OAR 410-122-0010
Definitions

In addition to the definitions in OAR 410-120-0000 (Acronyms and Definitions) the following definitions in these rules apply:
(1) “Activities of Daily Living (ADL’s)”means activities related to personal care including but not limited to tasks such as eating, toileting, grooming, dressing, and bathing that are necessary to maintain or improve the client’s health.
(2) “Buy-up” means a situation in which a client wants to upgrade to a higher level of service than he or she is eligible for; e.g., a heavy duty walker instead of a standard walker.
(3) “Consecutive Months” means any period of continuous use where no more than a 60-day break occurs.
(4) “Durable Medical Equipment” means equipment furnished by a durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) provider or a home health agency that is primarily and customarily used to serve a medical purpose; generally is not useful to a client in the absence of a medical disability, illness, or injury; can withstand repeated use; can be reusable or removable; and is appropriate for use in any non-institutional setting in which normal life activities take place. Some examples include wheelchairs, crutches, and hospital beds. Durable medical equipment extends to supplies and accessories that are necessary for the effective use of covered durable medical equipment.
(5) “Home” means, for purposes of purchase, rental, and repair of durable medical equipment (DME) that is used primarily as a supportive measure to support a client’s basic daily living activities, a place of permanent residence such as an assisted living facility (includes the common dining area), a 24-hour residential care facility, an adult foster home, a child foster home, or a private home. This does not include hospitals, nursing facilities, intermediate care facilities for individuals with intellectual disabilities, any setting that exists primarily for the purpose of providing medical/nursing care, or any setting in which payment is or could be made under Medicaid for inpatient services that include room and board. Separate payment may not be made to DME providers for equipment and medical supplies provided to a client when the cost of such items is already included in the capitated (per diem) rate paid to a facility or organization.
(6) “Lifetime Need” means 99 months or more.
(7) “Manufacturer Part Number (MPN)” means:
(a) Each manufacturer provides an MPN to identify that manufacturer’s part. It is a specification used by the manufacturer to store a part in an illustrated part catalog (graphics and text);
(b) An MPN uniquely identifies a part when used together with manufacturer code (external manufacturer), which is the own name used by the manufacturer and not the manufacturer name provided by other.
(8) “Medical Records” means the physician’s office records, hospital records, nursing facility records, home health agency records, records from other healthcare professionals, and diagnostic and test reports. This documentation must be made available to the Health Systems Division (Division) upon request.
(9) “Medical Supplies” means health care related items that are disposable or cannot withstand repeated use by more than one individual and are required to address an individual’s medical disability, illness, or injury. Examples of medical supplies include diapers, syringes, gauze bandages, and tubing. Some medical supplies may also be used on a repeated, limited duration basis.
(10) “Medically Appropriate” has the meaning given that term in OAR 410-120-0000 (Acronyms and Definitions).
(11) “Mobility-related Activities of Daily Living (MRADL’s)” means personal care activities including but not limited to tasks such as toileting, eating, dressing, grooming, and bathing.
(12) “Morbidity” means a diseased state, often used in the context of a “morbidity rate” (i.e., the rate of disease or proportion of diseased people in a population). In common clinical usage, any disease state including diagnosis and complications is referred to as morbidity.
(13) “Morbidity Rate” means the rate of illness in a population. The number of people ill during a time period is divided by the number of people in the total population.
(14) “The Division Maximum Allowable Rate” means the maximum amount paid by the Division for a service.
(15) “Practitioner” means an individual licensed pursuant to federal and state law to engage in the provision of health care services within the scope of the practitioner’s license and certification.
(16) “Prosthetic and Orthotic Devices” means devices that replace all or part of an internal body organ, including ostomy bags and supplies directly related to ostomy care and replacement of such devices and supplies. Prosthetic and orthotic devices also include leg, arm, back, and neck braces, and artificial legs, arms, and eyes, including replacements if required because of a change in the client’s physical condition.
(17) “Purchase price” means:
(a) Delivery;
(b) Assembly;
(c) Adjustments, if needed; and
(d) Training in the use of the equipment or supply.
(18) “Rental fees” means:
(a) Delivery;
(b) Training in the use of the equipment;
(c) Pick-up;
(d) Routine service, maintenance, and repair; and
(e) Moving equipment to a new residence, if coverage is to continue.
(19) “Technician” means a DMEPOS provider staff professionally trained through product or vendor-based training, technical school training (e.g., electronics), or through apprenticeship programs with on-the-job training.

