Designated Exceptional Durable Medical Equipment
[35 Pa.B. 4020]
On February 9, 2002, the Department of Public Welfare (Department) announced the adoption of amendments to 55 Pa. Code Chapter 1187 (relating to nursing facility services). The amendments were adopted under sections 201 and 443.1 of the Public Welfare Code (62 P. S. §§ 201 and 443.1) and sections 1902 and 1919 of the Social Security Act (42 U.S.C.A. §§ 1396a and 1396r). The amendments expand the Department's exceptional payment policy to authorize additional payments to nursing facilities for nursing facility services provided to certain Medical Assistance residents who require medically necessary exceptional durable medical equipment (DME). See 32 Pa.B. 734 (February 9, 2002).
The amendments require the Department to publish an annual list of exceptional DME by notice in the Pennsylvania Bulletin in July of each year. Interested persons may petition the Department to consider additions to the exceptional DME list by submitting a written request to the Department. Requests received on or before December 31 will be considered in developing the list for the following July.
During calendar year 2004, the Department received three written requests to add Vacuum Assisted Wound Closure (VAC) systems to the list of exceptional DME. VAC systems are used in the treatment of many types of ulcers and soft tissue wounds when those wounds sites do not respond to traditional methods of treatment. VAC systems use a computerized vacuum pump that applies continuous or intermittent negative pressure to wound sites to aid in and accelerate the healing process.
The Department, after researching Minimum Data Set data regarding wound therapy and discussions with wound clinics and the manufacturer of VAC systems, found that VAC systems are not offered for sale and are available only on a rental basis. The average rental cost per day is $71.79 and typical treatment time varies from 22 to 60 days. Treatment time beyond 60 days was found to be rare to nonexistent. Therefore, the Department determined that the conventional use of VAC systems would not meet the acquisition cost of $5,000 or more necessary to qualify as an item of exceptional DME and has decided that the request for the addition of VAC systems as a separate category of exceptional DME is unwarranted at this time. Accordingly, this notice makes no changes in either the acquisition cost or the list of qualifying DME.
''Exceptional DME'' is defined as DME that has an acquisition cost of $5,000 or more and is either Specially Adapted DME or other DME that is designated as Exceptional DME by the Department annually by notice in the Pennsylvania Bulletin.
''Specially Adapted DME'' is DME that is uniquely constructed or substantially adapted or modified in accordance with the written orders of a physician for the particular use of one resident, making its contemporaneous use by another resident unsuitable.
The list of Exceptional DME that has been designated by the Department is as follows:
(1) Air fluidized beds
The pressure relief provided by this therapy uses a high rate of airflow to fluidize fine particulate material (for example, beads or sand) to produce a support medium that has characteristics similar to liquid. May have a Gortex cover.
(2) Powered air flotation bed (low air loss therapy)
A semielectric or total electric bed with a fully integrated powered pressure-reducing mattress which is characterized by all of the following:
(a) An air pump or blower with a series of interconnected woven fabric air pillows which provides sequential inflation and deflation of the air cells or a low interface pressure throughout the mattress allowing some air to escape through the support surface to the resident. May have a Gortex cover.
(b) Inflated cell height of the air cells through which air is being circulated is 5 inches or greater.
(c) Height of the air chambers, proximity of the air chambers to one another, frequency of air cycling (for alternating pressure mattresses) and air pressure provide adequate patient lift, reducing pressure and prevent bottoming out.
(d) A surface designed to reduce friction and shear.
(e) May be placed directly on a hospital bed frame.
(f) Automatically readjusts inflation pressures with change in position of bed (for example, head elevation, and the like).
(3) Augmentative communication devices
Used by residents who are unable to use natural oral speech as a primary means of communication. The specific device requested must be appropriate for use by the resident and the resident must demonstrate the abilities or potential abilities to use the device selected. Portable devices need to supplement, aid or serve as an alternative to natural speech for residents with severe expressive communication disorders. Nonportable devices may be covered only if required for visual enhancement or physical access needs that cannot be accommodated by a portable device.
(4) Ventilators (and related supplies)
(a) Used by residents 21 years of age and older who require full ventilator support for a minimum of 8 hours per day to sustain life.
(b) Used by residents 20 years of age and younger who require ventilator support to sustain life (no minimum time requirement).
This notice is effective upon publication in the Pennsylvania Bulletin.
Interested persons are invited to submit written comments regarding this notice to Gail Weidman, Chief, Program Analysis and Review Section, Department of Public Welfare, Division of Long-Term Care Client Services, P. O. Box 2675, Harrisburg, PA 17105. Comments received within 30 days will be reviewed and considered for any subsequent revision of the notice.
Persons with a disability may use the AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
Fiscal Note: 14-NOT-434. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 05-1351. Filed for public inspection July 15, 2005, 9:00 a.m.]
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