(a) Specialized medical supplies may include medically necessary:

1. (1) Items necessary for life support or to address a beneficiary’s physical conditions, along with any ancillary supplies and equipment necessary for the proper functioning of such items;
2. (2) Durable and nondurable medical equipment necessary to address a beneficiary’s functional limitations that are not available under the Arkansas Medicaid State Plan, 20 CAR pt. 570;
3. (3) Medical supplies not available under the Arkansas Medicaid State Plan;
4. (4) Nutritional supplements;
5. (5) Nonprescription medications approved by the Federal Drug Administration; and
6. (6) Prescription drugs.

(b) Specialized medical supplies do not include:

1. (1) Medical equipment or medical supplies available under the Arkansas Medicaid State Plan;
2. (2) Items that are not of a direct medical or remedial benefit to a beneficiary; and
3. (3) Alternative medicines that are not approved by the Federal Drug Administration.

(c) A provider of specialized medical supplies must maintain the following documentation in a beneficiary’s service record:

1. (1) The date of the specialized medical supplies order;
2. (2) The quantity and price per item of the specialized medical supplies ordered;
3. (3) A written description of the beneficiary’s medical need addressed, or the remedial benefit provided by the specialized medical supplies;
4. (4) The delivery date of the specialized medical supplies; and
5. (5) If installation is required, the installation date and any instructions that are provided to the beneficiary or legal guardian regarding use of the specialized medical supplies.