Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers › Section 5160-10-09 - DMEPOS: apnea monitors

Current through all regulations passed and filed through July 1, 2024
(A)
								Coverage.
(1)
									Initial payment
			 may be made for rental of an apnea monitor for a period not to exceed four
			 months, and after the first four months payment may be made either for
			 additional rental or for purchase, only if the following conditions are
			 satisfied:
(a)
										The monitoring unit meets current United States food and
			 drug administration guidelines.
(b)
										The provider is
			 capable of performing all of the following services:
(i)
											Arranging to have
			 certified individuals provide infant cardiopulmonary resuscitation (CPR)
			 training to caregivers;
(ii)
											Providing education and instruction on the mechanical
			 aspects of monitors; and
(iii)
											Providing a
			 technician twenty-four hours a day to service monitoring
			 equipment;
(c)
										For this initial rental period, the following
			 information is recorded:
(i)
											At least one clinical indication from the following
			 list:
(a)
												The
			 occurrence of at least one apparent life-threatening event (ALTE) requiring
			 mouth-to-mouth resuscitation or vigorous stimulation;
(b)
												A need for active
			 medical management of apnea of prematurity;
(c)
												The occurrence of
			 sudden infant death syndrome (SIDS) in a sibling;
(d)
												A need for home
			 oxygen therapy or ventilatory support (either invasive or non-invasive) and
			 associated technology-dependence;
(e)
												Tracheotomy and
			 associated technology-dependence;
(f)
												An abnormal
			 pneumogram at discharge from a medical facility;
(g)
												Severe
			 gastroesophageal reflux and associated apnea;
(h)
												Severe upper
			 airway abnormality (e.g., achondroplasia, Pierre Robin syndrome);
			 or
(i)
												Another, specified disorder necessitating close
			 cardiorespiratory monitoring to facilitate a more timely discharge to home from
			 a medical facility; and
(ii)
											An attestation
			 that appropriate caregivers are capable of being trained to use the monitor
			 properly; and
(d)
										For additional rental or purchase, the following
			 information is recorded:
(i)
											An attestation by the prescriber to the need for
			 continued home monitoring and supplies, including the following information
			 pertinent to the child's circumstances:
(a)
												For a child who
			 is technology-dependent, documentation that the equipment or service on which
			 the child depends is still necessary and is still being used (evidenced, for
			 example, by a copy of a recent clinician follow-up report or home health agency
			 visit report noting equipment and services);
(b)
												For a child who
			 is not technology-dependent, documentation of recent, clinically significant
			 apnea or bradycardia (evidenced, for example, by a copy of recent monitor data
			 or a recent pneumogram showing instances of apnea or bradycardia) or
			 documentation of a recent emergency department visit or hospital admission for
			 an ALTE; and
(c)
												For a child whose sibling died of SIDS, the birth and
			 death dates of the sibling (for the purpose of indicating whether the child is
			 currently younger than the sibling was at the time of death);
			 and
(ii)
											Either a full report of the information recorded by the
			 apnea monitor during the initial rental period or a summary of the information
			 accompanied by a statement that a full report is available on
			 request.