtain and maintain all state and local licenses and permits necessary to
					 provide the services, goods, supplies, or merchandise being provided, including
					 but not limited to, the licenses specified below:
(A) One or more of the licenses issued by the
					 Bureau of Home Furnishings and Thermal Insulation of the Department of Consumer
					 Affairs, as applicable to the applicant's or provider's business activity:
1. If the applicant or provider intends to
					 rent or currently rents beds, a Sanitizer's License, a Furniture and Bedding
					 Manufacturer's License, a Custom Upholsterer's License, a Retail Furniture and
					 Bedding Dealer's License, or a Retail Bedding License.
2. If the applicant or provider intends to
					 sell, or currently sells beds, a Retail Bedding Dealer's License, an Importer's
					 License, a Furniture and Bedding Manufacturer's License, a Wholesale Furniture
					 and Bedding Dealer's License, or a Retail Furniture and Bedding Dealer's
					 License.
3. If the applicant or
					 provider intends to sell, or currently sells wheelchairs, a Retail Furniture
					 Dealer's License, an Importer's License, a Furniture and Bedding Manufacturer's
					 License, a Wholesale Furniture and Bedding Dealer's License, a Custom
					 Upholsterer's License, or a Retail Furniture and Bedding Dealer's
					 License.
(B) Licenses
					 issued by the Board of Pharmacy entitled "Medical Device Retailer Original
					 Certificate," and "Medical Device Retailer Original Exemptee Certificate," if
					 the applicant or provider intends to provide, or currently provides, ostomy
					 supplies, oxygen equipment and supplies, urinary catheters, bags, and related
					 supplies.
(6) Have
					 written policies and/or procedures that ensures all the following:
(A) Beneficiaries shall be advised that:
1. Medi-Cal may approve rental or purchase of
					 durable medical equipment on behalf of the beneficiary.
2. Except for life support equipment, such as
					 ventilators, when previously paid rental charges equal the maximum allowable
					 purchase price of the rented item, the item is considered to have been
					 purchased and no further reimbursement to the provider shall be made for the
					 beneficiary's use of the item, unless repair and maintenance is separately
					 authorized.
(B) All
					 warranties, expressed and implied, shall be honored and neither the beneficiary
					 nor the Medi-Cal program shall be charged for the repair or replacement of
					 Medi-Cal covered items or for services covered under warranty.
(C) Beneficiaries shall be provided with
					 necessary information and instructions on how to use items safely and
					 effectively.
(D) Questions or
					 complaints from beneficiaries about items that are sold or rented shall be
					 responded to within 10 calendar days of the date the beneficiary contacts the
					 provider.
(E) Maintenance and/or
					 repair or items shall be provided directly, or through a service contract with
					 another company.
(F) Returns of
					 substandard or unsuitable items shall be accepted from beneficiaries.
					 Substandard or unsuitable items shall be replaced by the provider at no
					 additional cost to the beneficiary or the Medi-Cal program. For the purposes of
					 this section only, the following shall apply:
1. A "substandard item" shall have the same
					 meaning specified in Section
					 14043.1, Welfare and Institutions
					 (W&I) Code.
2. An "unsuitable
					 item" is an item that, when in actual use, does not meet the medical needs of
					 the beneficiary when the beneficiary's medical condition has not significantly
					 changed since the item was fitted or sold.
(G) In addition to the written polices and
					 procedures specified in (A) through (F), above, a durable medical equipment and
					 medical supply applicant or provider who holds a license as a medical device
					 retailer, or a medical device retailer exemptee, and provides dangerous drugs
					 or dangerous devices, as defined in Section
					 4022, Business and Professions
					 (B&P) Code, shall meet the standards specified in Section
					 4131, B&P Code, and have
					 written policies and procedures that meet the requirements of Section
					 4132, B&P
					 Code.