Library: Policy

317:30-5-211.26. Bathroom equipment

Revised 9-12-22

(a) Bathroom equipment. Bathroom equipment is used for bathing and toileting and may be considered primarily medical in nature if used in the presence of an illness and/or injury and if it is necessary for activities of daily living that are considered to be essential to health and personal hygiene.

(b) Medical necessity. Bathroom equipment must be determined by a provider to be medically necessary and documented in the member's plan of care as medically necessary and used for medical purposes. A request by a qualified provider for bathroom equipment in and of itself shall not constitute medical necessity. The Oklahoma Health Care Authority (OHCA) shall serve as the final authority pertaining to all determinations of medical necessity. Refer to Oklahoma Administrative Code (OAC) 317:30-5-211.2 and 317:30-3-1(f) for policy on medical necessity.

(c) Documentation. All documentation submitted to request services must demonstrate, through adequate objective medical records, evidence sufficient to justify the member's need for the service, in accordance with OAC 317:30-3-1(f)(2).

(1) Current written prescription for specific medical supply, equipment, and appliance item;

(2) Letter of medical necessity;

(3) Product information;

(4) Manufacturer's suggested retail price (MSRP) for each item requested

(5) For full guidelines, please refer to www.okhca.org/mau.