PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 05-13-132.
Title of Rule and Other Identifying Information: Chapter 388-543 WAC, Durable medical equipment (DME) and related supplies, prosthetics, and orthotics, medical supplies and related services.
Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane, behind Goodyear Tire. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6097), on October 11, 2005, at 10:00 a.m.
Date of Intended Adoption: Not earlier than October 12, 2005.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., October 11, 2005.
Assistance for Persons with Disabilities: Contact Stephanie Schiller, DSHS Rules Consultant, by October 7, 2005, TTY (360) 664-6178 or (360) 664-6097 or by e-mail at schilse@dshs.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: This WAC revision is intended to accomplish several objectives:
| • | Add advanced registered nurse practitioners (ARNPs) and physician assistants certified (PACs) to the list of eligible prescribers under this chapter; |
| • | Exclude "Medicare/Medicaid" dual-eligible clients from the documentation requirement for prescriptions under WAC 388-543-1100 (1)(d) and 388-543-2800(1); |
| • | Add "washable protective underwear" to list of diapers and related supplies under WAC 388-543-1150; |
| • | Clarify language for standard specifications for disposable incontinence products to match the description in the healthcare common procedure coding system (HCPCS) manual; |
| • | Clarify products that cannot be used together under WAC 388-543-1150; and |
| • | Remove the word "unwilling" from WAC 388-543-1500 (5)(b) and (6)(b). |
Statutory Authority for Adoption: RCW 74.04.050, 74.04.57 [74.04.057], and 74.08.090.
Statute Being Implemented: RCW 74.04.050, 74.04.57 [74.04.057], and 74.08.090.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of Social and Health Services, governmental.
Name of Agency Personnel Responsible for Drafting: Wendy L. Boedigheimer, P.O. Box 45533, Olympia, WA 98504-5533, (360) 725-1306; Implementation and Enforcement: Dianne Baum, P.O. Box 45506, Olympia, WA 98504-5506, (360) 725-1590.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has determined that the proposed rule will not create more than minor costs for affected small businesses.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Dianne Baum, Division of Medical Management, P.O. Box 45506, Olympia, WA 98504-5506, phone (360) 725-1590, e-mail baumdl@dshs.wa.gov.
August 30, 2005
Andy Fernando, Manager
Rules and Policies Assistance Unit
3595.2 (1) The medical assistance administration (MAA) covers
DME and related supplies, prosthetics, orthotics, medical
supplies, related services, repairs and labor charges when
((all of the following apply. They must be)) they are:
(a) Within the scope of an eligible client's medical care program (see chapter 388-529 WAC);
(b) Within accepted medical or physical medicine community standards of practice;
(c) Prior authorized as described in WAC 388-543-1600, 388-543-1800, and 388-543-1900;
(d) Prescribed by a ((qualified provider, acting within
the scope of the provider's practice)) physician, advanced
registered nurse practitioner (ARNP), or physician assistant
certified (PAC). Except for dual eligible Medicare/Medicaid
clients, the prescription must:
(i) Be dated and signed by the prescriber;
(ii) Be less than six months in duration from the date the prescriber signs the prescription; and
(iii) State the specific item or service requested,
diagnosis, ((prognosis,)) estimated length of need (weeks,
((or)) months, ((not to exceed six months before being
reevaluated)) or years), and quantity;
(e) Billed to the department as the payor of last resort only. MAA does not pay first and then collect from Medicare and;
(f) Medically necessary as defined in WAC 388-500-0005. The provider or client must submit sufficient objective evidence to establish medical necessity. Information used to establish medical necessity includes, but is not limited to, the following:
(i) A physiological description of the client's disease, injury, impairment, or other ailment, and any changes in the client's condition written by the prescribing physician, ARNP, PAC, licensed prosthetist and/or orthotist, physical therapist, occupational therapist, or speech therapist; and/or
(ii) Video and/or photograph(s) of the client demonstrating the impairments as well and client's ability to use the requested equipment, when applicable.
(2) MAA evaluates a request for any equipment or devices that are listed as noncovered in WAC 388-543-1300 under the provisions of WAC 388-501-0165.
(3) MAA evaluates a request for a service that is in a covered category, but has been determined to be experimental or investigational under WAC 388-531-0550, under the provisions of WAC 388-501-0165 which relate to medical necessity.
