<html> <head> <title>Rule 67:16:29:02 Medical equipment covered.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:29:02"> <META NAME="Description" Content="Administrative Rules 67:16:29:02 Medical equipment covered."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink=purple> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:29:02.&nbsp;&nbsp;Medical equipment covered.</b> Covered medical equipment includes medical equipment,</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>prosthetic devices, and medical supplies required to improve the functioning of a malformed</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>body part or treatment of an illness or injury</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>, which</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'> are listed on the department's fee schedule</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>website and prescribed by a physician</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'> or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>. The recipient's condition must meet the coverage criteria</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>listed on the department's billing guidance website for the item to be covered. Items not</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>listed may not be covered by South Dakota Medicaid. Documentation substantiating</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>the recipient's condition must be on file with the provider. Items requiring prior authorization are</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>listed on the department's prior authorization website.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Supplies necessary for the effective use or proper functioning of covered medical equipment are covered when:</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>The equipment is covered by Medicaid;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>The recipient's condition meets the coverage criteria for equipment; and</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;&nbsp;</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>The equipment is owned by the recipient.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Supplies for rented durable medical equipment are included in the Medicaid rental</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>payment, unless specifically listed on the department's billing guidance website.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; In addition to the specific limits established in this chapter, replacement of medical equipment is allowed only when a medical condition exists which necessitates the replacement of the particular piece of equipment.&nbsp; The prescribing physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> must determine whether a medical necessity exists and must document the need on the prescription for the replacement equipment.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Non-covered items may be requested by the recipient's physician</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'> or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>. Requests for non</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>-</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>covered</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>items must demonstrate medical necessity and be prior authorized by the department.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 9 SDR 164, effective June 30, 1983; 12 SDR 70, effective October 31, 1985; transferred from &#167; 67:16:02:12, 14 SDR 46, effective September 28, 1987; 16 SDR 239, effective July 9, 1990; 17 SDR 194, effective July 1, 1991; 18 SDR 210, effective June 23, 1992; 22 SDR 138, effective May 2, 1996; 24 SDR 11, effective August 4, 1997; 25 SDR 18, effective August 18, 1998; 29 SDR 116, effective February 23, 2003; 35 SDR 88, effective October 23, 2008; 44 SDR 94, effective December 4, 2017; 47 SDR 38, effective October 6, 2020.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1(1)</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-Reference:</b> Limits on the provision of medical equipment</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'> and supplies</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>, &#167;</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>&nbsp;</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>67:16:29:04.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html>