CSHCN 2009 > Durable Medical Equipment (DME) > Benefits, Limitations, and Authorization Requirements

17.3.8.3 Hospital Cribs and Enclosed Beds

Hospital cribs and enclosed beds must be prior authorized. Hospital cribs or enclosed beds are considered custom equipment.

Prior Authorization Requirements

Documentation supporting medical necessity must be submitted with the prior authorization request. Prior authorization is not granted when the documentation indicates strictly a behavioral control need. A diagnosis alone without documentation of medical necessity and functional skills is insufficient information to approve a hospital crib or enclosed bed. Documentation must include all of the following:

•Client's diagnosis, medical needs, developmental level, and functional skills

•Age, length or height, and weight of client

•Description of any other less-restrictive devices that have been used, the length of time used, and why they were ineffective

•Description of why a regular child's crib, regular bed, or standard hospital bed cannot be used

•Name of manufacturer and the manufacturer's suggested retail price (MSRP)

Accessories may include safety enclosure frame or canopy. The protective crib top may also be prior authorized based on the criteria previously listed.

Requests for cribs or enclosed beds must be prior authorized and are referred for medical review. Providers must use procedure code E0316 when requesting a safety enclosure or canopy for a hospital bed or crib. Requests must be made to the CSHCN Services Program using the form located in Appendix B, "CSHCN Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME)," on page B-29.