(4) MAA evaluates requests for covered services in this chapter that are subject to limitations or other restrictions and approves such services beyond those limitations or restrictions when medically necessary, under the standards for covered services in WAC 388-501-0165.
(5) MAA does not reimburse for DME and related supplies, prosthetics, orthotics, medical supplies, related services, and related repairs and labor charges under fee-for-service (FFS) when the client is any of the following:
(a) An inpatient hospital client;
(b) Eligible for both Medicare and Medicaid, and is staying in a nursing facility in lieu of hospitalization;
(c) Terminally ill and receiving hospice care; or
(d) Enrolled in a risk-based managed care plan that includes coverage for such items and/or services.
(6) MAA covers medical equipment and related supplies, prosthetics, orthotics, medical supplies and related services, repairs, and labor charges listed in MAA's published issuances, including Washington Administrative Code (WAC), billing instructions, and numbered memoranda.
(7) An interested party may request MAA to include new equipment/supplies in the billing instructions by sending a written request plus all of the following:
(a) Manufacturer's literature;
(b) Manufacturer's pricing;
(c) Clinical research/case studies (including FDA approval, if required); and
(d) Any additional information the requester feels is important.
(8) MAA bases the decision to purchase or rent DME for a client, or to pay for repairs to client-owned equipment on medical necessity.
(9) MAA covers replacement batteries for purchased medically necessary DME equipment covered within this chapter.
(10) MAA covers the following categories of medical
equipment and supplies only when they are medically necessary,
prescribed by a physician ((or other licensed practitioner of
the healing arts)), ARNP, or PAC, are within the scope of his
or her practice as defined by state law, and are subject to
the provisions of this chapter and related WACs:
(a) Equipment and supplies prescribed in accordance with an approved plan of treatment under the home health program;
(b) Wheelchairs and other DME;
(c) Prosthetic/orthotic devices;
(d) Surgical/ostomy appliances and urological supplies;
(e) Bandages, dressings, and tapes;
(f) Equipment and supplies for the management of diabetes; and
(g) Other medical equipment and supplies, as listed in MAA published issuances.
(11) MAA evaluates a BR item, procedure, or service for its medical appropriateness and reimbursement value on a case-by-case basis.
(12) For a client in a nursing facility, MAA covers only the following when medically necessary. All other DME and supplies identified in MAA billing instructions are the responsibility of the nursing facility, in accordance with chapters 388-96 and 388-97 WAC. See also WAC 388-543-2900 (3) and (4). MAA covers:
(a) The purchase and repair of a speech generating device (SGD), a wheelchair for the exclusive full-time use of a permanently disabled nursing facility resident when the wheelchair is not included in the nursing facility's per diem rate, or a specialty bed; and
(b) The rental of a speciality bed.
(13) Vendors must provide instructions for use of equipment; therefore, instructional materials such as pamphlets and video tapes are not covered.
(14) Bilirubin lights are limited to rentals, for at-home newborns with jaundice.
[Statutory Authority: RCW 74.08.090, 34.05.353. 03-12-005, § 388-543-1100, filed 5/22/03, effective 6/22/03. Statutory Authority: RCW 74.08.090, 74.09.530. 02-16-054, § 388-543-1100, filed 8/1/02, effective 9/1/02; 01-01-078, § 388-543-1100, filed 12/13/00, effective 1/13/01.]
(1) Antiseptics and germicides:
(a) Alcohol (isopropyl) or peroxide (hydrogen) - one
((eight ounce bottle)) pint per month;
(b) Alcohol wipes (box of two hundred) - one box per month;
(c) Betadine or pHisoHex solution - one pint per month;
(d) Betadine or iodine swabs/wipes (box of one hundred) - one box per month;
(e) Disinfectant spray - one twelve-ounce((s)) bottle or
can per six-month period; or
(f) Periwash (when soap and water are medically contraindicated) - one five-ounce bottle of concentrate solution per six-month period.
(2) Blood monitoring/testing supplies:
(a) Replacement battery of any type, used with a client-owned, medically necessary home or specialized blood glucose monitor - one in a three-month period; and
(b) Spring-powered device for lancet - one in a six-month period.
