WAC 388-543-1000   Definitions for durable medical equipment (DME) and related supplies, prosthetics, and orthotics, medical supplies and related services.  The following definitions and abbreviations and those found in WAC 388-500-0005 apply to this chapter.

     "Artificial limb" - See "prosthetic device."

     "Augmentative communication device (ACD)" - See "speech generating device (SGD)."

     "Base year" means the year of the data source used in calculating prices.

     "By report (BR)" means a method of reimbursement for covered items, procedures, and services for which the department has no set maximum allowable fees.

     "Date of delivery" means the date the client actually took physical possession of an item or equipment.

     "Disposable supplies" means supplies which may be used once, or more than once, but are time limited.

     "Durable medical equipment (DME)" means equipment that:      (1) Can withstand repeated use;

     (2) Is primarily and customarily used to serve a medical purpose;

     (3) Generally is not useful to a person in the absence of illness or injury; and

     (4) Is appropriate for use in the client's place of residence.

     "EPSDT" - See WAC 388-500-0005.

     "Expedited prior authorization (EPA)" means the process for obtaining authorization for selected durable medical equipment, and related supplies, prosthetics, orthotics, medical supplies and related services, in which providers use a set of numeric codes to indicate to MAA which acceptable indications/conditions/MAA-defined criteria are applicable to a particular request for DME authorization.

     "Fee-for-service (FFS)" means the general payment method MAA uses to reimburse for covered medical services provided to clients, except those services covered under MAA's prepaid managed care programs.

     "Health care financing administration common procedure coding system (HCPCS)" means a coding system established by the Health Care Financing Administration (HCFA) to define services and procedures. HCFA is now known as the Centers for Medicare and Medicaid Services (CMS).

     "House wheelchair" means a nursing facility wheelchair that is included in the nursing facility's per-patient-day rate under chapter 74.46 RCW.

     "Limitation extension" means a process for requesting and approving covered services and reimbursement that exceeds a coverage limitation (quantity, frequency, or duration) set in WAC, billing instructions, or numbered memoranda. Limitation extensions require prior authorization.

     "Nonreusable supplies" are disposable supplies, which are used once and discarded.

     "Manual wheelchair" - See "wheelchair - manual."

     "Medical supplies" means supplies that are:

     (1) Primarily and customarily used to service a medical purpose; and

     (2) Generally not useful to a person in the absence of illness or injury.

     "Orthotic device" or "orthotic" means a corrective or supportive device that:

     (1) Prevents or corrects physical deformity or malfunction; or

     (2) Supports a weak or deformed portion of the body.

     "Personal or comfort item" means an item or service which primarily serves the comfort or convenience of the client.

     "Personal computer (PC)" means any of a variety of electronic devices that are capable of accepting data and instructions, executing the instructions to process the data, and presenting the results. A PC has a central processing unit (CPU), internal and external memory storage, and various input/output devices such as a keyboard, display screen, and printer. A computer system consists of hardware (the physical components of the system) and software (the programs used by the computer to carry out its operations).

     "Power-drive wheelchair" - See "wheelchair - power."

     "Prior authorization" means a process by which clients or providers must request and receive MAA approval for certain medical equipment and related supplies, prosthetics, orthotics, medical supplies and related services, based on medical necessity, before the services are provided to clients, as a precondition for provider reimbursement. Expedited prior authorization and limitation extension are types of prior authorization. Also see WAC 388-501-0165.

     "Prosthetic device" or "prosthetic" means a replacement, corrective, or supportive device prescribed by a physician or other licensed practitioner of the healing arts, within the scope of his or her practice as defined by state law, to:

     (1) Artificially replace a missing portion of the body;

     (2) Prevent or correct physical deformity or malfunction; or

     (3) Support a weak or deformed portion of the body.

     "Resource based relative value scale (RBRVS)" means a scale that measures the relative value of a medical service or intervention, based on the amount of physician resources involve.

     "Reusable supplies" are supplies which are to be used more than once.

     "Scooter" means a federally-approved, motor-powered vehicle that:

     (1) Has a seat on a long platform;

     (2) Moves on either three or four wheels;

     (3) Is controlled by a steering handle; and

     (4) Can be independently driven by a client.

