N.D. Admin Code 92-01-02-29.5 - Power mobility devices
1. An
injured employee must obtain a primary health care provider's order of medical
necessity supported by objective medical findings before the purchase of a
power mobility device may be approved by the organization. The primary health
care provider's order must contain the following:
a. Patient's name;
b. Date of patient's face-to-face
examination;
c. Pertinent diagnosis
or conditions that relate to the need for device or modification;
d. Description of what is ordered;
e. Length of need;
f. Primary health care provider's signature;
and
g. Date of primary health care
provider's signature.
2.
There must be clear medical documentation of functional limits of standing and
walking with an assistive device. Documentation must support reasons why a
cane, walker, or manual wheelchair cannot be used to complete activities of
daily living.
3. A primary health
care provider must make a referral for a mobility assessment and the assessment
must be performed by a licensed or certified occupational therapist or physical
therapist with specific training and experience in rehabilitation mobility or
wheelchair evaluations. The assessment must be completed prior to the approval
of a power mobility device.
4. When
the power mobility device is primarily intended for outdoor use or recreational
purposes, the device is not medically necessary.
5. Upgrades to a power mobility device are
not considered medically necessary if the upgrade is primarily intended for
luxury, outdoor, or recreational purposes. Specific items such as power tilt or
recline seating will only be approved if the injured employee is at risk of
additional medical complications, has issues with transfer, or an upgrade will
help manage the injured employee's tone and spasticity.
6. An injured employee who has been approved
for a power mobility device must independently qualify for a motor vehicle
purchase or home modification as provided in subsection 5 of North Dakota
Century Code section 65-05-07, section 92-01-02-29.3, and section
92-01-02-29.4.
7. If an injured
employee does not sustain a catastrophic injury or if exceptional circumstances
do not exist as provided in subsection 5 of North Dakota Century Code section
65-05-07, but the injured employee is approved for a power mobility device, the
organization, in its sole discretion, may approve a vehicle modification or
adaptation for the injured employee, but may not approve a vehicle
purchase.
8. All initial and
replacement requests for power mobility devices must meet the criteria in this
section.
9. An appeal of a decision
made by the organization under this section must be adjudicated pursuant to
North Dakota Century Code section 65-02-20.
Notes
General Authority: NDCC 65-02-08
Law Implemented: NDCC 65-05-07
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