(3) Braces, belts and supportive devices:
(a) Custom vascular supports (CVS) - two pair per six-month period. CVS fitting fee - two per six-month period;
(b) Surgical stockings (below-the-knee, above-the-knee, thigh-high, or full-length) - two pair per six-month period;
(c) Graduated compression stockings for pregnancy support (pantyhose style) - two per twelve-month period;
(d) Knee brace (neoprene, nylon, elastic, or with a hinged bar) - two per twelve-month period;
(e) Ankle, elbow, or wrist brace - two per twelve-month period;
(f) Lumbosacral brace, rib belt, or hernia belt - one per twelve-month period;
(g) Cervical head harness/halter, cervical pillow, pelvic belt/harness/boot, or extremity belt/harness - one per twelve-month period.
(4) Decubitus care products:
(a) Cushion (gel, sacroiliac, or accuback) and cushion cover (any size) - one per twelve-month period;
(b) Synthetic or lambs wool sheepskin pad - one per twelve-month period;
(c) Heel or elbow protectors - four per twelve-month period.
(5) Ostomy supplies:
(a) Adhesive for ostomy or catheter: Cement; powder; liquid (e.g., spray or brush); or paste (any composition, e.g., silicone or latex) - four total ounces per month.
(b) Adhesive or nonadhesive disc or foam pad for ostomy pouches - ten per month.
(c) Adhesive remover or solvent - three ounces per month.
(d) Adhesive remover wipes, fifty per box - one box per month.
(e) Closed pouch, with or without attached barrier, with a one- or two-piece flange, or for use on a faceplate - sixty per month.
(f) Closed ostomy pouch with attached standard wear barrier, with built-in one-piece convexity - ten per month.
(g) Continent plug for continent stoma - thirty per month.
(h) Continent device for continent stoma - one per month.
(i) Drainable ostomy pouch, with or without attached barrier, or with one- or two-piece flange - twenty per month.
(j) Drainable ostomy pouch with attached standard or extended wear barrier, with or without built-in one-piece convexity - twenty per month.
(k) Drainable ostomy pouch for use on a plastic or rubber faceplate (only one type of faceplate allowed) - ten per month.
(l) Drainable urinary pouch for use on a plastic, heavy plastic, or rubber faceplate (only one type of faceplate allowed) - ten per month.
(m) Irrigation bag - two every six months.
(n) Irrigation cone and catheter, including brush - two every six months.
(o) Irrigation supply, sleeve - one per month.
(p) Ostomy belt (adjustable) for appliance - two every six months.
(q) Ostomy convex insert - ten per month.
(r) Ostomy ring - ten per month.
(s) Stoma cap - thirty per month.
(t) Ostomy faceplate - ten per month. MAA does not allow the following to be used on a faceplate in combination with drainable pouches (refer to the billing instructions for further details):
(i) Drainable pouches with plastic face plate attached; or
(ii) Drainable pouches with rubber face plate.
(6) Supplies associated with client-owned transcutaneous electrical nerve stimulators (TENS):
(a) For a four-lead TENS unit - two kits per month. (A kit contains two leads, conductive paste or gel, adhesive, adhesive remover, skin preparation material, batteries, and a battery charger for rechargeable batteries.)
(b) For a two-lead TENS unit - one kit per month.
(c) TENS tape patches (for use with carbon rubber electrodes only) are allowed when they are not used in combination with a kit(s).
(d) A TENS stand alone replacement battery charger is allowed when it is not used in combination with a kit(s).
(7) Urological supplies - diapers and related supplies:
(a) The standards and specifications in this subsection
apply to all disposable incontinent products (e.g., ((adult))
briefs((/child)), diapers, pull-up ((training)) pants,
underpads for beds, ((and)) liners((/)), shields, guards,
pads, and undergarments). See subsections (b), (c), (d), and
(e) of this section for additional standards for specific
products. All of the following apply to all disposable
incontinent products:
(i) All materials used in the construction of the product must be safe for the client's skin and harmless if ingested;
(ii) Adhesives and glues used in the construction of the product must not be water-soluble and must form continuous seals at the edges of the absorbent core to minimize leakage;
(iii) The padding must provide uniform protection;
(iv) The product must be hypoallergenic; ((and))
(v) The product must meet the flammability requirements of both federal law and industry standards; and
(vi) All products are covered for client personal use only.
