Durable Medical Equipment and Adaptive Aids Process

Arizona Administrative Code R9-22-208: "Durable medical equipment means sturdy, long lasting items and appliances that can withstand repeated use, are designed primarily to serve a medical purpose and are not generally useful in a person in the absence of a medical condition, illness, or injury."

Durable Medical Equipment (DME) and adaptive aids must be medically necessary and prescribed by the Primary Care Provider (PCP) or other provider upon referral by the PCP. It is the responsibility of the PCP to fax in the request with documentation to support the medical need for the equipment, the risk to the Member without the equipment, and a comprehensive explanation of how the Member will benefit from the equipment. The documentation should include a therapist's recent evaluation indicating the specifics for the item to include size and model/style when appropriate.

Covered DME and adaptive aids should not duplicate existing equipment provided to the Member.

Please be aware that if a Member is enrolled with the Children's Rehabilitative Services (CRS), the requested item may be the responsibility of this agency and may be redirected to them for review.

Below is a clarification of the process Capstone will be following regarding DME:

PCP is informed of request and performs an independent assessment of the need for this item.
PCP submits request/Rx for DME along with his/her medical documentation/assessment of medical need, and as appropriate, a recent physical therapist evaluation or progress notes and care plan involving the use of the equipment with goals. Capstone has a "DME Request Worksheet" to assist with proper documentation of medical need.
The item requested includes description/correct item number, size and measurements.
Capstone may substitute a more cost-effective item if it is identified as comparable in meeting the Member's DME need.
Training of the Member, family or caregiver in the proper use of the DME equipment is the responsibility of the supplier, therapist, or health care professional that requested the item.