Contract Type: DME (Durable Medical Equipment)
The contractor and contractor staff that provide services described in this chapter also must comply with Chapters 1–3 of the VR Standards for Providers manual.
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The standards in this chapter apply to contracted durable medical equipment (DME) purchased by the Texas Workforce Commission Vocational Rehabilitation (TWC-VR) for customers.
TWC-VR may only purchase the DME described in this chapter from contracted providers.
The VR counselor may authorize the purchase of DME described in this chapter only when it is vocationally necessary and is expected to improve the customer's ability to participate in VR services that are required to obtain, maintain, advance in, or regain employment as defined in the customer's individualized plan for employment (IPE).
A contract with TWC-VR is required to provide the goods listed in 8.3 Description of DME.
The contractor is required to:
TWC-VR may purchase the following DME on a contract basis, including parts and accessories, when the medical prescription for the customer is less than six months old:
DME may be purchased or rented from a noncontracted provider when the cost:
Note: TWC-VR may purchase other types of DME (not listed) using TWC-VR's MAPS.
The provider determines the specific equipment needed based on professional recommendations, the customer's prescription and additional information from the VR counselor.
A provider will deliver prescribed DME that is fully functional, calibrated, set up, and ready for immediate use by the customer in accordance with the TWC-VR approved recommendations and the service authorization issued by TWC-VR. As requested by the customer or TWC-VR, the TWC-VR contractor must be able to make necessary adjustments when setting up the equipment.
The DME provider obtains written recommendations that include the specifications (type, size, and special features) of the equipment prescribed.
When an existing wheelchair owned by the customer needs to be repaired, TWC-VR obtains an estimate of the cost for repair to the original chair from the local provider of wheelchair repair services. TWC-VR applies best value principles in considering whether repair or replacement is the more cost-effective course.
Fabricated goods must meet the specification approved by the VR counselor. This includes:
The contractor gives the VR customer written instructions on how to operate and maintain the purchased equipment.
Based on the product type and the manufacturer's warranty, the contractor provides preventive maintenance at no additional cost to VR:
If goods or equipment purchased with VR funds are subsequently returned to the contractor, or exchanged or replaced by the contractor, the contractor must notify the VR office in writing.
The notice must include:
If the item or equipment being returned has a different price or is substantially different from the original item or equipment, then VR will issue a replacement service authorization for the new item or equipment.
When a refund is due, the contractor must by the 15th of each month send a check for the total credit accumulated during the previous calendar month. The payment must be accompanied by supporting documentation and/or credit invoices for each transaction or item for which the credit reimbursement is issued. The supporting documentation and/or credit invoices must include the service authorization number and the customer's case ID number.
Contractors agree to provide the contracted DME listed in 8.3 Description of DME at the established 18 percent discount from the manufacturer's suggested retail price (MSRP) for the entire functional unit.
TWC-VR is the payer of last resort. After the customer's primary and/or secondary benefit coverage has been applied, VR pays the contractor an amount equal to the copayment, coinsurance, or deductible due. VR does not pay more than the amount allowed by the customer's insurance or more than the rate specified in the VR contract, whichever is less.
Contracted DME that is vocationally necessary, but that is declined coverage by the customer's primary and/or secondary benefit coverage, is paid at the rate specified in the VR contract only when a service authorization has been issued by VR prior to the purchase.
VR staff provides the contractor with a copy of the recommendations for the prescriptions and equipment to be purchased.
The contractor determines the specific equipment needed based on professional recommendations, the customer's prescription, and additional information from the VR counselor.
The contractor provides the VR counselor with a cost estimate that includes the:
VR staff issues a service authorization, with the approved estimated cost, to confirm the purchase is approved. Purchase is not authorized until the contractor receives a service authorization from VR.
For the contractor to receive payment, the contractor:
The contracted DME provider must provide the following:
VR staff is authorized to pay the provider for the entire functional unit upon verification the equipment was delivered and all the documentation listed above was received.