Specialized Medical Equipment and Supplies and Assistive Technology shall only mean the following:
a. An assistive device or adaptive aid or control designed for individuals with special functional needs which:
(1) Increases the ability to perform activities of daily living (e.g., adaptive eating utensils and dishware; an adaptive toothbrush); or
(2) Increases the ability to communicate with others (e.g., a hearing aid; an augmentative alternative communication device or system; an adaptive phone for individual with visual or hearing impairments); or
(3) Increases the ability to perceive or control the environment within the home (e.g., a smoke alarm with a vibrating pad or flashing light); and
b. A stander or standing table; and
c. A gait trainer; and
d. A sidelyer or similar positioning device; positioning wedges or rolls or similar positioning items; and
e. Supplies necessary for the proper functioning of specialized medical equipment or assistive technology covered within the scope of this waiver definition; and
f. Repair of specialized medical equipment or assistive technology devices covered within the scope of this waiver definition when the repair is not covered by warranty and when it is substantially less expensive to repair the equipment or device than replace it.
Specialized Medical Equipment, Supplies, and Assistive technology shall be medically necessary and shall be recommended by a qualified health care professional (e.g., physician, occupational therapist, physical therapist).
The following items are excluded from coverage:
a. Items not of direct medical or remedial benefit to the waiver participant;
b. Items covered by the Medicaid State Plan/TennCare Program;
c. Hearing aids and augmentative alternative communication systems for children under age 21 years;
d. Eyeglasses, frames, and lenses;
e. Elevators, stairway lifts, stair glides, platform lifts, stair-climbing devices, electric powered recliners, elevating seats, and lift chairs;
f. Sensory processing/sensory integration equipment or other items used in sensory integration therapy (e.g., ankle weights, weighted vests or blankets, sensory/therapy balls, swings, vibrators, floor mats, balance boards, brushes, trampolines);
g. Carpets, rugs, flooring, floor pads and mats; curtains, drapes, and window treatments; furniture, lamps, and lighting;
h. Beds, mattresses, bedding, and overbed tables;
i. Air conditioning systems or units, heating systems or units; water purifiers, air purifiers, vaporizers, dehumidifiers, and humidifiers;
j. Electrical generators, electrical service, or emergency electrical backup systems;
k. Adaptive devices for use with items specifically excluded by this waiver definition;
l. Recreational or exercise equipment and adaptive devices for such; adaptive tricycles;
m. Toys, toy equipment, and adaptive devices for toys (e.g., flash switches);
n. Radios, televisions, or related electronic audiovisual equipment (e.g., DVD players); telephone, television, or internet service; and equipment or items for education, training, or entertainment purposes;
o. Personal computers; printers, monitors, scanners, and other computer-related hardware and software (excluding equipment designed specifically and primarily to be used as an augmentative alternative communication systems for adults);
q. Stethoscopes or blood pressure cuffs;
s. Diapers and other incontinence supplies;
t. Food, food supplements, food substitutes (including formulas), and thickening agents;
u. Prescription and over-the-counter medications; vitamins, minerals, and nutritional supplements;
v. Swimming pools, hot tubs, whirlpools and whirlpool equipment, and health club memberships;
w. Lifting and tracking systems for transfer of waiver participants;
x. Supplies other than those supplies specifically required for the proper functioning of specialized medical equipment or assistive technology devices that are covered within the scope of this definition;
y. Duplicate items of specialized medical equipment or assistive technology, excluding adaptive eating utensils and dishware, to provide the waiver participant with a backup or spare;
z. Repair of equipment covered by warranty;
aa. Physical modification of the interior or exterior of a place of residence; and
bb. Physical modification of a motor vehicle or motor vehicle parts and services, including adaptive devices to facilitate driving.
Specialized Medical Equipment, Supplies and Assistive Technology is not intended to replace services available through the Medicaid State Plan/TennCare Program or services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act. To the extent that such services are covered, all applicable Medicaid State Plan/TennCare Program services shall be exhausted prior to using the waiver service.
Reimbursement shall be subject to approval of an itemized competitive bid as required in accordance with the department’s policy on submission of bids.
If the requirement for an itemized competitive bid is applicable, documentation of an approved bid must be submitted with the request for the Specialized Medical Equipment, Supplies, and Assistive Technology or the request will be denied.
The purchase price for waiver-reimbursed Specialized Medical Equipment, Supplies and Assistive Technology shall be considered to include the cost of the item as well as basic training on operation and maintenance of the item.
Applicable limits, if any, on the amount, frequency, or duration of this service:
Specialized Medical Equipment, Supplies and Assistive Technology shall be limited to a maximum of $10,000 per waiver participant per 2 waiver program years.