Durable Medical Equipment (DME a. Coverage includes purchase or rental, when Medically Necessary, of such DME that:
Durable Medical Equipment (DME. Benefits are provided for DME. If more than one item can meet your functional needs, Benefits are available only for the item that meets the minimum specifications for your needs. If you purchase an item that exceeds these minimum specifications, we will pay only the amount that we would have paid for the item that meets the minimum specifications, and you will be responsible for paying any difference in cost. DME includes, but isn’t limited to: • Canes. • Cochlear implants and batteries for cochlear implants. • Commode chairs. • Continuous glucose monitors. • Continuous passive motion devices. • Continuous Positive Airway Pressure (CPAP) devices. • Crutches. • Hospital beds. • Insulin pumps. • Infusion pumps. • Nebulizers and peak flow meters. • Oxygen equipment. • Patient lifts. • Pressure-reducing support surfaces. • Suction pumps. • Traction equipment. • Walkers.
Durable Medical Equipment (DME. Provider – a Participating Provider of Durable Medical Equipment that has contracted with the HMO to provide Covered Supplies to Members.
Durable Medical Equipment (DME. You must purchase or rent the DME from the vendor we identify or purchase it directly from the prescribing Network Physician. 40% Yes Yes
Durable Medical Equipment (DME. Medical equipment that can withstand repeated use, is customarily used to serve a medical purpose, is generally not useful in the absence of illness or injury and is appropriate for use in the enrollee's home.
Durable Medical Equipment (DME. As medically necessary. Specified DME services shall be covered/non-covered in accordance with TennCare rules and regulations. Medical Supplies As medically necessary. Specified medical supplies shall be covered/non-covered in accordance with TennCare rules and regulations. Emergency Air And Ground Ambulance Transportation As medically necessary. Non-emergency Medical Transportation (including Non- Emergency Ambulance Transportation) Covered non-emergency medical transportation (NEMT) services are necessary non-emergency transportation services provided to convey members to and from TennCare covered services (see definition in Exhibit A to Attachment XI). Non emergency transportation services shall be provided in accordance with federal law and the Bureau of TennCare’s rules and policies and procedures. TennCare covered services (see definition in Exhibit A to Attachment XI) include services provided to a member by a non-contract or non-TennCare provider if (a) the service is covered by Tennessee’s Medicaid State Plan or Section 1115 demonstration waiver, (b) the provider could be a TennCare provider for that service, and (c) the service is covered by a third party resource (see definition in Section A.1 of the Contract). If a member requires assistance, an escort (as defined in TennCare rules and regulations) may accompany the member; however, only one (1) escort is allowed per member (see TennCare rules and regulations). Except for fixed route and commercial carrier transport, the CONTRACTOR shall not make separate or additional payment to a NEMT provider for an escort. Covered NEMT services include having an SERVICE BENEFIT LIMIT accompanying adult ride with a member if the member is under age eighteen (18). Except for fixed route and commercial carrier transport, the CONTRACTOR shall not make separate or additional payment to a NEMT provider for an adult accompanying a member under age eighteen (18). The CONTRACTOR is not responsible for providing NEMT to HCBS provided through a 1915(c) waiver program for persons with intellectual disabilities (i.e., mental retardation) and HCBS provided through the CHOICES program. However, as specified in Section A.2.11.1.8 in the event the CONTRACTOR is unable to meet the access standard for adult day care (see Attachment III), the CONTRACTOR shall provide and pay for the cost of transportation for the member to the adult day care facility until such time the CONTRACTOR has sufficient provider capacity. The CONTRACT...
Durable Medical Equipment (DME a. Items that are not covered include:
Durable Medical Equipment (DME is any equipment that meets all of the following requirements:
Durable Medical Equipment (DME. As medically necessary. Specified DME services shall be covered/non-covered in accordance with TennCare rules and regulations. Medical Supplies As medically necessary. Specified medical supplies shall be covered/non-covered in accordance with TennCare rules and regulations. Emergency Air And Ground Ambulance Transportation As medically necessary. Non-emergency Medical Transportation (including Non- Emergency Covered non-emergency medical transportation (NEMT) services are necessary non-emergency transportation services provided to convey members to and from TennCare covered services (see definition in Exhibit A to Attachment XI). Non emergency transportation services
Durable Medical Equipment (DME. Durable Medical Equipment (DME) includes equipment and supplies that provide therapeutic benefits and/or enables an individual to perform certain tasks s/he would otherwise be unable to undertake due to certain medical conditions and/or illnesses. DME equipment and supplies are primarily and customarily used for medical reasons—appropriate and suitable for use in the home. The CONTRACTOR must abide by the Managed Care Policy and Procedure Guide and other relevant Department Provider manuals in providing DME equipment and supplies. The CONTRACTOR shall:
