CurrentCareSourcePolicy N/A

Standing Frames — Arkansas PASSE

Coverage and medical necessity requirements for non-powered standing frames (standers) for Arkansas PASSE members; governs prior authorization, documentation, replacement, and exclusions for durable medical equipment.

Policy Summary

PayerCareSource

PolicyStanding Frames — Arkansas PASSE

Policy CodePolicy N/A

Change TypeNo material clinical or coverage changes

Effective DateAug 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization and submit Arkansas DMS-679A with stander details, diagnoses, training and home-use documentation.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5 yearsreplacement interval

Arkansasjurisdiction

not coveredpowered standers

DMS-679Arequired form

Coverage and Medical Necessity Criteria

Initial Coverage / Medical Necessity for New Equipment

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Eligibility and prescription: Arkansas DMS-679A form signed and dated by an appropriately Arkansas‑licensed/certified provider (PCP or APRN); the form may serve as the prescription if orders and medical necessity are adequately documented.

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Device identification: Stander information provided, including manufacturer, model number, and type of stander.

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Diagnosis: Specific recipient diagnosis documenting a neuromuscular condition (e.g., multiple sclerosis, cerebral palsy, spinal cord injury, stroke) or documented developmental delay that impairs independent standing.

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Training and safe use: Documentation that the member or parent/guardian received training in use of the stander and can safely use the device in the home (training may occur during scheduled therapy sessions; therapy documentation of trials is acceptable).

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Expected therapeutic benefit: Documentation that use of the device can be reasonably expected to provide therapeutic benefits or enable tasks otherwise not possible due to the diagnosis (examples include prevention of muscle atrophy, improved strength/circulation, prevention of decubitus ulcers, maintenance of bone/skin integrity, reduced swelling, improved ROM, improved bowel/bladder function, decreased spasticity, improved endurance, prevention/decrease of contractures/scoliosis, improved psychosocial outcomes, and increased ADL performance).

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Absence of contraindications: No contraindications to a supported standing program are present (examples include healing fracture or severe osteoporosis preventing weight bearing; significant joint contractures preventing standing; compromised cardiopulmonary status requiring frequent monitoring; significant inflexible skeletal deformities; lack of standing tolerance; or postural hypotension).

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Replacement of Non-powered Standing Frame

Replacement criteria

Replacement of a non-powered standing frame is considered medically necessary after 5 years when both of the following are met: 1) the original medical necessity criteria are still met; and 2) the device is out of warranty and cannot be refurbished or adequately repaired.5 years

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Coverage for standing frames is limited to non-powered standing frames. The policy explicitly excludes electric, motorized, or powered standing frames from coverage. Items or services that are covered under a manufacturer or dealer warranty are not covered by the payer. Requests for equipment that would duplicate or conflict with another DME item already in the recipient's possession may be denied. Additionally, replacements for items or previously approved equipment that have been damaged by perceived misuse, abuse, or negligence are not covered.

Coding and Replacement Interval

inv-04: Replacement interval — every 5 years

Replacement intervalEvery 5 years from date of original provision (replacement considered medically necessary after 5 years when original medical necessity criteria remain met and the device is out of warranty and cannot be refurbished or adequately repaired)

Conditions requiredOriginal medical necessity criteria must still be met at time of replacement (see medical necessity documentation requirements)

Warranty/repair statusDevice must be out of warranty and unable to be refurbished or adequately repaired

Exclusions to replacementReplacements for items damaged by misuse, abuse, or negligence are not covered

Prior Authorization & Provider Requirements

Prior Authorization

Prior Authorization Required

Prior authorization required. CareSource will review medical necessity requests for non-powered standing frames on a case-by-case basis once ALL required documentation is submitted.

Prior authorization required for new non-powered standing frames
Replacement considered medically necessary after 5 years when device is out of warranty and medical necessity criteria are met

Documentation Required

Provider action: submit complete documentation

Provider must submit a complete request packet; incomplete submissions may delay review or result in denial. Ensure documentation shows training and ability to safely use the device in the home, and that no contraindications to supported standing are present.

Document member or parent/guardian training in use of standers/standing frames
Document safe home use (therapy trial notes acceptable)
Document absence of contraindications (see list of examples)

Documentation Required

Required Documentation

Required documentation must include the dated signature of an Arkansas-licensed/certified professional within scope (PCP or APRN may serve). Arkansas DMS-679A may serve as the provider prescription if medical necessity and orders are documented adequately; CareSource may request additional information if medical necessity is not adequately documented.

Arkansas DMS-679A (may serve as prescription)
Provider signature: PCP or APRN (dated)
Stander details: manufacturer, model number, type of stander
Specific recipient diagnoses documenting neuromuscular condition or developmental delay

Denial Risk

Denial Triggers / Not Covered

Denial triggers include requests for electric/motorized/powered standing frames, items covered under manufacturer/dealer warranty, duplicate DME conflicting with items already in possession, and replacement of equipment damaged by misuse/abuse/negligence.

