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Minnesota Department of Human Services Community-Based Services Manual (CBSM)
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Specialized equipment and supplies

Page posted: 10/1/03

Page reviewed: 5/22/18

Page updated: 5/22/18

Legal authority

Federally approved BI, CAC, CADI and EW waiver plans, Alternative Care (AC) program (Minn. Stat. §256B.0913), Minn. R. 9505.0310, Essential Community Supports (ECS) program (Minn. Stat. §256B.0922)

Definition

Specialized equipment and supplies (SES): Devices, controls or medical appliances or supplies specified in the community support plan.

Covered services

This service covers specialized equipment and supplies that allow the person to increase his/her ability to:

  • • Communicate with others
  • • Perceive, control or interact with his/her environment
  • • Perform activities of daily living (ADLs).
  • Specialized equipment and supplies include:

  • • Durable and non-durable medical equipment and supplies not available or denied under the Medicaid state plan
  • • Electronic tablets both as part of a system of environmental controls and as an augmentative communication device
  • • Equipment repair and maintenance, unless covered by the manufacturer's warranty
  • • Items necessary for life support and supplies necessary for the proper functioning of such life support items
  • • Items that exceed the covered service limits under the Medicaid state plan
  • Personal emergency response systems (PERS)
  • • Pre-moistened cleansing wipes to aid in disability-related continence care
  • • Thickening agents when it is determined the person has a medical need
  • • Upgrades and add-ons to otherwise-approved state plan items determined necessary to meet the needs identified in the person’s support plan.
  • The purchase price includes necessary training or instruction on the use of specialized equipment and supplies.

    Essential Community Supports (ECS)

    Under ECS, the specialized equipment and supplies benefit is limited to personal emergency response systems (PERS).

    Non-covered services

    This service does not cover:

  • • Experimental treatments
  • • Items covered under third-party payer liability or that require co-insurance or deductibles
  • • Items that do not provide direct medical or remedial benefit to the person
  • • Oral nutritional products, electrolyte products, foods (including organic or special diet needs), organ extracts and over-the-counter food supplemental products
  • • Prescription and over-the-counter medications, compounds and solutions, and related fees (including premiums and co-payments).
  • In addition, an item is not covered if it restricts a person’s rights or restrains a person and either:

  • • The item is not an adaptive aid or equipment, orthotic device or other medical equipment ordered by a licensed health professional to treat a diagnosed medical condition
  • • The item violates the provisions of Minn. R. Chapter 9544.
  • Electronic tablet

    If the person uses an electronic tablet only for purposes of augmentative communication, the device is funded through the Medicaid state plan as durable medical equipment.

    If the person uses an electronic tablet as part of a system of environmental controls and as an augmentative communication device, the electronic tablet is funded through the waiver/AC program under specialized equipment and supplies.

    Service amounts

    BI, CAC and CADI waivers only

    The person may receive up to $3,909 of specialized equipment and supplies per year.

    For this purpose, a year is calculated based on a 365-day period. DHS determines the 365-day span by counting back from the service agreement header end-date. It may include previous service agreements if the 365 days crosses previous service agreements. Once the service limit has been reached, additional spending must wait until the next year. There are no exceptions to this limitation.

    Personal emergency response systems (PERS)

    The $3909 limit does not include PERS, which has its own service limits. See CBSM – Personal emergency response systems (PERS).

    Provider standards and qualifications

    Specialized equipment and supplies is an approval-option: purchased-item service. For more information, see CBSM – Waiver/AC service provider overview.

    Authorization, rates and billing

    The lead agency authorizes specialized equipment and supplies at the market rate. For more information, see Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

    For information about lead agency and MHCP-enrolled provider responsibilities during the authorization and billing process, see MHCP Provider Manual – Specialized equipment and supplies authorization and billing responsibilities.

    Personal emergency response systems

    PERS has different service limits and authorization codes. For more information, see the PERS-specific entries on Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF) and CBSM – Personal emergency response systems (PERS).

    Additional resources

    CBSM – BI, CAC, CADI and DD waivers general process and procedures
    CBSM – Environmental accessibility adaptations

    CBSM – Personal emergency response systems (PERS)

    CBSM – Rate methodologies for AC, ECS, and EW service authorization

    CBSM – Waiver oral and enteral nutritional products

    MHCP Provider Manual – Equipment and supplies

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