WAC 388-543-1700   When the department covers rented DME.  (1) The department's reimbursement amount for rented durable medical equipment (DME) includes all of the following:

     (a) Delivery to the client;

     (b) Fitting, set-up, and adjustments;

     (c) Maintenance, repair and/or replacement of the equipment; and

     (d) Return pickup by the provider.

     (2) The department requires a dispensing provider to ensure the DME rented to a client is both of the following:

     (a) In good working order; and

     (b) Comparable to equipment the provider rents to clients with similar medical equipment needs who are either private pay clients or who have other third-party coverage.

     (3) The department considers rented equipment to be purchased after twelve months' rental unless one of the following apply:

     (a) The equipment is restricted as rental only; or

     (b) Other department published issuances state otherwise.

     (4) The department rents, but does not purchase, certain medically necessary equipment for clients. This includes, but is not limited to, the following:

     (a) Bilirubin lights for newborns at home with jaundice; and

     (b) Electric breast pumps.

     (5) The department's minimum rental period for covered DME is one day.

     (6) If a fee-for-service (FFS) client becomes a managed care plan client, both of the following apply:

     (a) The department stops paying for any rented equipment on the last day of the month preceding the month in which the client becomes enrolled in the managed care plan; and

     (b) The plan determines the client's continuing need for the equipment and is responsible for reimbursing the provider.

     (7) The department stops paying for any rented equipment effective the date of a client's death. The department prorates monthly rentals as appropriate.

     (8) For a client who is eligible for both medicaid and medicare, the department pays only the client's coinsurance and deductibles. The department discontinues paying client's coinsurance and deductibles for rental equipment when either of the following applies:

     (a) The reimbursement amount reaches medicare's reimbursement cap for the equipment; or

     (b) Medicare considers the equipment purchased.

     (9) The department does not obtain or pay for insurance coverage against liability, loss and/or damage to rental equipment that a provider supplies to a DSHS client.



[Statutory Authority: RCW 74.08.090 and 74.04.050. 07-17-062, § 388-543-1700, filed 8/13/07, effective 9/13/07. Statutory Authority: RCW 74.08.090, 74.09.530. 01-01-078, § 388-543-1700, filed 12/13/00, effective 1/13/01.]