Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-1000 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The following definitions and abbreviations and those found
				  in chapter 182-500 WAC apply to this chapter.
"By-report (BR)"
- See WAC
				  182-500-0015.
"Complex needs patient"
- An individual with a
				  diagnosis or medical condition that results in significant physical or
				  functional needs and capacities.
"Complex rehabilitation technology (CRT)"
-
				  Wheelchairs and seating systems classified as durable medical equipment within
				  the medicare program that:
(a) Are individually configured for individuals to meet their
				  specific and unique medical, physical, and functional needs and capacities for
				  basic activities as medically necessary to prevent hospitalization or
				  institutionalization of a complex needs patient;
(b) Are primarily used to serve a medical purpose and
				  generally not useful to a person in the absence of an illness or injury;
				  and
(c) Require certain services necessary to allow for
				  appropriate design, configuration, and use of such item, including patient
				  evaluation and equipment fitting.
"Date of delivery"
- The date the client
				  actually took physical possession of an item or equipment.
"Digitized speech"
(also referred to as devices
				  with whole message speech output) - Words or phrases that have been recorded by
				  an individual other than the speech generating device (SGD) user for playback
				  upon command of the SGD user.
"Disposable supplies"
- Supplies which may be
				  used once, or more than once, but are time limited.
"EPSDT"
- See WAC
				  182-500-0030.
"Expedited prior authorization (EPA)"
- See WAC
				  182-500-0030.
"Fee-for-service (FFS)"
- See WAC
				  182-500-0035.
"Health care common procedure coding system (HCPCS)"
- A coding system established by the Health Care Financing
				  Administration (HCFA) to define services and procedures. HCFA is now known as
				  the Centers for Medicare and Medicaid Services (CMS).
"Home"
- For the purposes of this chapter, means
				  location, other than hospital or skilled nursing facility where the client
				  receives care.
"House wheelchair"
- A skilled nursing facility
				  wheelchair that is included in the skilled nursing facility's per-patient-day
				  rate under chapter 74.46 RCW.
"Individually configured"
- A device has a
				  combination of features, adjustments, or modifications specific to a complex
				  needs patient that a qualified complex rehabilitation technology supplier
				  provides by measuring, fitting, programming, adjusting, or adapting the device
				  as appropriate so that the device is consistent with an assessment or
				  evaluation of the complex needs patient by a health care professional and
				  consistent with the complex needs patient's medical condition, physical and
				  functional needs and capacities, body size, period of need, and intended
				  use.
"Manual wheelchair"
- See "Wheelchair -
				  Manual."
"Medical equipment"
- Includes medical equipment
				  and appliances, and medical supplies.
"Medical equipment and appliances"
- Health
				  care-related items that:
(a) Are primarily and customarily used to serve a medical
				  purpose;
(b) Generally are not useful to a person in the absence of
				  illness or injury;
(c) Can withstand repeated use;
(d) Can be reusable or removable; and
(e) Are suitable for use in any setting where normal life
				  activities take place.
"Medical supplies"
- Health care-related items
				  that are:
(a) Consumable or disposable or cannot withstand repeated use
				  by more than one person;
(b) Required to address an individual medical disability,
				  illness, or injury;
(c) Suitable for use in any setting which is not a medical
				  institution and in which normal life activities take place; and
(d) Generally not useful to a person in the absence of
				  illness or injury.
"Medically necessary"
- See WAC
				  182-500-0070.
"National provider indicator (NPI)"
- See WAC
				  182-500-0075.
"Orthotic device"
or
"orthotic"
-
				  A corrective or supportive device that:
(a) Prevents or corrects physical deformity or malfunction;
				  or
(b) Supports a weak or deformed portion of the body.
"Power-drive wheelchair"
- See "Wheelchair -
				  Power."
"Pricing cluster"
- A group of manufacturers'
				  list prices for brands/models of medical equipment that the agency considers
				  when calculating the reimbursement rate for a procedure code that does not have
				  a fee established by medicare.
"Prior authorization"
- See WAC
				  182-500-0085.
"Prosthetic device"
or
"prosthetic"
- See WAC
				  182-500-0085.
"Qualified complex rehabilitation technology supplier"
- A company or entity that:
(a) Is accredited by a recognized accrediting organization as
				  a supplier of CRT;
(b) Meets the supplier and quality standards established for
				  durable medical equipment suppliers under the medicare program;
(c) For each site that it operates, employs at least one CRT
				  professional, certified by the rehabilitation engineering and assistive
				  technology society of North America as an assistive technology professional, to
				  analyze the needs and capacities of clients, and provide training in the use of
				  the selected covered CRT items;
(d) Has the CRT professional physically present for the
				  evaluation and determination of the appropriate individually configured CRT for
				  the complex needs patient;
(e) Provides service and repairs by qualified technicians for
				  all CRT products it sells; and
(f) Provides written information to the complex needs patient
				  at the time of delivery about how the individual may receive service and repair
				  of the delivered CRT.
"Resource-based relative value scale (RBRVS)"
-
				  A scale that measures the relative value of a medical service or intervention,
				  based on the amount of physician resources involved.
