Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.09 - MEDICAID BASIC PLAN BENEFITS › COVERED SERVICES › SUB AREA: DURABLE MEDICAL EQUIPMENT AND SUPPLIES › Section 16.03.09.755 - DURABLE MEDICAL EQUIPMENT AND SUPPLIES: PROVIDER REIMBURSEMENT

Current through August 31, 2023
01.
Items Included in Per Diem
				  Excluded
. No payment will be made for any participant's DME or medical
				  supplies that are included in the per diem payment while such an individual is
				  an inpatient in a hospital nursing facility or ICF/IID. (3-17-22)
02.
Least Costly Limitation
.
				  When multiple features, models or brands of equipment or supplies are
				  available, coverage will be limited to the least costly version that will
				  reasonably and effectively meet the minimum requirements of the individual's
				  medical needs. (3-17-22)
03.
Billing Procedures
. The Department will provide billing instructions to
				  providers of DME/medical supplies. When prior authorization by the Department
				  is required, the authorization number must be included on the claim form.
				  (3-17-22)
04.
Fees and Upper
				  Limits
. The Department will reimburse according to Section
				  230 of these rules.
				  (3-17-22)
05.
Date of
				  Service
. Unless specifically authorized by the Department the date of
				  services for durable medical equipment and supplies is the date of delivery of
				  the equipment or supply(s) for items provided in-person or the date of shipment
				  for supplies mailed through a third-party courier. (3-17-22)
06.
Manually Priced Codes
. For
				  codes that are manually priced, including miscellaneous codes, a copy of the
				  manufacturer's suggested retail pricing (MSRP) or an invoice or quote from the
				  manufacturer is required. Reimbursement will be seventy-five percent (75%) of
				  MSRP. If the pricing documentation is the invoice, reimbursement will be at
				  cost plus ten percent (10%), plus shipping, if that documentation is provided.
				  (3-17-22)
07.
Warranties and
				  Cost of Repairs
. No reimbursement will be made for the cost of repairs
				  (materials or labor, or both) covered under the manufacturer's warranty. The
				  date of purchase and the warranty period must be kept on file by the DME
				  vendor. The following warranty periods are required to be provided on equipment
				  purchased by the Department: (3-17-22)
a. A
				  power drive wheelchair must have a minimum one (1) year warranty period;
				  (3-17-22)
b. An ultra-light or
				  high-strength lightweight wheelchair must have a lifetime warranty period on
				  the frame and crossbraces; (3-17-22)
c. All other wheelchairs must have a minimum
				  one (1) year warranty period; (3-17-22)
d. All electrical components and new or
				  replacement parts must have a minimum six (6) month warranty period;
				  (3-17-22)
e. All other DME not
				  specified in Subsections
				  755.07.a. through 755.07.d. of
				  this rule must have a minimum one (1) year warranty period; (3-17-22)
f. If the manufacturer denies the warranty
				  due to user misuse or abuse, or both, that information must be forwarded to the
				  Department at the time of the request for repair or replacement;
				  (3-17-22)
g. The monthly rental
				  payment must include a full service warranty. All routine maintenance, repairs,
				  and replacement of rental equipment are the responsibility of the provider.
				  (3-17-22)