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317:40-5-104.Specialized medical supplies

[Revised 08-01-20]
(a) Applicability.  The rules in this Section apply to medical supplies, equipment, and appliances provided through home and community-based waiver services operated by the Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services (DDS).

(b) General information.  Medical supplies, equipment, and appliances include supplies specified in the plan of care that enable the member to increase his or her ability to perform activities of daily living. Medical supplies, equipment, and appliances include the purchase of ancillary supplies not available through SoonerCare.

(1) Medical supplies, equipment, and appliances must be included in the member's plan and arrangements for this service must be made through the member's case manager. Items reimbursed with home and community-based waiver services (HCBS) funds are in addition to any supplies furnished by SoonerCare.

(2) Medical supplies, equipment, and appliances meet the criteria for service necessity given in Oklahoma Administrative Code (OAC) 340:100-3-33.1.

(3) All items meet applicable standards of manufacture, design, and installation.

(4) Medical supplies, equipment, and appliance providers must hold a current SoonerCare Durable Medical Equipment (DME) and/or Medical Supplies Provider Agreement with the Oklahoma Health Care Authority, and be registered to do business in Oklahoma or the state in which they are domiciled. Providers must enter into the agreement giving assurance of ability to provide products and services and agree to the audit and inspection of all records concerning goods and services provided.

(5) Items that can be purchased as  medical supplies, equipment, and appliances include:

(A) Incontinence supplies, as described in subsection (b) of this Section;

(B) Nutritional supplements;

(C) Supplies for respirator or ventilator care;

(D) Decubitus care supplies;

(E) Supplies for catheterization; and

(F) Supplies needed for health conditions.

(6) Items that cannot be purchased as medical supplies, equipment, and appliances include:

(A) Over-the-counter medications(s);

(B) Personal hygiene items;

(C) Medicine cups;

(D) Items that are not medically necessary; and

(E) Prescription medication(s).

(7) Medical supplies, equipment, and appliances must be:

(A) Necessary to address a medical condition;

(B) Of direct medical or remedial benefit to the member;

(C) Medical in nature; and

(D) Consistent with accepted health care practice standards and guidelines for the prevention, diagnosis, or treatment of symptoms of illness, disease, or disability.

(c) Limited coverage.  Items available in limited quantities through medical supplies, equipment, and appliances include:

(1) Incontinence wipes, three-hundred (300) wipes per month;

(2) Non-sterile gloves, as approved by the Team;

(3) Disposable underpads, sixty (60) pads per month; and

(4) Incontinence briefs, one-hundred and eighty (180) briefs per month.

(A) Adult briefs are purchased only in accordance with the implementation of elimination guidelines developed by the team.

(B) Exceptions to the requirement for implementation of elimination guidelines may be approved by the DDS nurse when the member has a medical condition that precludes implementation of elimination guidelines, such as atonic bladder, neurogenic bladder, or following a surgical procedure.

(d) Exceptions.  Exceptions to the requirements of this Section are explained in this subsection.

(1) When a member's team determines that the member needs medical supplies that:

(A) Are not available through SoonerCare and for which no healthcare common procedure code exists, the case manager e-mails pertinent information regarding the member's medical supply need to the programs manager responsible for medical supplies, equipment, and appliances. The e-mail includes all pertinent information that supports the need for the supply, including but not limited to, quantity and purpose; or

(B) Exceed the limits stated in subsection(c) of this Section, the case manager documents the need in the individual plan for review and approval per OAC 340:100-33.

(2) Approval or denial of exception requests is made on a case-by-case basis and does not override the general applicability of this Section.

(3) Approval of a medical supplies, equipment, and appliances exception does not exceed one (1) plan of care year.

 

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.