"Reusable supplies"
- Supplies which are to be
				  used more than once.
"Scooter"
- A federally approved, motor-powered
				  vehicle that:
(a) Has a seat on a long platform;
(b) Moves on either three or four wheels;
(c) Is controlled by a steering handle; and
(d) Can be independently driven by a client.
"Specialty bed"
- A pressure reducing support
				  surface, such as foam, air, water, or gel mattress or overlay.
"Speech generating device (SGD)"
- An electronic
				  device or system that compensates for the loss or impairment of a speech
				  function due to a congenital condition, an acquired disability, or a
				  progressive neurological disease. The term includes only that equipment used
				  for the purpose of communication. Formerly known as "augmentative communication
				  device (ACD)."
"Synthesized speech"
- Is a technology that
				  translates a user's input into device-generated speech using algorithms
				  representing linguistic rules, unlike prerecorded messages of digitized speech.
				  A SGD that has synthesized speech is not limited to prerecorded messages but
				  rather can independently create messages as communication needs dictate.
"Three- or four-wheeled scooter"
- A three- or
				  four-wheeled vehicle meeting the definition of scooter (see "scooter") and
				  which has the following minimum features:
(a) Rear drive;
(b) A twenty-four volt system;
(c) Electronic or dynamic braking;
(d) A high to low speed setting; and
(e) Tires designed for indoor/outdoor use.
"Trendelenburg position"
- A position in which
				  the patient is lying on his or her back on a plane inclined thirty to forty
				  degrees. This position makes the pelvis higher than the head, with the knees
				  flexed and the legs and feet hanging down over the edge of the plane.
"Usual and customary charge"
- See WAC
				  182-500-0110.
"Warranty-period"
- A guarantee or assurance,
				  according to manufacturers' or provider's guidelines, of set duration from the
				  date of purchase.
"Wheelchair - Manual"
- A federally approved,
				  non-motorized wheelchair that is capable of being independently propelled and
				  fits one of the following categories:
(a) Standard:
(i) Usually is not capable of being modified;
(ii) Accommodates a person weighing up to two hundred fifty
				  pounds; and
(iii) Has a warranty period of at least one year.
(b) Lightweight:
(i) Composed of lightweight materials;
(ii) Capable of being modified;
(iii) Accommodates a person weighing up to two hundred fifty
				  pounds; and
(iv) Usually has a warranty period of at least three
				  years.
(c) High-strength lightweight:
(i) Is usually made of a composite material;
(ii) Is capable of being modified;
(iii) Accommodates a person weighing up to two hundred fifty
				  pounds;
(iv) Has an extended warranty period of over three years;
				  and
(v) Accommodates the very active person.
(d) Hemi:
(i) Has a seat-to-floor height lower than eighteen inches to
				  enable an adult to propel the wheelchair with one or both feet; and
(ii) Is identified by its manufacturer as "Hemi" type with
				  specific model numbers that include the "Hemi" description.
(e) Pediatric: Has a narrower seat and shorter depth more
				  suited to pediatric patients, usually adaptable to modifications for a growing
				  child.
(f) Recliner: Has an adjustable, reclining back to facilitate
				  weight shifts and provide support to the upper body and head.
(g) Tilt-in-space: Has a positioning system, which allows
				  both the seat and back to tilt to a specified angle to reduce shear or allow
				  for unassisted pressure releases.
(h) Heavy duty:
(i) Specifically manufactured to support a person weighing up
				  to three hundred pounds; or
(ii) Accommodating a seat width of up to twenty-two inches
				  wide (not to be confused with custom manufactured wheelchairs).
(i) Rigid: Is of ultra-lightweight material with a rigid
				  (nonfolding) frame.
(j) Custom heavy duty:
(i) Specifically manufactured to support a person weighing
				  over three hundred pounds; or
(ii) Accommodates a seat width of over twenty-two inches wide
				  (not to be confused with custom manufactured wheelchairs).
(k) Custom manufactured specially built:
(i) Ordered for a specific client from custom measurements;
				  and
(ii) Is assembled primarily at the manufacturer's
				  factory.
"Wheelchair - Power"
- A federally approved,
				  motorized wheelchair that can be independently driven by a client and fits one
				  of the following categories:
(a) Custom power adaptable to:
(i) Alternative driving controls; and
(ii) Power recline and tilt-in-space systems.
(b) Noncustom power: Does not need special positioning or
				  controls and has a standard frame.
(c) Pediatric: Has a narrower seat and shorter depth that is
				  more suited to pediatric patients. Pediatric wheelchairs are usually adaptable
				  to modifications for a growing child.
11-14-075, recodified as §
											182-543-1000, filed 6/30/11,
					 effective 7/1/11. Statutory Authority:
					 RCW
					 74.08.090 and
					 74.04.050. 11-14-052, §
					 388-543-1000, filed 6/29/11, effective 8/1/11. Statutory Authority:
					 RCW
					 74.08.090,
					 74.09.530. 02-16-054, §
					 388-543-1000, filed 8/1/02, effective 9/1/02; 01-01-078, § 388-543-1000,
					 filed 12/13/00, effective 1/13/01.