Chapter 14 Durable Medical Equipment (DME)

Durable Medical Equipment (DME)Age GroupChildren 6 years ofage or underChildren 7 through18 years of ageRecipients 18 yearsof age and aboveChildren and AdultsPurchase or Rental RequirementsPurchases require documentation of previous episodes ofsevere respiratory distress associated with one of the followingdiagnoses:• Asthma• Reactive Airway Disease• Cystic Fibrosis• Bronchiectasis• BronchospasmShort-term Rentals (6 months or less) are allowed for first timeepisodes associated with one of the above diagnoses.Supporting documentation must accompany the request.Purchases require documentation of one of the diagnoseslisted above.Documentation must also be submitted of one of the following:• The recipient has had a failed trial of a least four weeks ofanti-inflammatory drugs (for example, Cromolyn,Nedocromil, and steroids) and bronchodilators (for example,B2 adrenergics, Ipratropium) delivered by metered doseinhaler (MDI) and spacer or dry powder inhalers (DPI).• The recipient’s medical condition prevents the coordinationnecessary to effectively use an MDI and spacer or DPI (i.e.cerebral palsy, mental retardation, neuromuscularweakness, or muscle paralysis).Purchases require documentation of one of the followingdiagnoses:• Asthma• Bronchiectasis• Cystic FibrosisRecipients with a diagnosis of asthma must have documentationof one of the following:• The recipient has had a failed trial of at least four weeks ofinhaled or oral anti-inflammatory drugs and inhaledbronchodilators.• The recipient is a moderate or severe asthmatic whoserescue treatment with MDIs is insufficient to preventhospitalizations or emergency room visits (2 or more ERvisits for asthma or 1 or more hospitalizations in the past 12months).Rentals are approved only on a short-term basis (6 months orless) for acute complications of pneumonia.Purchases may be approved to deliver medications that can beadministered only by aerosol (i.e. Pulmozyme for cystic fibrosis).Must be accompanied by supporting documentation.Rentals may be approved on a short-term basis (6 months orless) to administer medications as an alternative to intravenousadministration of those drugs (for example, nebulizedtobramycin, colistin, or gentamicin). Must be accompanied bysupporting documentation.NOTE:Purchase of the nebulizer is limited to one every four years for recipients whomeet the above criteria.14-12 April 2005