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care; or

(2) provided by or under arrangements made by the hospice program. (d) The department will not pay for the repair of durable medical equipment while the recipient is in a skilled nursing facility or an intermediate care facility. (e) The department will not pay separately for the repair, return shipping, or preventive maintenance or service of durable medical equipment for which the cost of repair, return shipping, or preventive maintenance or service is included in the rental fee. (f) The department will not pay for the repair or preventive maintenance or service of durable medical equipment for which there is no documented medical necessity that is current under 7 AAC 120.200( l) for the continued use of that item. (g) The department will not pay a provider enrolled as a durable medical equipment provider under 7 AAC 105.210 for medical supplies that are required under federal law to be provided at no cost to employees, including gloves, masks, and isolation gowns. (h) For a recipient who is eligible for both Medicare and Medicaid,

(1) a provider enrolled as a durable medical equipment provider under 7 AAC 105.210 must follow Medicare guidelines for use of the Advance Beneficiary Notice of Noncoverage, Form CMS-R-131, in situations where Medicare payment is expected to be denied;

(2) the department will not pay for durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2) billed with codes exceeding the recipient’s medical necessity as determined by evidence-based clinical protocols and Medicare national and local coverage determinations; and

(3) the department will not pay for durable medical equipment for a Medicare-covered item, including a manual or power wheelchair, for a recipient who is eligible for both Medicare and Medicaid if Medicare has determined the equipment medically unnecessary for that recipient; a provider enrolled as a durable medical equipment provider under 7 AAC 105.210 must get a Medicare determination of medical necessity before seeking payment from the department in excess of the copay and deductible. (i) A provider may not bill for durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics or related items and services under 7 AAC 120.200(a)(2) using a miscellaneous code from the Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900, if a specific code is available and appropriate. If the department pays a claim based on a provider’s erroneous use of a miscellaneous code under this subsection, the department may seek recovery under 7 AAC 105.260 of payment for those services or items and impose sanctions under 7 AAC 105.400 — 7 AAC 105.490. (j) The department will not pay for durable medical equipment, medical supplies, prefabricated off-the-shelf orthotics, or related items and services under 7 AAC 120.200(a)(2) that require CMS prior authorization under 42 C.F.R. 414.234(c)(1) and for which the provider