Name that DME
This item helps a member put on clothing without bending or reaching.
What is a dressing stick?
Bathroom equipment such as grab bars or bath seats may be covered through this payer path when criteria are met.
What is Medicaid or waiver, depending on the criteria and process.
A raised toilet seat primarily supports this functional need.
What is toileting safety and transfer support?
Before requesting a grab bar, the coordinator should document these two things
What are functional needs and safety risk?
A member asked if waiver will pay for a shower chair. Should do this before promising coverage.
What is verify criteria, payer path, and the approval process
This bathroom item allows a member to sit while bathing when standing in the shower is unsafe.
What is a shower chair or bath seat?
Compression socks (18mm compression or higher)
What is Medicaid
Grab bars, transfer benches, and gait belts may support this safety concern.
What is fall prevention and safe transfers?
Before requesting transfer-related DME, document these movement-related concerns.
What is mobility limitations, transfer difficulty, fall history, caregiver assistance needed, and safety risk.
A member has a share of chair but still feels unsafe bathing. The care coordinator do next?
What is reassessed baiting safety, ADL needs, fall risk, caregiver support, equipment effectiveness, and update the PCCP and or HSAP if needed
This item helps a caregiver safely assist a member with transfers or walking.
What is a gait belt?
Canes, crutches, walkers, and manual wheelchairs may be covered through this payer path when criteria are met.
What is Medicare and/or Medicaid, depending on criteria and authorization requirements.
A medication lock box, pill organizer, or alarm may support this type of safety need.
What is medication safety, adherence support, or protection from unsafe access.
Before Requesting an assistive technology item, document how the item helps the member do this.
what is maintained safety, independence, communication, access, ADLS/IADLs or community living
A caregiver says transfers from bed to chair are becoming unsafe. The coordinator do next?
What is reassessed transfer safety, caregiver capacity, fall risk, current supports, possible DME or therapy needs, and update the PCCP as needed?
This long-handled tool helps a member pick up items without bending, stretching, or reaching too far.
What is a reacher?
Home modification items, such as grab bar or handrail installation, may be handled through this waiver-related pathway when they support safe community living.
What is waiver/home modification, if criteria are met and the process is followed.
A door/window alarm, floor alarm, or bed alarm may support this risk area when a member has cognitive concerns or unsafe movement.
What is safety monitoring, wandering risk, fall risk, or emergency awareness?
A strong DME request should connect the item to these parts of the member story.
What are assessed need, functional limitation, safety risk, current supports, payer criteria, and the PCCP?
A member request an item that may be assistive technology or home modification, but the coordinator is unsure of the payer path. What should happen next?
What is verified current guidance, review criteria, consult the desktop processes or supervisor, and document the members need and next steps?
This item can help a member reposition or get in and out of bed more safely when they have weakness or transfer difficulty.
What is a bed assist handle?
If an item appears on a DME guide or looks like it could be covered by more than one payer, this must happen before telling a member it will be paid for.
What is verify the payer path, coverage criteria, medical necessity, documentation, and authorization process.
A member with congestive heart failure and limited endurance reports she can walk short distances inside the home but become short of breath when standing to bathe, prepare meals, or complete grooming tasks. She requests the shower chair, roll later, and handled shower head. Functional need do these items primarily support?
what is energy conservation and safe completion of ADLS?
A member requests multiple durable medical equipment items after a recent decline in function. Before submitting the request, what key documentation should the coordinator include to show the item is medically and or functionally necessary and not just preferred?
What is the member's diagnosis or condition, specific functional limitation, safety risk or unmet needs, or member requested item to help remain safe in the home.
ADME item is denied, but the members still has an unresolved safety risk. What is the coordinator's next responsibility?
What is continued care coordination, reassess risk, explore alternatives, escalate as appropriate, update the PCCP, document actions, and monitor follow-up?