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016.06.48-242.194. Replacement, Growth and Modification of Specialized Wheelchairs and Wheelcha...

AR ADC 016.06.48-242.194Arkansas Administrative CodeEffective: September 1, 2018

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 48. Prosthetics Provider Manual (Refs & Annos)
Section 242.000. CMS-1500 Billing Procedures.
Section 242.100. HCPCS Procedure Codes.
Effective: September 1, 2018
Ark. Admin. Code 016.06.48-242.194
016.06.48-242.194. Replacement, Growth and Modification of Specialized Wheelchairs and Wheelchair Seating Systems
Currentness
Arkansas Medicaid will cover replacement equipment as needed due to growth, normal wear and tear, theft, irreparable damage or loss not covered by insurance.
The following requirements must be met:
A. Detailed documentation from the beneficiary's PCP or ordering physician /APRN describing the significant changes in the beneficiary's condition that require growth/modification or replacement must be submitted.
B. The request must be submitted on form DMS-679 (Prescription & Prior Authorization Request for Medical Equipment). View or print form DMS-679 and instructions for completion.
C. An Evaluation for Wheelchair and Wheelchair Seating form (DMS-0843) must be submitted. The evaluation must be signed and dated by the beneficiary's PCP/APRN or ordering physician. The signature must be an original signature. A stamped signature will not be accepted by Arkansas Medicaid. An electronic signature will be accepted. View or print form DMS-0843.
D. A manufacturer's suggested retail price list and a manufacturer's quote must be submitted. A quote created by the DME provider will not be accepted.
E. Requests for replacement where malicious damage, neglect or misuse of the equipment may have occurred may be investigated by Arkansas Medicaid. Requests may be denied if such circumstances are confirmed.
F. If a wheelchair is stolen or damaged by vehicle, fire or in the home, the beneficiary must provide the following with the request:
1. A police or fire report.
2. Copy of the homeowner's or auto insurance coverage.
3. Detailed documentation of events leading to the loss and damage.
If Arkansas Medicaid denies a repair or replacement in a case of malicious damage or misuse, payment of repairs is the responsibility of the beneficiary or caregiver.

Credits

Adopted July 1, 2017. Amended Sept. 1, 2018.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through May 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.48-242.194, AR ADC 016.06.48-242.194
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