23 Miss. Code. R. 209-1.28 - Hospital Beds
A. The Division of
Medicaid defines a hospital bed as a medical device with:
1. An articulating frame allowing adjustment
of the head and foot of the bed,
2.
A headboard,
3. A
footboard,
4. A mattress,
and
5. Side
rails.
B. The Division of
Medicaid covers hospital beds when medically necessary, prior authorized by the
Utilization Management/Quality Improvement Organization (UM/QIO), the Division
of Medicaid or designated entity and ordered by a physician for purchase or
rental up to the purchase amount.
1. The
Division of Medicaid defines a manual fixed-height hospital bed as one with
manual head and leg elevation adjustments but no height adjustment and is
covered when a beneficiary meets one (1) of the following:
a) Requires positioning of the body in ways
not feasible with a non-hospital bed in order to alleviate pain,
b) Requires the head of the bed to be
elevated thirty (30) degrees or more due to a medical condition including, but
not limited to, congestive heart failure, chronic pulmonary disease, or risk of
aspiration,
c) Has failed to
achieve the desired clinical outcome, with pillows or wedges,
d) Requires equipment that can only be
attached to a hospital bed,
e) Has
a disease, injury, or condition causing paralysis, immobility, or severe
malaise and weakness requiring the performance of bathing, bodily functions,
and other treatment or care while in bed, or
f) Is semi-comatose or comatose.
2. The Division of Medicaid
defines a manual variable-height hospital bed as one with manual height, head
and leg elevation adjustments and is covered when a beneficiary:
a) Meets one (1) of the criteria listed in
Miss. Admin. Code Part 209, Rule 1.28.B.1., and
b) Requires a bed height different than a
fixed height hospital bed to permit transfers to chair, wheelchair or standing
position.
3. The Division
of Medicaid defines a semi-electric hospital bed as one with manual height
adjustment and with electric head and leg elevation adjustments and is covered
when a beneficiary:
a) Meets one (1) of the
criteria in Miss. Admin. Code Part 209, Rule 1.28.B.1.a) through e) and
B.2.b),
b) Is able to operate the
hospital bed controls, and
c) Lives
alone or with assistance of a caregiver, but without continuous twenty-four
(24) hours per day caregiver support.
4. The Division of Medicaid defines bariatric
hospital beds as heavy duty extra-wide and extra-heavy duty extra wide hospital
beds used for beneficiaries whose weight and/or body measurements exceed the
manufacturer's limit for size or weight of a standard hospital bed and is
covered when:
a) The beneficiary meets one
(1) of the criteria listed in Miss. Admin. Code Part 209, Rule 1.28.B.1., and
b) Documentation includes current
weight and body measurements that exceed the manufacturer's limit for size and
weight of a standard hospital bed which is obtained within thirty (30) days of
request.
C. The
Division of Medicaid covers total electric hospital beds when medically
necessary, prior authorized by the Utilization Management/Quality Improvement
Organization (UM/QIO), the Division of Medicaid or designated entity and when
the following criteria are met:
1. An
orthopedist, neurologist, physiatrist, or a physician with expertise in
treating beneficiaries with disabilities and/or special needs orders the
hospital bed and documents the following:
a)
Medical necessity detailing the clinical rationale for the hospital bed,
b) The number of hours and times
of the day the beneficiary is expected to be in the hospital bed, and
c) The reason a lower cost
hospital bed does not meet the needs of the beneficiary.
2. A Mississippi licensed occupational or
physical therapist conducts an on-site evaluation of the location where the
hospital bed is to be used includes certification of the following:
a) The hospital bed is for the exclusive use
of the beneficiary,
b) The hospital
bed can be installed without structural or electrical modifications to the
environment, and
c) The beneficiary
and/or caregiver are trained in the use, cleaning and care of the hospital
bed.
3. The hospital bed
has a full two (2) year warranty.
4. The beneficiary has not received a total
electric hospital bed within the last five (5) years.
Notes
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No prior version found.