Source: Rule 410-122-0010 — Definitions, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-122-0010.

410‑122‑0010
Definitions 410‑122‑0020
Orders 410‑122‑0040
Prior Authorization 410‑122‑0080
Conditions of Coverage, Limitations, and Restrictions 410‑122‑0090
Face-to-Face Encounter Requirements (for Fee-For-Service Clients) 410‑122‑0180
Healthcare Common Procedure Coding System Level II Coding 410‑122‑0182
Legend 410‑122‑0184
Repairs, Servicing, Replacement, Delivery, and Dispensing 410‑122‑0186
Payment Methodology 410‑122‑0188
DMEPOS Rebate Agreements 410‑122‑0200
Pulse Oximeter for Home Use 410‑122‑0202
Positive Airway Pressure (PAP) Devices for Adult Obstructive Sleep Apnea 410‑122‑0203
Oxygen and Oxygen Equipment 410‑122‑0204
Nebulizer 410‑122‑0205
Respiratory Assist Devices 410‑122‑0206
Intermittent Positive Pressure Breathing 410‑122‑0207
Respiratory Supplies 410‑122‑0208
Suction Pumps 410‑122‑0209
Tracheostomy Care Supplies 410‑122‑0210
Ventilators 410‑122‑0211
Cough Stimulating Device 410‑122‑0220
Pacemaker Monitor 410‑122‑0240
Apnea Monitors for Infants 410‑122‑0250
Breast Pumps 410‑122‑0260
Home Uterine Monitoring 410‑122‑0280
Heating/Cooling Accessories 410‑122‑0300
Light Therapy 410‑122‑0320
Manual Wheelchair Base 410‑122‑0325
Power Wheelchair Base 410‑122‑0330
Power-Operated Vehicle 410‑122‑0340
Wheelchair Options/Accessories 410‑122‑0360
Canes and Crutches 410‑122‑0365
Standing and Positioning Aids 410‑122‑0375
Walkers 410‑122‑0380
Hospital Beds 410‑122‑0400
Pressure Reducing Support Surfaces 410‑122‑0420
Hospital Bed Accessories 410‑122‑0475
Therapeutic Shoes for Diabetics 410‑122‑0510
Osteogenesis Stimulator 410‑122‑0515
Neuromuscular Electrical Stimulator (NMES) 410‑122‑0520
Glucose Monitors and Diabetic Supplies 410‑122‑0525
External Insulin Infusion Pump 410‑122‑0540
Ostomy Supplies 410‑122‑0560
Urological Supplies 410‑122‑0580
Bath Supplies 410‑122‑0590
Patient Lifts 410‑122‑0600
Toilet Supplies 410‑122‑0620
Miscellaneous Supplies 410‑122‑0625
Surgical Dressing 410‑122‑0630
Incontinent Supplies 410‑122‑0640
Eye Prostheses 410‑122‑0655
External Breast Prostheses 410‑122‑0658
Gradient Compression Stockings/Sleeves 410‑122‑0660
Orthotics and Prosthetics 410‑122‑0662
Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses 410‑122‑0678
Dynamic Adjustable Extension/Flexion Device 410‑122‑0680
Facial Prostheses 410‑122‑0700
Negative Pressure Wound Therapy Pumps 410‑122‑0720
Pediatric Wheelchairs
Last Updated

Jun. 8, 2021

Rule 410-122-0010’s source at or​.us