Pressure Reducing Support Surface

Pressure Reducing Support Surface A. Medicaid defines pressure reducing support surfaces as surfaces designed for beneficiaries with limited or no mobility who are bed confined most or all of the day and prone to developing pressure ulcers. B. Medicaid covers pressure reducing support surfaces for all eligible beneficiaries when ordered by a physician, medically necessary and prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity for rental up to purchase amount or purchase. C. Beneficiaries requiring pressure reducing support surfaces must have a care plan, established by the beneficiary's physician or home care nurse, documented in the beneficiary's medical record, which includes all of the following: 1. Education of the beneficiary and caregiver on the prevention and/or management of pressure ulcers. 2. Regular assessment by a nurse, physician, or other licensed health care practitioner. 3. Appropriate turning and positioning. 4. Appropriate wound care for a stage II, III or IV ulcer. 5. Appropriate management of moisture/incontinence. 6. Nutritional assessment and intervention consistent with the overall plan of care. D. Medicaid defines a pressure pad for a mattress as a non-powered pressure reducing mattress overlay designed to be placed on top of a standard hospital or home mattress which includes a gel mattress overlay, an air mattress overlay, a water mattress overlay and a foam mattress overlay with a waterproof cover. 1. Medicaid covers a pressure pad when one (1) or more of the following apply: a) The beneficiary is completely immobile and cannot make changes in body position without assistance. b) The beneficiary has limited mobility and cannot independently make changes in body position significant enough to alleviate pressure. c) The beneficiary has any stage of a pressure ulcer on the trunk or pelvis. d) The beneficiary is essentially bedbound with an impaired nutritional status, fecal or urinary incontinence, altered sensory perception, or compromised circulatory status. 2. A replacement pad for use with a medically necessary power alternating pressure device owned by the beneficiary is covered if the beneficiary meets one (1) or more of the criteria in Rule 1.52, D.1.a-d. 3. A foam overlay or mattress, such as an egg crate without a waterproof cover, is not considered durable and is not covered under the DME program. E. Powered Pressure Reducing Overlays and Mattresses 1. Medicaid defines a powered pressure reducing overlay as a low air loss, powered flotation device without low air loss, or alternating pressure with an air pump or blower providing either sequential inflation or deflation of the air cells or a low interface pressure throughout the overlay designed to reduce friction and shear and are to be placed on top of a standard hospital or home mattress. 2. Medicaid defines a powered pressure reducing mattress as a mattress with alternating pressure, low air loss, or powered flotation without low air loss. An air pump or blower provides both sequential inflation and deflation of the air cells or a low interface pressure throughout the mattress. The surface is designed to reduce friction and shear and can be placed directly on a hospital bed frame. 3. Powered pressure reducing overlays and mattresses are covered when one (1) or more of the following applies: a) The beneficiary has multiple stage II pressure ulcers, defined as partial thickness skin loss involving epidermis and/or dermis, on the truck or pelvis. b) The beneficiary has been on a comprehensive ulcer treatment program and the ulcers have worsened or remained the same for one (1) month. c) Large or multiple stage III pressure ulcers, defined as full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia, or stage IV pressure ulcers, defined as full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures, on the trunk or pelvis. d) Myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis within the previous sixty (60) days.