CurrentCareSourcePolicy N/A

Non-powered standing frames (standers) — Arkansas PASSE

Covers medical necessity review and coverage criteria for non-powered standing frames for Arkansas PASSE members; applies to providers requesting DME authorization and Arkansas-enrolled prescribing clinicians.

Policy Summary

PayerCareSource

PolicyNon-powered standing frames (standers) — Arkansas PASSE

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 1, 2025

Next Review DateN/A

Key ActionSubmit Arkansas DMS-679A with required clinical documentation and a dated signature from an Arkansas-licensed prescriber to request prior authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5 yearsreplacement interval

non-powered onlypowered excluded

DMS-679Arequired form

Home-basedplace of use

Coverage & Medical Necessity Criteria

Initial Medical Necessity Criteria

Policy Summary

PayerCareSource

PolicyNon-powered standing frames (standers) — Arkansas PASSE

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 1, 2025

Next Review DateN/A

Key ActionSubmit Arkansas DMS-679A with required clinical documentation and a dated signature from an Arkansas-licensed prescriber to request prior authorization.

SourceLink

On This Page

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Primary documentation and prescriber: Submission of Arkansas DMS-679A with dated signature by an Arkansas-licensed and/or certified medical professional within scope of practice and with a professional relationship with the member (e.g., PCP or APRN).

CareSource may request additional information if medical necessity is not adequately documented.

Device details: Provide stander manufacturer, model number, and type of stander.

Clinical diagnosis: Specific recipient diagnosis documenting a neuromuscular condition (e.g., multiple sclerosis, cerebral palsy, spinal cord injury, stroke) or documented developmental delay impairing ability to stand independently.

Training and home safety: Documentation that member or parent/guardian received training in use of the stander and can safely use the device in the home setting (e.g., PT trial notes).

Training may be completed during a scheduled therapy session.

Expected therapeutic benefit: Documentation that use is reasonably expected to provide one or more therapeutic benefits such as prevention of muscle atrophy, improved strength/circulation, prevention of decubitus ulcers, reduced lower-extremity swelling, maintenance of bone/skin integrity, improved range of motion or skeletal development, decreased muscle spasms, improved renal/bladder/bowel function, improved cardiovascular endurance, improved social/psychological well-being, prevention/decrease of contractures or progressive scoliosis, or increased ADL performance.

Contraindications absent: No contraindications to a supported standing program (examples include significant hip/knee/ankle contractures preventing standing, significant inflexible skeletal deformities, compromised cardiovascular or respiratory systems requiring frequent monitoring, lack of standing tolerance, postural hypotension, or healing fracture/severe osteoporosis precluding weight bearing).

Exceptions and duplication rules: items or services covered under manufacturer or dealer warranty are not eligible for coverage, and replacement requests must demonstrate the device is out of warranty and cannot be refurbished or adequately repaired. CareSource will also deny coverage for DME that would duplicate or conflict with another item currently in the recipient's possession. Replacement requests that document damage due to misuse, abuse, or negligence are not covered.

Codes & Replacement Interval

Required forms / administrative codesmixed

DMS-679A

Prescription & Prior Authorization Request for Medical Equipment (Arkansas form)

inv-06: Replacement interval — 5 years

Replacement intervalReplacement of a non-powered standing frame is considered medically necessary after 5 years when the original medical necessity criteria are met and the device is out of warranty and cannot be refurbished or adequately repaired.

Condition for replacementDevice must be out of warranty and not able to be refurbished or adequately repaired.

Documentation requirementCurrent medical necessity documentation must be on file demonstrating continued need per policy criteria.

Prior Authorization & Submission Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for non-powered standing frames. Submit the Arkansas DMS-679A form (Prescription & Prior Authorization Request for Medical Equipment) with a dated prescriber signature from an appropriately licensed Arkansas provider within their scope of practice and with a professional relationship to the member (examples: PCP, APRN). CareSource may request additional information if medical necessity is not adequately documented.

Required form: Arkansas DMS-679A
Acceptable signers: primary care physician (PCP), advanced practice registered nurse (APRN)
Dated prescriber signature required

Documentation Required

Provider Submission Requirements

Providers must include complete device and clinical documentation at time of submission to avoid delays. Ensure the request clearly documents medical necessity as specified in policy (diagnosis, functional limitations, expected therapeutic benefit).

