WAC 388-543-1300   Equipment, related supplies, or other nonmedical supplies, and devices that are not covered.  (1) The department pays only for DME and related supplies, medical supplies and related services that are medically necessary, listed as covered in this chapter, and meet the definition of DME and medical supplies as defined in WAC 388-543-1000 and prescribed per WAC 388-543-1100 and 388-543-1200.

     (2) The department pays only for prosthetics or orthotics that are listed as such by the Centers for Medicare and Medicaid Services (CMS), formerly known as HCFA, that meet the definition of prosthetic and orthotic as defined in WAC 388-543-1000 and are prescribed per WAC 388-543-1100 and 388-543-1200.

     (3) The department considers all requests for covered DME, related supplies and services, medical supplies, prosthetics, orthotics, and related services under the provisions of WAC 388-501-0165.

     (4) The department evaluates a request for any DME item listed as noncovered in this chapter under the provisions of WAC 388-501-0160.

     (5) The department specifically excludes services and equipment in this chapter from fee-for-service (FFS) scope of coverage when the services and equipment do not meet the definition for a covered item, or the services are not typically medically necessary. This exclusion does not apply if the services and equipment are:

     (a) Included as part of a managed care plan service package;

     (b) Included in a waivered program;

     (c) Part of one of the medicare programs for qualified medicare beneficiaries; or

     (d) Requested for a child who is eligible for services under the EPSDT program. The department reviews these requests according to the provisions of chapter 388-534 WAC.

     (6) Excluded services and equipment include, but are not limited to:

     (a) Services, procedures, treatment, devices, drugs, or the application of associated services that the Food and Drug Administration (FDA) and/or the Centers for Medicare and Medicaid Services (CMS) consider investigative or experimental on the date the services are provided;

     (b) Any service specifically excluded by statute;

     (c) A client's utility bills, even if the operation or maintenance of medical equipment purchased or rented by the department for the client contributes to an increased utility bill (refer to the aging and disability services administration's (ADSA) COPES program for potential coverage);

     (d) Hairpieces or wigs;

     (e) Material or services covered under manufacturers' warranties;

     (f) Shoe lifts less than one inch, arch supports for flat feet, and nonorthopedic shoes;

     (g) Outpatient office visit supplies, such as tongue depressors and surgical gloves;

     (h) Prosthetic devices dispensed solely for cosmetic reasons (refer to WAC 388-531-0150 (1)(d));

     (i) Home improvements and structural modifications, including but not limited to the following:

     (i) Automatic door openers for the house or garage;

     (ii) Saunas;    

     (iii) Security systems, burglar alarms, call buttons, lights, light dimmers, motion detectors, and similar devices;

     (iv) Swimming pools;

     (v) Whirlpool systems, such as jacuzzies, hot tubs, or spas; or

     (vi) Electrical rewiring for any reason;

     (vii) Elevator systems and elevators; and

     (viii) Lifts or ramps for the home; or

     (ix) Installation of bathtubs or shower stalls.

     (j) Nonmedical equipment, supplies, and related services, including but not limited to, the following:

     (i) Back-packs, pouches, bags, baskets, or other carrying containers;

     (ii) Bed boards/conversion kits, and blanket lifters (e.g., for feet);

     (iii) Car seats for children under five, except for positioning car seats that are prior authorized. Refer to WAC 388-543-1700(13) for car seats;

     (iv) Cleaning brushes and supplies, except for ostomy-related cleaners/supplies;

     (v) Diathermy machines used to produce heat by high frequency current, ultrasonic waves, or microwave radiation;

     (vi) Electronic communication equipment, installation services, or service rates, including but not limited to, the following:

     (A) Devices intended for amplifying voices (e.g., microphones);

     (B) Interactive communications computer programs used between patients and healthcare providers (e.g., hospitals, physicians), for self care home monitoring, or emergency response systems and services (refer to ADSA COPES or outpatient hospital programs for emergency response systems and services);

     (C) Two-way radios; and

     (D) Rental of related equipment or services;

