OAR 410-122-0365
Standing and Positioning Aids
(1)
Indications and coverage: If a client has one aid that meets medical needs, regardless of who obtained it, the Division may not provide another aid of same or similar function.(2)
Documentation to be submitted for PA and kept on file by the Durable Medical Equipment (DME) provider:(a)
Documentation of medical appropriateness, which has been reviewed and signed by the prescribing practitioner;(b)
The care plan outlining positioning and treatment regime and all DME currently available for use by the client;(c)
The physician’s order;(d)
The documentation for a customized positioner shall include objective evidence that commercially available positioners are not appropriate;(e)
Each item requested shall be itemized with description of product, make, model number, and manufacturers’ suggested retail price (MSRP);(f)
Submit Positioner Justification form (DMAP 3155) or reasonable facsimile with recommendation for most appropriate equipment. This shall be submitted by a physical therapist, occupational therapist, or prescribing practitioner when requesting a PA;(3)
Gait Belts:(a)
Covered when:(A)
The client weighs 60 lbs. or more; and(B)
The care provider is trained in the proper use; and(C)
The client can walk independently but needs:(i)
A minor correction of ambulation; or(ii)
Minimal or standby assistance to walk alone; or(iii)
Requires assistance with transfer;(b)
Use code E0700.(4)
Standing frame systems, prone standers, supine standers or boards, and accessories for standing frames are covered when:(a)
The client has been sequentially evaluated by a physical or occupational therapist to make certain the client can tolerate and obtain medical benefit; and,(b)
The client is following a therapy program initially established by a physical or occupational therapist; and(c)
The home is able to accommodate the equipment; and(d)
The weight of the client does not exceed manufacturer’s weight capacity; and(e)
The client has demonstrated an ability to utilize the standing aid independently or with caregiver; and(f)
The client has demonstrated compliance with other programs; and(g)
The client has demonstrated a successful trial period in a monitored setting; and(h)
The client does not have access to equipment from another source.(5)
Sidelyers and custom positioners shall meet the following criteria in addition to the criteria in Table 122-0365:(a)
The client shall be sequentially evaluated by a physical or occupational therapist to make certain the client can tolerate and obtain medical benefit; and(b)
The client shall be following a therapy program initially established by a physical or occupational therapist; and,(c)
The home shall be able to accommodate the equipment; and(d)
The caregiver or family are capable of using the equipment appropriately.(6)
Criteria for Specific Accessories:(a)
A back support may be covered when a client:(A)
Needs balance, stability, or positioning assistance; or(B)
Has extensor tone of the trunk muscles; or(C)
Needs support while being raised or while completely standing;(b)
A tall back may be covered when:(A)
The client is over 5’11” tall; and(B)
The client has no trunk control and needs additional support; or(C)
The client has more involved need for assistance with balance, stability, or positioning;(c)
Hip guides may be covered when a client:(A)
Lacks motor control or strength to center hips; or(B)
Has asymmetrical tone that causes hips to pull to one side; or(C)
Has spasticity; or(D)
Has low tone or high tone; or(E)
Needs balance, stability, or positioning assistance;(d)
A shoulder retractor or harness may be covered when:(A)
Erect posture cannot be maintained without support due to lack of motor control or strength; or(B)
Has kyphosis; or(C)
Presents strong flexor tone;(e)
Lateral supports may be covered when a client:(A)
Lacks trunk control to maintain lateral stability; or(B)
Has scoliosis that requires support; or(C)
Needs a guide to find midline;(f)
A headrest may be covered when a client:(A)
Lacks head control and cannot hold head up without support; or(B)
Has strong extensor thrust pattern that requires inhibition;(g)
Independent adjustable knee pads may be covered when a client:(A)
Has severe leg length discrepancy; or(B)
Has contractures in one leg greater than the other;(h)
An actuator handle extension may be covered when a client:(A)
Has no caregiver; and(B)
Is able to transfer independently into standing frame; and(C)
Has limited range of motion in arm or shoulder and cannot reach actuator in some positions;(i)
Arm troughs may be covered when a client:(A)
Has increased tone that pulls arms backward so hands cannot come to midline; or(B)
Has poor tone, strength, or control that causes arms to hang out to side and backward causing pain and risking injury; or(C)
Has needs for posture;(j)
A tray may be covered when proper positioning cannot be accomplished by other accessories;(k)
Abductors may be covered to reduce tone for proper alignment and weight bearing;(L)
Sandals (shoe holders) may be covered when a client:(A)
Has dorsiflexion of the foot or feet; or(B)
Has planar flexion of the foot or feet; or(C)
Has eversion of the foot or feet; or(D)
Has need for safety.(7)
Table 122-0365.
Source:
Rule 410-122-0365 — Standing and Positioning Aids, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-122-0365.