Electric, motorized or powered standing frames — not covered
Items under manufacturer/dealer warranty — not covered
Duplicate/conflicting DME — not covered
Replacement for damage due to misuse/abuse/negligence — not covered

Clinical Background

Supported standing is a common adjunctive therapeutic practice for patients with neurological conditions who cannot stand or walk independently. Home-based supported standing programs are used as part of postural management to help prevent contracture and deformity, reduce pain and asymmetry, and to promote therapeutic outcomes such as improved range of motion, reduced spasticity, preservation of bone density, improved circulation and bowel/bladder function, and psychosocial benefits including increased social interaction and well-being.

Definitions

inv-10: Supported standing / Standing frames — device types and distinguishing features

Device types includedProne, supine, vertical, multi-positional, and sit-to-stand standing frames (non-powered)

Primary functionProvide upright support with straps; these frames provide no mobility but enable supported standing as part of postural management

Distinguishing features — prone/supineDesigned to support the patient in prone or supine orientations to facilitate weightbearing and positioning

Distinguishing features — vertical/multi-positionalAllow upright or adjustable positioning (vertical or multiple positions) to achieve therapeutic goals like ROM and pressure relief

Distinguishing features — sit-to-standEnable transition from sitting to standing for users who require assistance to achieve upright posture

Powered devicesElectric, motorized or powered standing frames are not covered under this policy

DME Medical Necessity Criteria

DME medical necessity criteria

Diagnoses: Documented neuromuscular condition (e.g., multiple sclerosis, cerebral palsy, spinal cord injury, stroke) or developmental delay impairing independent standing.

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Training and safety: Documentation that the member or parent/guardian received training and can safely use the device in the home (therapy session trials acceptable).

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Therapeutic benefit: Documentation that the device is reasonably expected to provide therapeutic benefits such as prevention of muscle atrophy, improved strength/circulation, prevention of decubitus ulcers, maintenance of bone/skin integrity, reduced swelling, improved range of motion, improved bowel/bladder function, decreased spasticity, improved endurance, prevention or reduction of contractures/scoliosis, improved psychosocial well‑being, and increased ability to perform ADLs.

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Contraindications absent: No contraindications to supported standing are present (examples: healing fracture or severe osteoporosis; significant hip/knee/ankle contractures preventing standing; compromised cardiovascular or respiratory systems requiring frequent monitoring; significant inflexible skeletal deformities; lack of standing tolerance; postural hypotension).

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Item	Rule
Non-powered standing frames (standers)
Purchase — Initial provision is treated as a purchase; replacement considered medically necessary after 5 years when original medical necessity criteria are met and the device is out of warranty and cannot be refurbished or adequately repaired.

Replacement Policies

inv-13: non-powered standing frames — replacement interval every 5 years

Replacement interval (non-powered)Every 5 years

Replacement criteriaReplacement considered medically necessary after 5 years when original medical necessity criteria are met and device is out of warranty and cannot be refurbished or adequately repaired

Coverage limitationReplacements for items damaged by misuse, abuse, or negligence are excluded from coverage

Prior Authorization Packet and Documentation

Prior Authorization

Prior authorization packet — required contents

When requesting prior authorization, assemble a complete packet including the Arkansas DMS-679A (which may serve as the prescription), stander manufacturer/model/type, specific diagnoses, training and home-use documentation, signatures, and evidence of expected therapeutic benefit.

Arkansas DMS-679A signed/dated by PCP or APRN
Manufacturer, model number, and type of stander
Specific neuromuscular diagnosis or documented developmental delay
Documentation of training and safe home-use trials (therapy notes acceptable)
Documentation that device is expected to provide therapeutic benefits

Items and Services Not Covered

The policy identifies items that are explicitly not covered: electric, motorized, or powered standing frames; items or services covered under a manufacturer or dealer warranty; DME that would duplicate or conflict with another item currently in the recipient’s possession; and replacement items damaged by misuse, abuse, or negligence. These exclusions should be considered when preparing prior authorization requests and when assessing the recipient’s existing equipment inventory.

Policy Summary

PayerCareSource

PolicyStanding Frames — Arkansas PASSE

Policy CodePolicy N/A

Change TypeNo material clinical or coverage changes

Effective DateAug 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization and submit Arkansas DMS-679A with stander details, diagnoses, training and home-use documentation.

SourceLink

On This Page

OpenPayer

Standing Frames — Arkansas PASSE

Coverage and Medical Necessity Criteria

Coding and Replacement Interval

Prior Authorization & Provider Requirements

Clinical Background

Definitions

DME Medical Necessity Criteria

Rental and Purchase Rules

Replacement Policies

Prior Authorization Packet and Documentation

Items and Services Not Covered