1. (1) Indications and limitations of coverage and medical appropriateness: The Division may cover a hospital bed when conditions of coverage in OAR 410-122-0080 and the following criteria are met:

   1. (a) A fixed height hospital bed (E0250, E0251, E0290, E0291, E0328) when the client meets at least one (1) of the following criteria:

      1. (A) Has a medical condition that requires positioning of the body in ways not feasible with an ordinary bed. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed;
      2. (B) Requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain;
      3. (C) Requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration. Pillows or wedges shall have been considered and ruled out;
      4. (D) Requires traction equipment that can only be attached to a hospital bed;

   2. (b) A variable height hospital bed (E0255, E0256, E0292 and E0293) when all of the following criteria are met:

      1. (A) Criteria for a fixed height hospital bed are met;
      2. (B) A bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair, or standing position is required;

   3. (c) A semi-electric hospital bed (E0260, E0261, E0294, E0295, and E0329) when all of the following criteria are met:

      1. (A) Criteria for a fixed height hospital bed are met;
      2. (B) Frequent changes or an immediate need for a change in body position are required;
      3. (C) The client or caregiver is capable of safely and effectively operating the bed controls;

   4. (d) A heavy duty extra wide hospital bed (E0301, E0303) when all of the following criteria are met:

      1. (A) Criteria for a fixed height hospital bed are met;
      2. (B) The client weighs more than 350 pounds but less than 600 pounds;
      3. (C) The client or caregiver is capable of safely and effectively operating the bed controls;

   5. (e) An extra heavy duty hospital bed (E0302, E0304) when all of the following are met:

      1. (A) Criteria for one of the hospital beds described in (1)(a)-(d) are met;
      2. (B) The client weighs more than 600 pounds;
      3. (C) The client or caregiver is capable of safely and effectively operating the bed controls;
      4. (D) When provided for a nursing facility client, the bed shall be rated for institutional use;
   6. (f) Total electric hospital beds (E0265, E0266, E0296, E0297, and E0329) are reviewed on a case-by-case basis to determine if the client’s documentation supports the height adjustment feature is medically necessary and medically appropriate for the treatment of the client’s condition;
   7. (g) No prior authorization (PA) is required for the initial two (2) months rental of a hospital bed unless otherwise specified in this rule (2)(b) and (d). The DMEPOS provider is responsible to ensure all requirements in this rule are met.

2. (2) PA Required: PA is obtained from the same authorizing authority as specified in OAR 410-122-0040 and required for the following services:

   1. (a) Initial purchase or subsequent rentals of a hospital bed starting with the third (3rd) month date of service;
   2. (b) Total electric hospital beds starting with the first (1st) month rental or upon initial purchase;
   3. (c) Replacement of a hospital bed during the five (5) year reasonable useful lifetime due to loss, theft, or irreparable damage;
   4. (d) Enclosed safety beds starting with the first (1st) month rental or upon initial purchase. Refer to the Division’s policy for criteria and coverage guidelines: https://www.oregon.gov/oha/HSD/OHP/Announcements/Safety-Bed-Policy1124.pdf.

3. (3) Documentation requirements:

   1. (a) For services requiring prior authorization, submit documentation that supports coverage criteria specified in this rule are met, including:

      1. (A) For all hospital beds:

         1. (i) Primary diagnosis code for the condition necessitating the need for a hospital bed;
         2. (ii) The type of bed currently used by the client and why it doesn’t meet the medical needs of the client;
      2. (B) For semi-electric beds: Why a variable height bed cannot meet the medical needs of the client;
      3. (C) For heavy duty and extra heavy-duty beds: The client’s height and weight.
   2. (b) Documentation and medical records to support the client meets all criteria and conditions of coverage in this rule must be kept on file with the DMEPOS provider and shall be made available to the Division upon request.

4. (4) Table 122-0380 — Hospital Beds.

   [ED. NOTE: To view attachments referenced in rule text, click here for PDF copy.]

Statutory/Other Authority

ORS 413.042 & 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 87-2025, amend filed 12/09/2025, effective 12/09/2025
DMAP 14-2024, minor correction filed 01/04/2024, effective 01/04/2024
DMAP 101-2023, amend filed 12/29/2023, effective 01/01/2024
DMAP 11-2016, f. 2-24-16, cert. ef. 3-1-16
DMAP 15-2007, f. 12-5-07, cert. ef. 1-1-08
OMAP 47-2006, f. 12-15-06, cert. ef. 1-1-07
OMAP 44-2004, f. & cert. ef. 7-1-04
OMAP 25-2004, f. & cert. ef. 4-1-04
OMAP 47-2002, f. & cert. ef. 10-1-02
OMAP 32-2001, f. 9-24-01, cert. ef. 10-1-01
OMAP 37-2000, f. 9-29-00, cert. ef. 10-1-00
OMAP 13-1999, f. & cert. ef. 4-1-99
OMAP 11-1998, f. & cert. ef. 4-1-98
HR 7-1997, f. 2-28-97, cert. ef. 3-1-97
HR 17-1996, f. & cert. ef. 8-1-96
HR 41-1994, f. 12-30-94, cert. ef. 1-1-95
HR 10-1994, f. & cert. ef. 2-15-94
HR 9-1993, f. & cert. ef. 4-1-93
HR 32-1992, f. & cert. ef. 10-1-92
HR 13-1991, f. & cert. ef. 3-1-91