17 Durable Medical Equipment (DME)

17.1 Enrollment 17-3

17.1.1 Custom DME Requirements 17-3

17.2 Program Overview and Guidelines 17-4

17.2.1 Custom DME 17-4

17.2.2 Standard DME 17-4

17.2.3 Program Guidelines 17-5

17.3 Benefits, Limitations, and Authorization Requirements 17-5

17.3.1 Adaptive Strollers 17-6

17.3.1.1 Authorization Requirements 17-6

17.3.2 Ambulation Aids 17-7

17.3.2.1 Crutches, Walkers, Gait and Ambulation Belts, and Canes 17-7

17.3.3 Breast Prosthesis 17-7

17.3.3.1 Breast Prosthesis Prior Authorization Requirements 17-7

17.3.4 Burn Care Garments 17-8

17.3.5 Cochlear Implant Device 17-8

17.3.6 Continuous Passive Motion (CPM) Device 17-8

17.3.7 Enuresis Alarms 17-9

17.3.7.1 Prior Authorization Requirements 17-9

17.3.8 Gait Trainers (Supported or Sling Walkers) 17-9

17.3.8.1 Authorization Requirements 17-9

17.3.9 Hospital Beds (Manual and Electric) 17-9

17.3.9.1 Authorization and Prior Authorization Requirements 17-9

17.3.9.2 Pressure Reducing Pads 17-10

17.3.9.3 Hospital Cribs and Enclosed Beds 17-10

17.3.10 Hygiene Equipment 17-11

17.3.10.1 Authorization Requirements 17-11

17.3.10.2 Adaptive Feeder Seats 17-12

17.3.10.3 Commode Chair 17-12

17.3.10.4 Commode Chair with Integrated Seat Lifts 17-13

17.3.10.5 Commode Seat Lift Mechanism 17-14

17.3.11 Infusion Pumps 17-15

17.3.12 Portable Paraffin Units 17-15

17.3.13 Seat Lift Mechanism 17-15

17.3.14 Special Needs Car Seats and Travel Restraints 17-16

17.3.14.1 Car Seats 17-16

17.3.14.2 Travel Restraints 17-17

17.3.15 Standers, Prone or Supine 17-17

17.3.15.1 Authorization Requirements 17-17

17.3.16 TENS Units 17-17

17.3.17 Transfer Boards 17-18

17.3.18 Travel Chairs 17-18

17.3.18.1 Prior Authorization Requirements 17-18

17.3.19 Wheelchairs 17-18

17.3.19.1 Wheelchair Authorization Requirements 17-18

17.3.19.2 Manual Wheelchairs 17-18

17.3.19.3 Custom Manual Wheelchairs 17-19

17.3.19.4 Power Wheelchairs 17-19

17.3.19.5 Approval Criteria for Power Wheelchairs 17-20

17.3.19.6 Wheelchair Battery 17-20

17.3.19.7 Wheelchair Positioning Equipment 17-20

17.3.19.8 Wheelchair Power Elevating Leg Lifts 17-21

17.3.19.9 Wheelchair Power Seat Elevation System 17-21

17.3.20 Portable Wheelchair Ramps 17-22

17.3.21 Noncovered Rehabilitative and Therapeutic DME 17-22

17.3.22 Repairs and Modifications 17-22

17.4 Documentation of Receipt 17-23

17.5 Rental of Equipment 17-23

17.6 Claims Information 17-23

17.7 Reimbursement 17-24

17.8 TMHP-CSHCN Services Program Contact Center 17-25