Adaptive Beds

Medicaid general guidelines

1. A hospital bed is covered if the member is bed-confined (not necessarily 100 percent of the time) and the member's condition necessitates positioning of the body in a way not feasible in an ordinary bed, or attachments are required which cannot be used on an ordinary bed.

2. Used in the home

3. Side rail pads and shields are covered when there is documented need to reduce risk of entrapment or injury

4. When the extent and duration of the medical need is not known at the time of ordering, hospital beds and related accessories should be rented.

   1. E0328 Pediatric Bed-Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress (prior approval required for ages less than 3 or over 20. Includes manual articulation and manual height adjustment)

   2. The member has a medical condition which 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; or

   3. The member requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain; or

   4. The member 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 must have been considered and ruled out; or

   5. The member requires traction equipment, which can only be attached to a hospital bed

AND

10. The patient has a diagnosis-related cognitive or communication impairment or a severe behavioral disorder that results in risk for safety in bed; and

11. There is evidence of mobility that puts the patient at risk for injury while in bed (more than standing at the side of the bed), or the patient has had an injury relating to bed mobility; and

12. Less costly alternatives have been tried and were unsuccessful or contraindicated (e.g., putting a mattress on the floor, padding added to ordinary beds or hospital beds, transparent plastic shields, medications, helmets); and;

13. The ordering practitioner has ruled out physical and environmental factors as reasons for patient behavior; such as hunger, thirst, restlessness, pain, need to toilet, fatigue due to sleep deprivation, acute physical illness, temperature, noise levels, lighting, medication side effects, over-or under-stimulation, or a change in caregivers or routine.  Please note: For patients with a behavioral disorder, a behavioral management plan is required.

With Canopy

• Safety enclosure frame/canopy for use with hospital bed, any type Coverage Criteria:

• A hospital bed safety enclosure frame/canopy is covered when criteria 10-15 are met, and 16 and 17, if applicable:14. The member’s bed mobility results in risk for safety in bed that cannot be accommodated by an enclosed pediatric manual hospital bed; and

  15. A written monitoring plan approved by the ordering and all treating practitioners has been completed which describes when the bed will be used, how the member will be monitored at specified time intervals, how all of the member’s needs will be met while using the enclosed bed (including eating, hydration, skin care, toileting, and general safety), identification by relationship of all caregivers providing care to the member and an explanation of how any medical conditions (e.g., seizures) will be managed while the member is in the enclosed bed; and

  16. In the absence of injury relating to bed mobility, a successful trial in the home or facility; and

  17. For members residing in an OMRDD certified residence, approval as a restraint with the agency’s Human Rights Committee