10A NCAC 22G .0507. DURABLE MEDICAL EQUIPMENT AND RELATED SUPPLIES

(a)  Effective August 1, 1991, payment for each claim for durable medical equipment and supplies will be equal to the lower of the supplier's usual and customary billed charges or the maximum fee established for each item of durable medical equipment or related supply.  The maximum fees are set at the Medicaid fee schedule in effect on July 1, 1991.  Fees for added equipment will be set at Medicare Part B fees.  If a Medicare fee cannot be obtained for added equipment, then the fee will be based on an estimate of reasonable cost.  The maximum allowable fee will be updated each August 1 based on the Gross National Product (GNP) implicit price deflator, but not to exceed the percentage increase approved by the North Carolina State Legislature.  (The maximum allowable fee may be adjusted for any changes resulting from market and cost analysis conducted by the Division of Medical Assistance.)  There will be no retroactive payment adjustments for fee changes.

(b)  Each equipment item will be assigned to one of the following categories of payment methods:

(1)           Purchase fee paid for inexpensive, routinely purchased, and customized equipment, and DME Supplies.

(2)           Monthly rental paid up to purchase price but for no more than 15 continuous months.  Monthly rental is paid for other types of equipment when the initial expected medical needs is less than six months, but not to exceed the purchase price if need extends beyond six months.  Equipment with an initial expected medical need of six months or more may be paid as a purchase or a rental.

(3)           Monthly rental payment for oxygen and oxygen equipment without any limitations.

(4)           Servicing and repair fees shall be established for appropriate items.  Through a prior approval process, recipient owned equipment is repaired on an "as needed" basis if the repair estimate is less than the cost of replacement and if the equipment has not gone beyond its established life expectancy.  Service contracts are not covered and manufacturer's warranties are expected to be honored when appropriate.  Rental equipment repairs are not reimbursed separately but are considered to be covered in the monthly rental fee.

(c)  The changes to this Rule shall become effective when the Health Care Financing Administration, U.S. Department of Health and Human Services, approves amendment submitted to HCFA by the Director of the Division of Medical Assistance on or about August 1, 1995 as #MA 95-17, wherein the Director proposes amendments of the State Plan to amend Payments for Services - Durable Medical Equipment.

 

History Note:        Filed as a Temporary Amendment Eff. August 1, 1991 for a period of 180 days to expire on

January 31, 1992;

Authority G.S. 108A‑25(b); 42 C.F.R. 447, Subpart D; 1991 S.L, s. 95, c. 689;

Eff. March 1, 1990;

Amended Eff. December 1, 1995; February 1, 1992.