Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 122 - DURABLE MEDICAL EQUIPMENT, PROSTHETIC ORTHOTICS AND SUPPLIES (DMEPOS) › Section 410-122-0010 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
In addition to the definitions in OAR 410-120-0000, the
				following definitions in these rules apply:
(1) "Activities of Daily Living (ADL's)"
			 means activities related to personal care including, but not limited to, tasks
			 such as eating, toileting, grooming, dressing, and bathing that are necessary
			 to maintain or improve the client's health.
(2) "Buy-up" means a situation in which a
			 client wants to upgrade to a higher level of service than he or she is eligible
			 for; e.g., a heavy-duty walker instead of a standard walker.
(3) "Consecutive Months" means any period of
			 continuous use where no more than a 60-day break occurs.
(4) "Durable Medical Equipment" means
			 equipment and appliances that are primarily and customarily used to serve a
			 medical purpose, generally are not useful to an individual in the absence of a
			 disability, illness or injury, can withstand repeated use, can be reusable or
			 removable, and is appropriate for use in any non-institutional setting in which
			 normal life activities take place. Some examples include wheelchairs, crutches,
			 and hospital beds.
(5) "Division"
			 means the Health Systems Division within the Authority. The Division is
			 responsible for coordinating the medical assistance programs within the State
			 of Oregon including the Oregon Health Plan (OHP) Medicaid demonstration, the
			 State Children's Health Insurance Program (SCHIP-Title XXI), and several other
			 programs.
(6) "EPSDT" means the
			 Early and Periodic Screening, Diagnostic and Treatment program which provides
			 comprehensive and preventive health care services to OHP clients under the age
			 of 21 in accordance with federal regulations and as defined in OAR 410,
			 Division 151.
(7) "Home" for
			 purposes of purchase, rental, and repair of durable medical equipment (DME)
			 means a place of permanent residence such as an assisted living facility,
			 24-hour residential care facility, adult foster home, child foster home, or a
			 private home. This does not include hospitals, nursing facilities, intermediate
			 care facilities for individuals with intellectual disabilities, any setting
			 that exists primarily for the purpose of providing medical/nursing care, or any
			 setting in which payment is or could be made under Medicaid for inpatient
			 services that include room and board. Separate payment may not be made to DME
			 providers for equipment and medical supplies provided to a client when the cost
			 of such items is already included in the capitated (per diem) rate paid to a
			 facility or organization.
(8)
			 "Lifetime Need" means 99 months or more.
(9) "Manufacturer Part Number (MPN)" means:
(a) Each manufacturer provides an MPN to
			 identify that manufacturer's part. It is a specification used by the
			 manufacturer to store a part in an illustrated part catalog (graphics and
			 text).
(b) An MPN uniquely
			 identifies a part when used together with manufacturer code (external
			 manufacturer), which is the own name used by the manufacturer and not the
			 manufacturer name provided by other.