12VAC30-60-350: Criteria for coverage of specialized treatment beds

A. DMAS will pay $10 per day toward the cost of specialized treatment beds for eligible NF recipients who have at least one treatable Stage IV pressure ulcer. Specialized treatment bed means either an air-fluidized bed or a low-air-loss bed. To be approved for this service, the following criteria must be met:

1. The individual must have at least one Stage IV pressure ulcer as documented on the MDS.

2. The individual must require the use of a specialized treatment bed as ordered by a physician for the treatment of at least one Stage IV pressure ulcer.

3. The nursing facility must obtain authorization by submitting the authorization request to DMAS or the preauthorization agent.

B. Nursing facilities shall not be eligible to receive this additional payment for residents who are enrolled in the specialized care program.

C. Limits. DMAS shall provide the additional $10 per day reimbursement for recipients meeting criteria for no more than 246 days annually. Nursing facilities may receive the reimbursement for up to 82 days per new occurrence of a Stage IV ulcer. There must be at least 30 days between each reimbursement period. Limits are per recipient, regardless of the number of providers rendering services.