Sec. 10.67.06.13. Benefits — Disposable Medical Supplies and Durable Medical Equipment

A. An MCO shall provide to its enrollees medically necessary disposable medical supplies and durable medical equipment, including but not limited to:

(1) All supplies and equipment used in the administration or monitoring of prescriptions by the enrollees; and

(2) Incontinency pants and disposable underpads for medical conditions associated with prolonged urinary or bowel incontinence if necessary to prevent institutionalization or infection.

B. Except as required in §C(1), an MCO shall provide preauthorization within 72 hours for DMS/DME services and supplies that require preauthorization by the MCO.

C. An MCO shall provide its enrollees the disposable medical supplies and durable medical equipment in a timely manner so as to not adversely affect the health of the enrollees, in accordance with the following:

(1) For medical equipment or supplies, or both, when there is an urgent medical need such as to facilitate hospital discharge or when a potential exists for worsening of enrollee's condition, the MCO shall provide needed items within 24 hours of request; and

(2) For all other requests for DMS/DME, the MCO shall provide these items within 7 days from the date of request unless the MCO can document to the Department that justification for additional time is necessary.

D. An MCO is responsible for paying for any durable medical equipment authorized and ordered while the member is active with the MCO if:

(1) The delivery of the item occurs within 90 days after the member's termination date from the MCO; and

(2) The member remains a Medicaid recipient.