<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.12.05" title_num="10" subtitle_num="09" chapter_num="12" heading="Limitations.">
  <text>The Program does not cover:</text>
  <paragraph num="A.">
    <text>Incontinency pants and disposable underpads unless the following conditions are met:</text>
    <paragraph num="(1)">
      <text>The incontinence supplies are medically necessary for medical conditions associated with prolonged urinary or bowel incontinence;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For pull-on underwear type garments, the recipient is capable of independently putting on and removing the garment; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Disposable incontinence supplies meet, at a minimum, the following absorbent capacity standards:</text>
      <paragraph num="(a)">
        <text>For children's diapers and underwear, not less than 800cc;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>For youth diapers and underwear, not less than 1,000cc;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>For small adult diapers and underwear, not less than 1,200cc;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>For medium adult diapers and underwear, not less than 1,750cc;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>For large, extra large, and bariatric adult diapers and underwear, not less than 2,000cc; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>For disposable underpads, not less than 1,000 cc;</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Osteogenesis stimulators unless the following criteria are met:</text>
    <paragraph num="(1)">
      <text>The use is for noninvasive therapy;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The bone fracture is at least 6 months old, except when used for pseudarthrosis; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The space gap of the fracture measures 1/2 centimeter or less, except when used for pseudarthrosis;</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Osteogenesis stimulators beyond the first 6 weeks of use unless evaluations at the 6-week and 3-month intervals after initial date of service verify recipient use of at least 50 percent of the time prescribed, on a form designated by the Program;</text>
  </paragraph>
  <paragraph num="D.">
    <text>The following durable medical equipment:</text>
    <paragraph num="(1)">
      <text>Equipment prescribed primarily to provide comfort or convenience, including, but not limited to, emesis basins, posture support chairs, over-the-bed tables;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Self-help devices including, but not limited to, grab bars, shower stools, and commode seats;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Abdominal supports;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Bed boards;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Enema bags;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Environmental controls;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Exercise equipment and devices, unless home use of such equipment is a necessary component of an active physical therapy program;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Geriatric chairs;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Heating pads or lamps;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Hot water bottles;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Hydrocollators;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Ice bags;</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Knee cages;</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Nasal atomizers;</text>
    </paragraph>
    <paragraph num="(15)">
      <text>Restraints;</text>
    </paragraph>
    <paragraph num="(16)">
      <text>Sitz baths;</text>
    </paragraph>
    <paragraph num="(17)">
      <text>Soft collars;</text>
    </paragraph>
    <paragraph num="(18)">
      <text>Whirlpools;</text>
    </paragraph>
    <paragraph num="(19)">
      <text>Whirlpool bath equipment;</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Disposable medical supplies and durable medical equipment provided in a facility or by a group when reimbursement is covered by another segment of the Program;</text>
  </paragraph>
  <paragraph num="F.">
    <text>Items which are investigational or experimental in nature;</text>
  </paragraph>
  <paragraph num="G.">
    <text>Nutritional supplements supplied by a DMS/DME provider under this chapter if the provider is also a licensed pharmacy and has a Medicaid Pharmacy provider number;</text>
  </paragraph>
  <paragraph num="H.">
    <text>Food supplements or infant formulas, including enteral nutritional products and supplemental vitamin and mineral products, when administered orally;</text>
  </paragraph>
  <paragraph num="I.">
    <text>Purchase of used equipment, except as approved by the Department as per Regulation .07L of this chapter;</text>
  </paragraph>
  <paragraph num="J.">
    <text>Equipment if the recipient owns or otherwise has access to useable equipment that serves the same purpose as the requested equipment;</text>
  </paragraph>
  <paragraph num="K.">
    <text>Replacement of equipment or a device while the item is still under warranty or before having met the Department’s life expectancy schedule unless prepayment authorization has been obtained.</text>
  </paragraph>
  <paragraph num="L.">
    <text>Replacement of a prosthetic device or component if necessary due to misuse.</text>
  </paragraph>
  <paragraph num="M.">
    <text>Rental of any equipment not in good working condition for the entire length of rental;</text>
  </paragraph>
  <paragraph num="N.">
    <text>Rental of equipment for any period longer than 90 days without renewed documentation of continued medical need from the prescriber for each 90-day period;</text>
  </paragraph>
  <paragraph num="O.">
    <text>Modifications to motor vehicles;</text>
  </paragraph>
  <paragraph num="P.">
    <text>Disposable medical supplies and durable medical equipment ordered by an individual who is not enrolled as a provider in the Program on the date of service; and</text>
  </paragraph>
  <paragraph num="Q.">
    <text>Disposable medical supplies and durable medical equipment ordered by an entity, facility, or other provider that is not an individual.</text>
  </paragraph>
</regulation>