A determination will be made by HHSC or its designee whether the equipment will be rented, purchased, repaired, or modified based on the client’s needs, duration of use, and age of equipment. All modifications, adjustments, and repairs within the first six months after delivery are considered to be part of the purchase price.
A fixed height bed may be considered for prior authorization if the client requires the head of the bed to be elevated more than 30 degrees most of the time due to conditions such as congestive heart failure, chronic pulmonary disease, or problems with aspiration. Pillows or wedges must have been used and found to be ineffective.
A variable height hospital bed may be considered for prior authorization if the client meets the criteria for a fixed height hospital bed and requires a bed height different than a fixed height hospital bed to permit transfers to a chair, wheelchair, or standing position.
A semi-electric hospital bed may be considered for prior authorization if the client meets the criteria for a variable height bed and either requires frequent changes in body position or has a need for rapid changes in body position.
A fully-electric bed may be considered for prior authorization only for clients with paraplegia or partial hemiplegia when the fully electric bed will allow for functional independence. Documentation must include that the bed will allow for the client’s functional independence with self-care. A fully-electric bed will not be authorized for the convenience of the caregiver.
The safety enclosure frame/canopy/bubble top may be considered for prior authorization with documentation that the protective canopy top/bubble will provide for the client’s safety. Prior authorization will not be considered when it will be used as a restraint or for the convenience of family or caregivers.
Reflux slings or wedges may be considered for prior authorization for clients who are 11 months of age and younger. These may be used as positioning devices for infants who require the head of the bed or crib to be elevated greater than 30 degrees after feedings when prescribed by a physician as medically necessary and appropriate.
Positioning pillows and cushions may be considered for prior authorization with documentation of medical necessity that indicates the item will provide for or assist in the positioning needs of the client to maintain proper body alignment and skin integrity. Documentation must include what other devices have been used previously and why they proved to be ineffective.
Replacement equipment may also be considered if loss or irreparable damage has occurred. A copy of the police or fire report, when appropriate, and the measures to be taken to prevent reoccurrence must be submitted.