Prior Approval for Medical Equipment, Supplies, Prosthetic Devices and Orthotic Devices

Section 140 TITLE 89: SOCIAL SERVICES CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES SUBCHAPTER d: MEDICAL PROGRAMS PART 140 MEDICAL PAYMENT SECTION 140.478 PRIOR APPROVAL FOR MEDICAL EQUIPMENT, SUPPLIES, PROSTHETIC DEVICES AND ORTHOTIC DEVICES Section 140.478  Prior Approval for Medical Equipment, Supplies, Prosthetic Devices and Orthotic Devices a)         The following time frames shall be adhered to by the Department when prior approval is required for medical equipment, prosthetic devices and orthotic devices (see also Section 140.40): 1)         Decisions to approve or deny a request for prior approval of life-sustaining respiratory supplies and equipment will be made within 30 days after the date of receipt of the request by the Department.  Prior approval is not required for such items for the first 30 days of service. 2)         Decisions to approve or deny requests for artificial limbs and braces shall be made within 21 days after the date of receipt of the request by the Department. 3)         Decisions to approve or deny requests for standard wheelchairs and hospital beds shall be made within 21 days after the date of receipt of the request by the Department. 4)         Decisions to approve or deny requests for hearing aids, communication devices, custom molded shoes, shoe corrections, orthopedic shoes used in conjunction with a brace, and custom wheelchairs, shall be made within 30 days after the date of receipt of the request by the Department. 5)         Decisions to approve or deny requests for medical supplies costing less than $100 shall be made within 21 days after the date of receipt of the requests by the Department. 6)         Decisions to approve or deny requests for medical supplies costing more than $100 shall be made within 30 days after the date of receipt of the request by the Department. b)         Post approval may be requested.  Post approval will be granted in circumstances when prior approval could not be requested, such as: 1)         determination of the patient's eligibility for public assistance was delayed; 2)         the medical need arose unexpectedly outside of the Department's normal business hours and prior approval could not be obtained; 3)         other third party resources denied payment.