     (vii) Environmental control devices, such as air conditioners, air cleaners/purifiers, dehumidifiers, portable room heaters or fans (including ceiling fans), heating or cooling pads;

     (viii) Ergonomic equipment;

     (ix) Exercise classes or equipment such as exercise mats, bicycles, tricycles, stair steppers, weights, trampolines;

     (x) Generators;

     (xi) Computer software other than speech generating, printers, and computer accessories (such as anti-glare shields, backup memory cards);

     (xii) Computer utility bills, telephone bills, internet service, or technical support for computers or electronic notebooks;

     (xiii) Any communication device that is useful to someone without severe speech impairment (e.g., cellular telephone, walkie-talkie, pager, or electronic notebook);

     (xiv) Racing strollers/wheelchairs and purely recreational equipment;

     (xv) Room fresheners/deodorizers;

     (xvi) Bidet or hygiene systems, paraffin bath units, and shampoo rings;

     (xvii) Timers or electronic devices to turn things on or off, which are not an integral part of the equipment;

     (xviii) Vacuum cleaners, carpet cleaners/deodorizers, and/or pesticides/insecticides; or

     (xix) Wheeled reclining chairs, lounge and/or lift chairs (e.g., geri-chair, posture guard, or lazy boy).

     (k) Personal and comfort items that do not meet the DME definition, including but not limited to the following:

     (i) Bathroom items, such as antiperspirant, astringent, bath gel, conditioner, deodorant, moisturizer, mouthwash, powder, shampoo, shaving cream, shower cap, shower curtains, soap (including antibacterial soap), toothpaste, towels, and weight scales;

     (ii) Bedding items, such as bed pads, blankets, mattress covers/bags, pillows, pillow cases/covers and sheets;

     (iii) Bedside items, such as bed trays, carafes, and over-the-bed tables;

     (iv) Clothing and accessories, such as coats, gloves (including wheelchair gloves), hats, scarves, slippers, and socks;

     (v) Clothing protectors and other protective cloth furniture coverings;

     (vi) Cosmetics, including corrective formulations, hair depilatories, and products for skin bleaching, commercial sun screens, and tanning;

     (vii) Diverter valves for bathtub;

     (viii) Eating/feeding utensils;

     (ix) Emesis basins, enema bags, and diaper wipes;

     (x) Health club memberships;

     (xi) Hot or cold temperature food and drink containers/holders;

     (xii) Hot water bottles and cold/hot packs or pads not otherwise covered by specialized therapy programs;

     (xiii) Impotence devices;

     (xiv) Insect repellants;

     (xv) Massage equipment;

     (xvi) Medication dispensers, such as med-collators and count-a-dose, except as obtained under the compliance packaging program. See chapter 388-530 WAC;

     (xvii) Medicine cabinet and first-aid items, such as adhesive bandages (e.g., Band-Aids, Curads), cotton balls, cotton-tipped swabs, medicine cups, thermometers, and tongue depressors;

     (xviii) Page turners;

     (xix) Radio and television;

     (xx) Telephones, telephone arms, cellular phones, electronic beepers, and other telephone messaging services; and

     (xxi) Toothettes and toothbrushes, waterpics, and peridontal devices whether manual, battery-operated, or electric.

     (l) Certain wheelchair features and options are not considered by the department to be medically necessary or essential for wheelchair use. This includes, but is not limited to, the following:

     (i) Attendant controls (remote control devices);

     (ii) Canopies, including those for strollers and other equipment;

     (iii) Clothing guards to protect clothing from dirt, mud, or water thrown up by the wheels (similar to mud flaps for cars);

     (iv) Identification devices (such as labels, license plates, name plates);

     (v) Lighting systems;

     (vi) Speed conversion kits; and

     (vii) Tie-down restraints, except where medically necessary for client-owned vehicles.



[Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. 07-04-036, § 388-543-1300, filed 1/29/07, effective 3/1/07. Statutory Authority: RCW 74.08.090, 74.09.530. 02-16-054, § 388-543-1300, filed 8/1/02, effective 9/1/02; 01-01-078, § 388-543-1300, filed 12/13/00, effective 1/13/01.]