(b) In addition to the standards in subsection (a) of
this section, ((adult briefs/child)) diapers must meet all the
following specifications. They must:
(i) Be hourglass shaped with formed leg contours;
(ii) Have an absorbent filler core that is at least one-half inch from the elastic leg gathers;
(iii) Have leg gathers that consist of at least three strands of elasticized materials;
(iv) Have an absorbent core that consists of cellulose fibers mixed with absorbent gelling materials;
(v) Have a backsheet that is moisture impervious and is at least 1.00 mm thick, designed to protect clothing and linens;
(vi) Have a topsheet that resists moisture returning to the skin;
(vii) Have an inner lining that is made of soft, absorbent material; and
(viii) Have either a continuous waistband, or side panels with a tear-away feature, or refastenable tapes, as follows:
(A) ((For adult briefs, at least four tapes, two on each
side.
(B))) For child diapers, at least two tapes, one on each side.
(((C))) (B) The tape adhesive must release from the
backsheet without tearing it, and permit a minimum of three
fastening/unfastening cycles.
(c) In addition to the standards in subsection (a) of
this section, pull-up ((training)) pants and ((incontinent
pants)) briefs must meet the following specifications. They
must:
(i) Be made like regular underwear with an elastic waist or have at least four tapes, two on each side or two large tapes, one on each side;
(ii) Have an absorbent core filler that is at least one-half inch from the elastic leg gathers;
(iii) Have an absorbent core that consists of cellulose fibers mixed with absorbent gelling;
(iv) Have leg gathers that consist of at least three strands of elasticized materials;
(v) Have a backsheet that is moisture impervious, is at least 1.00 mm thick, and is designed to protect clothing and linens;
(vi) Have an inner lining made of soft, absorbent material; and
(vii) Have a top sheet that resists moisture returning to the skin.
(d) In addition to the standards in subsection (a) of
this section, underpads ((for beds)) are covered only for
incontinent purposes in a client's bed and must meet the
following specifications((. They must)):
(i) Have an absorbent layer that is at least one and one-half inches from the edge of the underpad;
(ii) Be manufactured with a waterproof backing material;
(iii) Be able to withstand temperatures not to exceed one hundred-forty degrees Fahrenheit;
(iv) Have a covering or facing sheet that is made of nonwoven, porous materials that have a high degree of permeability, allowing fluids to pass through and into the absorbent filler. The patient contact surface must be soft and durable;
(v) Have filler material that is highly absorbent. It must be heavy weight fluff filler or the equivalent; and
(((iv))) (vi) Have four-ply, nonwoven facing, sealed on
all four sides.
(e) In addition to the standards in subsection (a) of
this section, liners((/)), shields, guards, (((including))
pads, and undergarments(())) are covered for incontinence only
and must meet the following specifications((. They must)):
(i) Have channels to direct fluid throughout the absorbent area, and leg gathers to assist in controlling leakage, and/or be contoured to permit a more comfortable fit;
(ii) Have a waterproof backing designed to protect clothing and linens;
(iii) Have an inner liner that resists moisture returning to the skin;
(iv) Have an absorbent core that consists of cellulose fibers mixed with absorbent gelling materials;
(v) Have pressure-sensitive tapes on the reverse side to fasten to underwear; and
(vi) For undergarments only, be contoured for good fit, have at least three elastic leg gathers, and may be belted or unbelted.
(f) MAA covers the products in this subsection only when they are used alone; they cannot be used in combination with each other. MAA approves a client's use of a combination of products only when the client uses different products for daytime and nighttime use (see MAA's billing instructions for how to specify this when billing). The total of all products used cannot exceed the monthly limitation for the product with the highest limit (see subsections (g), (h), (i), (j), (k), (l), and (m) of this section for product limitations). The following products cannot be used together:
(i) Disposable ((briefs (incontinent pants)/))diapers;
(ii) Disposable pull-up ((training)) pants and briefs;
(iii) Disposable liners((/pads)), shields, guards, pads,
and undergarments;
(iv) Rented reusable ((briefs/))diapers (e.g., from a
diaper service); and
(v) Rented reusable briefs (((incontinent pants))) (e.g.,
from a diaper service), or pull-up ((training)) pants.