Include manufacturer, model number, and type of stander
Provide recipient diagnosis documenting a neuromuscular condition or developmental delay impairing independent standing
Document therapeutic benefit expected from standing/stander use

Documentation Required

Required Documentation

The following documentation must be submitted with the prior authorization request; missing, incomplete, or unsigned items are common triggers for denial.

Completed Arkansas DMS-679A with dated prescriber signature
Device details: manufacturer, model number, type of stander
Documentation of training in use of stander (member or parent/guardian) — may be completed during a therapy session
Documentation that the member or parent/guardian can safely use the device in the home setting (eg, therapy trial notes)
Clinical documentation of diagnosis and functional limitations (eg, MS, CP, SCI, stroke, developmental delay)

Denial Risk

Triggers for Denial

Denials may be issued when required forms or documentation are missing, incomplete, or unsigned, or when medical necessity criteria are not met or cannot be validated from the submission.

Missing Arkansas DMS-679A or no dated prescriber signature
Missing device details (manufacturer, model, type)
No documentation of training or home-use safety
Insufficient clinical documentation of diagnosis or expected therapeutic benefit
Device is electric/motorized (not covered) or duplicates existing DME

DME Medical Necessity Documentation

DME Medical Necessity

Medical necessity criteria for non-powered standing frames mirror the Coverage criteria and must be documented.

Device type: Non-powered standing frame appropriate for the member's needs (e.g., prone, supine, vertical, multi-positional, sit-to-stand types).

Diagnosis: Neuromuscular condition or documented developmental delay impairing the recipient's ability to stand independently.

Training/home safety: Documentation that member or parent/guardian received training in use of the stander and can safely use the device in the home setting (e.g., PT trial notes).

Arkansas DMS-679A may serve as the provider prescription if medical necessity and orders are documented adequately; dated prescriber signature required.

Purchase vs Rental

Equipment	Purchase / Rental Rule	Replacement interval	Coverage notes
Non-powered standing frames (standers) — includes prone, supine, vertical, multi-positional, and sit-to-stand types	Purchase	5 years from initial purchase when device is out of warranty and cannot be refurbished or adequately repaired	Covered when all medical necessity criteria are met (see Coverage Criteria); powered/electric standing frames are not covered; items under manufacturer/dealer warranty or duplicate/conflicting DME are not covered

Required Documentation Details

Billing Rule

DMS-679A can serve as the prescription if fully completed

The Arkansas DMS-679A may serve as the prescription if it includes the prescriber's dated signature, device details (manufacturer, model number, type), the recipient diagnosis, and documentation of training/home use.

Must include dated signature of an appropriately Arkansas-licensed and/or certified medical professional within scope of practice (PCP or APRN) (chunk 4)
Must document device manufacturer, model number, and type of stander (chunk 4)
Must document specific diagnosis and training/home-use safety (chunk 4)

Clinical Background

Background: supported standing is an adjunctive, home-based therapeutic practice intended for members who cannot stand independently due to neuromuscular conditions or developmental delays. Supported standing with a non-powered stander may help prevent contractures and progressive deformity, maintain joint range of motion and bone integrity, reduce lower-extremity swelling, prevent decubitus ulcers, improve bladder/bowel function and cardiovascular endurance, and provide psychosocial benefits. Contraindications include significant contractures or inflexible skeletal deformities, compromised cardiopulmonary status that requires frequent monitoring, lack of standing tolerance, postural hypotension, or recent healing fracture/severe osteoporosis that precludes weight bearing.

Key Definitions

inv-12: Definition — Durable Medical Equipment (DME)

DefinitionDurable Medical Equipment (DME): A collective term for a covered DME item, prosthetic device, orthotic device, or medical supply item furnished by an eligible provider to an eligible recipient.

ScopeIncludes prosthetic and orthotic devices and medical supplies when furnished by eligible providers.

PurposeDME items support recipients' health care needs in the community/home setting as specified by the policy.

inv-13: Definition — Postural Management

DefinitionPostural Management: A multi-disciplinary approach incorporating a comprehensive schedule of daily and night-time positions, equipment, and physical activity to help maintain or improve body structures and function and increase activity and participation.

ComponentsIncludes daily/night-time positioning, appropriate supportive equipment, and activity programs.

GoalDesigned to maintain or improve body structure/function and increase activity and participation for recipients requiring postural support.

OpenPayer