Md. Code Regs. 10.09.12.05

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.12.05 - Limitations

The Program does not cover:

A. Incontinency pants and disposable underpads unless the following conditions are met:

(1) The incontinence supplies are medically necessary for medical conditions associated with prolonged urinary or bowel incontinence;

(2) For pull-on underwear type garments, the recipient is capable of independently putting on and removing the garment; and

(3) Disposable incontinence supplies meet, at a minimum, the following absorbent capacity standards:

(a) For children's diapers and underwear, not less than 800cc;

(b) For youth diapers and underwear, not less than 1,000cc;

(c) For small adult diapers and underwear, not less than 1,200cc;

(d) For medium adult diapers and underwear, not less than 1,750cc;

(e) For large, extra large, and bariatric adult diapers and underwear, not less than 2,000cc; and

(f) For disposable underpads, not less than 1,000 cc;

B. Osteogenesis stimulators unless the following criteria are met:

(1) The use is for noninvasive therapy;

(2) The bone fracture is at least 6 months old, except when used for pseudarthrosis; and

(3) The space gap of the fracture measures 1/2 centimeter or less, except when used for pseudarthrosis;

C. Osteogenesis stimulators beyond the first 6 weeks of use unless evaluations at the 6-week and 3-month intervals after initial date of service verify recipient use of at least 50 percent of the time prescribed, on a form designated by the Program;

D. The following durable medical equipment:

(1) Equipment prescribed primarily to provide comfort or convenience, including, but not limited to, emesis basins, posture support chairs, over-the-bed tables;

(2) Self-help devices including, but not limited to, grab bars, shower stools, and commode seats;

(3) Abdominal supports;

(4) Bed boards;

(5) Enema bags;

(6) Environmental controls;

(7) Exercise equipment and devices, unless home use of such equipment is a necessary component of an active physical therapy program;

(8) Geriatric chairs;

(9) Heating pads or lamps;

(10) Hot water bottles;

(11) Hydrocollators;

(12) Ice bags;

(13) Knee cages;

(14) Nasal atomizers;

(15) Restraints;

(16) Sitz baths;

(17) Soft collars;

(18) Whirlpools;

(19) Whirlpool bath equipment;

E. Disposable medical supplies and durable medical equipment provided in a facility or by a group when reimbursement is covered by another segment of the Program;

F. Items which are investigational or experimental in nature;

G. Nutritional supplements supplied by a DMS/DME provider under this chapter if the provider is also a licensed pharmacy and has a Medicaid Pharmacy provider number;

H. Food supplements or infant formulas, including enteral nutritional products and supplemental vitamin and mineral products, when administered orally;

I. Purchase of used equipment, except as approved by the Department as per Regulation .07L of this chapter;

J. Equipment if the recipient owns or otherwise has access to useable equipment that serves the same purpose as the requested equipment;

K. Replacement of equipment while the item is still under warranty or before having met the Department's life expectancy schedule unless prepayment authorization has been obtained;

L. Rental of any equipment not in good working condition for the entire length of rental;

M. Rental of equipment for any period longer than 90 days without renewed documentation of continued medical need from the prescriber for each 90-day period;

N. Modifications to motor vehicles ;

O. Disposable medical supplies and durable medical equipment ordered by an individual who is not enrolled as a provider in the Program on the date of service; and

P. Disposable medical supplies and durable medical equipment ordered by an entity, facility, or other provider that is not an individual.

Md. Code Regs. 10.09.12.05

Regulations .05 effective February 8, 1980 (7:3 Md. R. 264) and April 4, 1980 (7:7 Md. R. 708)
Regulation .05 amended effective July 2, 1984 (11:13 Md. R. 1176); July 11, 1988 (15:13 Md. R. 1553); July 25, 1988 (15:14 Md. R. 1655); May 29, 1989 (16:10 Md. R. 1108)
Regulation .05A-3 and A-4 adopted, B amended effective July 1, 1987 (14:13 Md. R. 1473)
Regulation .05B and D amended effective June 2, 1986 (13:11 Md. R. 1273); March 23, 1987 (14:6 Md. R. 715)
Regulation .05 amended effective August 1, 2005 (32:15 Md. R. 1320); September 11, 2006 (33:18 Md. R. 1505)
Regulation .05A amended effective February 9, 2009 (36:3 Md. R. 208)
Regulation .05D amended effective April 19, 2010 (37:8 Md. R. 615); amended effective 44:26 Md. R. 1214, eff. 1/1/2018