1. (1) Specialized medical equipment and supplies service is the provision of items of medical equipment and supplies to an enrolled member for the purpose of maintaining and improving the enrolled member's ability to reside at home and to function in the community.

2. (2) Specialized medical equipment and supplies must:

   1. (a) be functionally necessary and relate specifically to the enrolled member's disability;
   2. (b) substantively meet the enrolled member's needs for accessibility, independence, health, or safety;
   3. (c) be likely to improve the enrolled member's functional ability or the ability of a caregiver or service provider to maintain the enrolled member in the enrolled member's home; and
   4. (d) be the most cost-effective item that can meet the needs of the enrolled member.

3. (3) Specialized medical equipment and supplies service does not include:

   1. (a) items used for leisure and recreational purposes only;
   2. (b) items of clothing;
   3. (c) basic household furniture;
   4. (d) educational items including computers, software, and books unless such items are purchased in conjunction with an environmental control unit; or
   5. (e) coverage for dentistry or dental-related procedures, services, equipment or supplies. This includes any 'D' procedure code definitions identified in the current American Medical Association's Common Procedural Terminology (CPT) manual or identified as dental pursuant to Medicare, the American Dental Association, and/or Montana Medicaid.
4. (4) Specialized medical equipment and supplies service includes service animals as defined in ARM 37.90.463.
5. (5) Certain items of medical equipment or supplies for short term use, as specified by the department, may be leased or rented instead of purchased.
6. (6) The department may require a consultation prior to the purchase of certain equipment and supplies.

Authorizing statute(s): 53-2-201, 53-6-402, MCA

Implementing statute(s): 53-6-402, MCA

History: NEW, 2006 MAR p. 2665, Eff. 10/27/06; AMD, 2020 MAR p. 1173, Eff. 7/1/20; AMD, 2024 MAR p. 2234, Eff. 9/21/24.