     "Specialty bed" means a pressure reducing support surface, such as foam, air, water, or gel mattress or overlay.

     "Speech generating device (SGD)" means an electronic device or system that compensates for the loss or impairment of a speech function due to a congenital condition, an acquired disability, or a progressive neurological disease. The term includes only that equipment used for the purpose of communication. Formerly known as "augmentative communication device (ACD)."

     "Three- or four-wheeled scooter" means a three- or four-wheeled vehicle meeting the definition of scooter (see "scooter") and which has the following minimum features:

     (1) Rear drive;

     (2) A twenty-four volt system;

     (3) Electronic or dynamic braking;

     (4) A high to low speed setting; and

     (5) Tires designed for indoor/outdoor use.

     "Trendelenburg position" means a position in which the patient is lying on his or her back on a plane inclined thirty to forty degrees. This position makes the pelvis higher than the head, with the knees flexed and the legs and feet hanging down over the edge of the plane.

     "Usual and customary charge" means the amount the provider typically charges to fifty percent or more of his or her nonmedicaid clients, including clients with other third-party coverage.

     "Warranty-wheelchair" means a warranty, according to manufacturers' guidelines, of not less than one year from the date of purchase.

     "Wheelchair - manual" means a federally-approved, nonmotorized wheelchair that is capable of being independently propelled and fits one of the following categories:

     (1) Standard:

     (a) Usually is not capable of being modified;

     (b) Accommodates a person weighing up to two hundred fifty pounds; and

     (c) Has a warranty period of at least one year.

     (2) Lightweight:

     (a) Composed of lightweight materials;

     (b) Capable of being modified;

     (c) Accommodates a person weighing up to two hundred fifty pounds; and

     (d) Usually has a warranty period of at least three years.

     (3) High strength lightweight:

     (a) Is usually made of a composite material;

     (b) Is capable of being modified;

     (c) Accommodates a person weighing up to two hundred fifty pounds;

     (d) Has an extended warranty period of over three years; and

     (e) Accommodates the very active person.

     (4) Hemi:

     (a) Has a seat-to-floor height lower than eighteen inches to enable an adult to propel the wheelchair with one or both feet; and

     (b) Is identified by its manufacturer as "Hemi" type with specific model numbers that include the "Hemi" description.

     (5) Pediatric: Has a narrower seat and shorter depth more suited to pediatric patients, usually adaptable to modifications for a growing child.

     (6) Recliner: Has an adjustable, reclining back to facilitate weight shifts and provide support to the upper body and head.

     (7) Tilt-in-space: Has a positioning system, which allows both the seat and back to tilt to a specified angle to reduce shear or allow for unassisted pressure releases.

     (8) Heavy duty:

     (a) Specifically manufactured to support a person weighing up to three hundred pounds; or

     (b) Accommodating a seat width of up to twenty-two inches wide (not to be confused with custom manufactured wheelchairs).

     (9) Rigid: Is of ultra-lightweight material with a rigid (nonfolding) frame.

     (10) Custom heavy duty:

     (a) Specifically manufactured to support a person weighing over three hundred pounds; or

     (b) Accommodates a seat width of over twenty-two inches wide (not to be confused with custom manufactured wheelchairs).

     (11) Custom manufactured specially built:

     (a) Ordered for a specific client from custom measurements; and

     (b) Is assembled primarily at the manufacturer's factory.

     "Wheelchair - power" means a federally-approved, motorized wheelchair that can be independently driven by a client and fits one of the following categories:

     (1) Custom power adaptable to:

     (a) Alternative driving controls; and

     (b) Power recline and tilt-in-space systems.

     (2) Noncustom power: Does not need special positioning or controls and has a standard frame.

     (3) Pediatric: Has a narrower seat and shorter depth that is more suited to pediatric patients. Pediatric wheelchairs are usually adaptable to modifications for a growing child.



[Statutory Authority: RCW 74.08.090, 74.09.530. 02-16-054, § 388-543-1000, filed 8/1/02, effective 9/1/02; 01-01-078, § 388-543-1000, filed 12/13/00, effective 1/13/01.]