(g) Purchased disposable diapers (any size) are limited to:
(i) Three hundred per month for a child ((age)) three
((and older)) to eighteen years of age; and
(ii) Two hundred forty per month for an adult nineteen years of age and older.
(h) Reusable cloth diapers (any size) are limited to:
(i) Purchased - thirty-six per year; and
(ii) Rented - two hundred forty per month.
(i) Disposable briefs (((incontinent pants))) and pull-up
((training)) pants (any size) are limited to:
(i) Three hundred per month for a child age three ((and
older)) to eighteen years of age; and
(ii) One hundred fifty per month for an adult nineteen years of age and older.
(j) Reusable briefs (((incontinent pants))), washable
protective underwear, or pull-up ((training)) pants (any size)
are limited to:
(i) Purchased - four per year.
(ii) Rented - one hundred fifty per month.
(k) Disposable pant ((liner/pads)) liners, shields,
guards, pads, and undergarments are limited to two hundred
forty per month.
(l) Underpads for beds are limited to:
(i) Disposable (any size) - one hundred eighty per month.
(ii) Purchased, reusable (large) - forty-two per year.
(iii) Rented, reusable (large) - ninety per month.
(8) Urological supplies - urinary retention:
(a) Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube - two per month. This cannot be billed in combination with any of the following:
(i) With extension drainage tubing for use with urinary leg bag or urostomy pouch (any type, any length), with connector/adapter; and/or
(ii) With an insertion tray with drainage bag, and with or without catheter.
(b) Bedside drainage bottle, with or without tubing - two per six month period.
(c) Extension drainage tubing (any type, any length), with connector/adapter, for use with urinary leg bag or urostomy pouch. This cannot be billed in combination with a vinyl urinary leg bag, with or without tube.
(d) External urethral clamp or compression device (not be used for catheter clamp) - two per twelve-month period.
(e) Indwelling catheters (any type) - three per month.
(f) Insertion trays:
(i) Without drainage bag and catheter - one hundred and twenty per month. These cannot be billed in combination with other insertion trays that include drainage bag, catheters, and/or individual lubricant packets.
(ii) With indwelling catheters - three per month. These cannot be billed in combination with: Other insertion trays without drainage bag and/or indwelling catheter; individual indwelling catheters; and/or individual lubricant packets.
(g) Intermittent urinary catheter - one hundred twenty per month. These cannot be billed in combination with: An insertion tray with or without drainage bag and catheter; or other individual intermittent urinary catheters.
(h) Irrigation syringe (bulb or piston) - cannot be billed in combination with irrigation tray or tubing.
(i) Irrigation tray with syringe (bulb or piston) - thirty per month. These cannot be billed in combination with irrigation syringe (bulb or piston), or irrigation tubing set.
(j) Irrigation tubing set - thirty per month. These cannot be billed in combination with an irrigation tray or irrigation syringe (bulb or piston).
(k) Leg straps (latex foam and fabric). Allowed as replacement only.
(l) Male external catheter, specialty type, or with adhesive coating or adhesive strip - sixty per month.
(m) Urinary suspensory with leg bag, with or without tube - two per month. This cannot be billed in combination with: a latex urinary leg bag; urinary suspensory without leg bag; extension drainage tubing; or a leg strap.
(n) Urinary suspensory without leg bag, with or without tube - two per month.
(o) Urinary leg bag, vinyl, with or without tube - two per month. This cannot be billed in combination with: A leg strap; or an insertion tray with drainage bag and without catheter.
(p) Urinary leg bag, latex - one per month. This cannot be billed in combination with an insertion tray with drainage bag and with or without catheter.
(9) Miscellaneous supplies:
(a) Bilirubin light therapy supplies - five days' supply. MAA reimburses only when these are provided with a prior authorized bilirubin light.
(b) Continuous passive motion (CPM) softgoods kit - one, with rental of CPM machine.
(c) Eye patch with elastic, tied band, or adhesive, to be attached to an eyeglass lens - one box of twenty.
(d) Eye patch (adhesive wound cover) - one box of twenty.
(e) Lice comb (e.g., LiceOut TM, or LiesMeister TM, or combs of equivalent quality and effectiveness) - one per year.
(f) Nontoxic gel (e.g., LiceOut TM) for use with lice combs - one bottle per twelve month period.
(g) Syringes and needles ("sharps") disposal container for home use, up to one gallon size - two per month.
