Non-covered items and services include, but are not limited to:

1. (1) Items of a deluxe nature.
2. (2) Replacement of usable equipment.
3. (3) Items for use in hospitals, nursing homes, or other institutions. However, DME items may be provided in nursing homes or other institutions for children through the EPSDT Program.
4. (4) Items for the patient or patient’s caregiver’s comfort and convenience.
5. (5) Items not listed as covered by Medicaid.

6. (6) Rental of equipment, with the following exceptions:

   1. (a) Rental for six months or less, or
   2. (b) Medicare crossover, or
   3. (c) Certain intravenous therapy equipment, or
   4. (d) Short term use due to institutionalization, or
   5. (e) Short term use due to death of a recipient.

Author: Kelli Littlejohn Newman, PharmD, Director, Clinical Services

Statutory Authority: State Plan; 42 CFR §441.15; Title XIX, Social Security Act.

History: Rule effective October 1, 1982. Amended: Filed February 3, 1997; effective March 10, 1997. Amended: Filed April 11, 2008; effective May 16, 2008. Amended: Filed January 11, 2016; effective February 25, 2016.