Durable Medical Equipment Provided to Members in Facilities

(A) MassHealth Members Residing in Nursing Facilities. (1) The MassHealth agency pays for the following services for members residing in nursing facilities. (a) Mobility Systems for Members in Nursing Facilities with No Written Discharge Plan. The MassHealth agency pays DME providers for the purchase, rental, or repair of medically necessary mobility systems, positioning seating systems and add-ons, subject to all limitations and conditions of payment in 130 CMR 409.000 and 130 CMR 450.000: Administrative and Billing Regulations, when purchased solely for the full-time use of the member while residing in a nursing facility, with the exception of equipment described under 130 CMR 409.415(A)(2). The nursing facility in which the member resides is responsible for payment to the DME provider for $500 toward the purchase of the mobility system, unless the member has a written discharge plan in accordance with 130 CMR 409.415(A)(1)(b). If a MassHealth member needs a custom positioning seating system the nursing facility must check its existing inventory for a wheelchair base that can be used for a customized seating system for the sole use of a member. If the facility provides a base, the nursing facility is not responsible for the $500.00 toward the purchase of a customized positioning/seating system. (b) Mobility Systems for Members in Nursing Facilities Who Have a Written Discharge Plan. The MassHealth agency pays DME providers for the purchase, rental, or repair of medically necessary mobility systems, positioning seating systems, and add-ons, subject to all limitations and conditions of payment in 130 CMR 409.000 and 130 CMR 450.000: Administrative and Billing Regulations, when purchased solely for the full-time use of the member while residing in a nursing facility, with the exception of equipment described under 130 CMR 409.415(A)(2). The DME provider may deliver equipment to a nursing facility up to ten business days prior to the member’s scheduled discharge date, for the purpose of teaching the member how to use the equipment, taking measurements, or adjusting equipment to be used in the member’s home. The DME provider must document the member’s discharge plan and discharge date in the member’s record before the equipment is delivered to the nursing facility, and provide such documentation to the MassHealth agency upon request. For equipment delivered to a nursing facility for use by a member after discharge from the facility, the date of service is the date of discharge. (c) Support Surfaces. The MassHealth agency pays DME providers for the rental or purchase of support surfaces for the exclusive full-time use of a member residing in a nursing facility. (2) The MassHealth agency does not pay DME providers for the following services for members residing in nursing facilities. (a) medical supplies, including but not limited to absorbent products, urological supplies, ostomy supplies, diabetic supplies, and enteral/parenteral products or supplies for MassHealth members residing in nursing facilities. (b) the purchase, rental, or repair of standard, manual wheelchairs. This includes, but is not limited to transport chairs, standard manual wheelchairs, standard hemi wheelchairs, lightweight wheelchairs, high-strength lightweight wheelchairs, ultra-lightweight wheelchairs, heavy duty wheelchairs, semi-reclining wheelchairs, amputee wheelchairs, and extra heavy duty wheelchairs. (B) MassHealth Members Who Are Inpatients in Acute, Chronic Disease and Rehabilitation, and Psychiatric Hospitals. The MassHealth agency does not pay DME providers for medical supplies, including but not limited to absorbent products, or the purchase, rental, or repair of DME provided to a MassHealth member who is an inpatient in a hospital, except for DME delivered to the member in accordance with 130 CMR 409.419(C). (C) MassHealth Members Who Are Residing in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). (1) Covered Services. (a) Customized Seating and Mobility Equipment. The MassHealth agency pays DME providers for the purchase, rental, or repair of customized medically necessary mobility systems, positioning seating systems, and add-ons, subject to all limitations and conditions of payment in 130 CMR 409.000 and 130 CMR 450.000: Administrative and Billing Regulations, when purchased solely for the full-time use of a member residing in an ICF/IID (if the customization precludes the use of equipment by other individuals in the ICF/IID). (b) Other Customized Durable Medical Equipment. The MassHealth agency pays DME providers for other customized DME that is purchased solely for the full-time use of a member residing in an ICF/IID (if the customization precludes the use of equipment by other individuals in the ICF/IID). (c) Durable Medical Equipment for Members to Be Discharged from an ICF/IID. The MassHealth agency allows a DME provider to deliver equipment to an ICF/IID, before the member’s scheduled discharge date, for the purpose of teaching the member how to use the equipment, taking measurements, or adjusting equipment to be used in the member’s home (see 130 CMR 409.419(C)). The DME provider must document the member’s discharge plan and discharge date in the member’s record before the equipment is delivered to the ICF/IID, and provide such documentation to the MassHealth agency upon request. For equipment delivered to a ICF/IID for use by a member after discharge from the facility, the date of service is the date of discharge. (2) Noncovered Services. The MassHealth agency does not pay a DME provider for medical supplies, including but not limited to absorbent products, or the purchase, rental, or repair of non-customized DME provided to a member residing in an ICF/IID.