(10) Miscellaneous DME:
(a) Bilirubin light or light pad - five days rental per twelve-month period.
(b) Blood glucose monitor (specialized or home) - one in a three-year period.
(c) Continuous passive motion (CPM) machine - up to ten days rental and requires prior authorization.
(d) Diaphragmatic pacing antennae - four per twelve month-period.
(e) Lightweight protective helmet/soft shell (including adjustable chin/mouth strap) - two per twelve-month period.
(f) Lightweight ventilated hard-shell helmet (including unbreakable face bar, woven chin strap w/adjustable buckle and snap fastener, and one set of cushion pads for adjusting fit to head circumference) - two per twelve-month period.
(11) Prosthetics and orthotics:
(a) Thoracic-hip-knee-ankle orthosis (THKAO) standing frame - one every five years.
(b) Preparatory, above knee "PTB" type socket, nonalignable system, pylon, no cover, SACH foot plaster socket, molded to model - one per lifetime, per limb.
(c) Preparatory, below knee "PTB" type socket, nonalignable system, pylon, no cover, SACH foot thermoplastic or equal, direct formed - one per lifetime, per limb.
(d) Socket replacement, below the knee, molded to patient model - one per twelve-month period.
(e) Socket replacement, above the knee/knee disarticulation, including attachment plate, molded to patient model - one per twelve-month period.
(12) Positioning devices:
(a) Deluxe floor sitter/feeder seat (small, medium, or large), including floor sitter wedge, shoulder harness, and hip strap - one in a three-year period.
(b) High-back activity chair, including adjustable footrest, two pairs of support blocks, and hip strap - one in a three-year period.
(c) Positioning system/supine boards (small or large), including padding, straps adjustable armrests, footboard, and support blocks - one in a five-year period.
(d) Prone stander (child, youth, infant or adult size) - one in a five-year period.
(e) Adjustable standing frame (for child/adult thirty - sixty-eight inches tall), including two padded back support blocks, a chest strap, a pelvic strap, a pair of knee blocks, an abductor, and a pair of foot blocks - one in a five-year period.
[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, and Public Law 104-191. 03-19-082, § 388-543-1150, filed 9/12/03, effective 10/13/03. Statutory Authority: RCW 74.08.090, 74.09.530. 01-16-141, § 388-543-1150, filed 7/31/01, effective 8/31/01.]
(a) Be dated and signed by the prescriber;
(b) Be less than six months in duration from the date the prescriber signs the prescription; and
(c) State the specific item or service requested,
diagnosis, ((prognosis,)) estimated length of need (weeks
((or)), months, ((not to exceed six months before being
reevaluated)) or years), and quantity.
(2) MAA bases its determination about which DME and related supplies, prosthetics, orthotics, medical supplies and related services require prior authorization (PA) or expedited prior authorization (EPA) on utilization criteria (see WAC 388-543-1000 for PA and WAC 388-543-1800 for EPA). MAA considers all of the following when establishing utilization criteria:
(a) High cost;
(b) The potential for utilization abuse;
(c) A narrow therapeutic indication; and
(d) Safety.
(3) MAA requires a provider to obtain a limitation extension in order to exceed the stated limits for nondurable medical equipment and medical supplies. See WAC 388-501-0165.
(4) MAA categorizes medical supplies and non-DME (MSE) as follows (see WAC 388-543-1150, 388-543-1600, and MAA's billing instructions for further information about specific limitations and requirements for PA and EPA):
(a) Antiseptics and germicides;
(b) Bandages, dressings, and tapes;
(c) Blood monitoring/testing supplies;
(d) Braces, belts, and supportive devices;
(e) Decubitus care products;
(f) Ostomy supplies;
(g) Pregnancy-related testing kits and nursing equipment supplies;
(h) Supplies associated with transcutaneous electrical nerve stimulators (TENS);
(i) Syringes and needles;
(j) Urological supplies (e.g., diapers, urinary retention catheters, pant liners, and doublers); and
(k) Miscellaneous supplies.
[Statutory Authority: RCW 74.08.090, 74.09.530. 01-16-141, § 388-543-2800, filed 7/31/01, effective 8/31/01; 01-01-078, § 388-543-2800, filed 12/13/00, effective 1/13/01.]