Library: Policy

317:30-5-211.10. Medical supplies, equipment, and appliances

Revised 9-12-22

(a) Medical supplies, equipment, and appliances. See the definition for medical supplies, equipment, and appliances at Oklahoma Administrative Code (OAC) 317:30-5-211.1.

(b) Certificate of medical necessity (CMN). Certain items of medical supplies, equipment, and appliances require a CMN/OHCA CMN which should be submitted with the request for prior authorization. These items include, but are not limited to:

(1) External infusion pumps;

(2) Hospital beds;

(3) Oxygen and oxygen related products;

(4) Pneumatic compression devices;

(5) Support surfaces;

(6) Enteral and parenteral nutrition; and

(7) Osteogenesis stimulator.

(c) Rental. Several medical supplies, equipment, and appliance products are classified as either a capped rental or a continuous rental. Payment for a capped rental is capped at thirteen (13) months and a continuous rental is paid monthly for as long as it is medically necessary. Both require documentation showing that the product is medically necessary.

(d) Purchase.  Medical supplies, equipment, and appliances may be purchased when a member requires the product for an extended period of time. During the prior authorization review, the Oklahoma Health Care Authority (OHCA) may change the authorization from a rental to a purchase or a purchase to a rental based on the documentation submitted.

(e) Backup equipment. Backup equipment is considered part of the rental cost and is not a covered service without prior authorization.

(f) Home modification. Home modifications that require permanent installation are not covered services as they are not removable and therefore do not meet the definition of medical supplies, equipment, and appliances per 42 Code of Federal Regulations (C.F.R.) ' 440.70. Refer to Title 317, Chapters 40 and 50 for home modifications covered under Home and Community Based Services Waivers, including the ADvantage Waiver.