HAR §17-1737-73. Medical supplies

(a) Medical supplies means medical items prescribed by a licensed physician that are medically necessary for the treatment, care, or observation of a medical condition. (b) Medical supplies include, but are not limited to, insulin syringes and needles, ostomy appliances and supplies, urine test materials, contraceptive devices, incontinence pads or devices, catheters, urine bags and tubing, ice bags, and hot water bottles or heating pads. (c) Medical Authorization shall be required when the line item billed cost of the items prescribed exceeds $50 per month, except for intra-uterine devices for family planning purposes for which the cost may exceed $50 per month. (d) The following items shall not be covered by the program: (1) Tooth brushes of any type, including standard or mechanical, except when distributed through the EPSDT program and included as part of the oral screening visit, water cleansing devices, toothpaste, denture cleaners, and mouth washes; (2) Baby oil and powder; (3) Sanitary napkins; (4) Health food and food supplements; (5) Non-medicated shampoos; (6) Soaps including medicated soaps; (7) Lip balm; (8) Band aids; (9) Prepared food formula except when necessary for nutrition due to inborn metabolic abnormalities, abnormalities of digestion or absorption, or when persons are being fed by nasogastric, gastrostomy or jejunostomy tube. Milk substitutes and related compounds may be made available under this exception with prior authorization; (10) Bowel and bladder incontinence care supplies with the exception of diapers, underpads and gloves, for a recipient age three or older and catheters, subject to medical necessity; (11) For individuals over the age of twenty- one, incontinence care supplies in excess of UNOFFICIAL 1737-82 two hundred diapers per month, fifty underpads per month, and fifty pairs of gloves per month; and (12) Other supplies not primarily medical in nature. (e) Medical supplies billed using a miscellaneous Health Care Financing Procedure Coding System (HCPCS) code are required to have a copy of the invoice submitted for the equipment billed. Payment for medical supplies will be based on the invoice amount plus a negotiated percentage amount. (f) Medicare’s criteria is followed for the coverage of medical supplies unless specifically stated elsewhere. This provision also applies to the maintenance, replacement, and repair of medical supplies. [Eff 08/01/94; am 02/16/02; am 05/10/03; am 09/17/07 ] (Auth: HRS §346-14) (Imp: 42 C.F.R. §§440.20, 440.90)