10A NCAC 71J .0111. OPTIONAL RESOURCES/COMPONENT 4

The special health needs component allows for the provision of necessities which constitute an imperative health need of an individual because of health deterioration or because the need is specific to the correction, improvement or amelioration of a disability, and the provision of such necessities will enable the individual to continue to live in his own home.

(1)           Reimbursement is allowable at costs not to exceed an amount reasonable and necessary to ensure quality products and to provide for periodic adjustment and repair.

(2)           The following items or services are specifically excluded from the scope of this resource component:

(a)           diagnostic assessment or reassessment procedures;

(b)           special food or diet regimen;

(c)           clothing other than special apparel prescribed or advised by a physician;

(d)           any furniture not in the nature of an adaptive device;

(e)           supplies, appliances and equipment of a cosmetic nature unless the person cannot do without the item and continue to remain in his own home;

(f)            services, equipment, supplies or appliances available under medicaid or medicare to the individual in his own home;

(g)           x‑rays ‑‑ diagnostic or treatment;

(h)           a physician's care, physical, speech or occupation therapy;

(i)            prescription drugs;

(j)            non‑prescription medicine except as advised or prescribed by a physician.

(3)           An item may be rented only if it is unavailable otherwise or the expected duration of need makes renting more cost‑effective.  Any item provided through this component is purchased for the individual recipient.  Therefore, the provider agency holds no ownership and may not reclaim the item.  However, the recipient may make an agreement to donate the item to the agency for another client's use when he ceases to need it.

(4)           When a particular item is donated back to the agency by a previous user as described in this Rule, reimbursement for the cost of the item may not be claimed again when it is provided to another client.  However, reasonable and necessary charges for renovations and repairs may be claimed and reimbursed as a cost of service to the second recipient.

 

History Note:        Authority G.S. 143B‑153;

Eff. July 1, 1984;

Amended Eff. July 1, 1990.