Current through Register Vol. 49, No. 9, September, 2024
215.000
Augmentative Communication Device (ACD) Evaluation
Arkansas Medicaid covers evaluations for augmentative
communication devices (ACDs) under the following conditions.
A. Prior authorization by the Division of
Medical Services Utilization Review Section is required for approval of the ACD
evaluation. (See section
231.000 of this manual for prior
authorization procedures for ACD evaluations.)
B. A multidisciplinary team must conduct the
ACD evaluation. The evaluation team must meet the following requirements:
1. A speech-language pathologist who has
earned a Master's Degree in speech-language pathology must lead the team. The
individual is also required to have a Certification of Clinical Competence from
the American Speech-Language and Hearing Association.
2. The team must also include an occupational
therapist who is licensed by the Arkansas State Medical Board.
3. Both the speech-language pathologist and
occupational therapist must have verifiable training and experience in the use
and evaluation of ACD equipment. Their knowledge must include, but not be
limited to, the equipment's use and its working capabilities, mounting and
training requirements, warranties and maintenance.
4. A physical therapist may be added to the
team if it is determined that there is a need for assistance in the evaluation
as it relates to the positioning and seating in utilizing specific ACD
equipment.
5. The team may include
regular and special educators, caregivers and parents. Vocational
rehabilitation counselors may be included for beneficiaries of all
ages.
6. The team must use an
interdisciplinary approach in the evaluation, incorporating the goals,
objectives, skills and knowledge of various disciplines.
7. The team must evaluate at least three ACD
systems, with written documentation of each usage included in the ACD
assessment.
C. After the
team has completed the evaluation, the evaluation report must be submitted to
the prosthetics provider who will request prior authorization for the ACD.
The evaluation report must meet the following
requirements.
1. The report must
indicate the medical reason for the ACD.
2. The report must give specific
recommendations of the system and justify why one system is more appropriate
than another.
3. The
speech-language pathologist must sign the ACD evaluation report.
Refer to section
216.000 of this manual for
benefit limits and section
260.000 of this manual for
procedures code and billing instructions.
230.000 PRIOR
AUTHORIZATION
231.000
Prior
Authorization Request Procedures for Augmentative
Communication Device (ACD) Evaluation
To perform an evaluation for the augmentative communication
device (ACD), the provider must request prior authorization from the Division
of Medical Services, Utilization Review Section, using the following
procedures.
A. A primary care physician
(PCP) written referral is required for prior authorization of the ACD
evaluation. If the beneficiary is exempt from the PCP process, then the
attending physician must make the referral.
B. The physical and intellectual capabilities
(functional level) of the beneficiary must be documented in the referral. The
referring physician must justify the medical reason the individual requires the
ACD.
C. If the beneficiary is
currently receiving speech therapy, the speech-language pathologist must
document the prerequisite communication skills for the augmentative
communication system and the cognitive level of the beneficiary.
D. A completed Request for Prior
Authorization and Prescription Form (DMS-679) must be used to request prior
authorization. View or print form DMS-679 and instructions
for completion. Copies of form DMS-679 can be requested
using the Medicaid Form Request, EDS-MFR-001. View or print
the Medicaid Form Request EDS-MFR-001.
E. Submit the request to the Division of
Medical Services, Utilization Review Section. View or print
the Division of Medical Services, Utilization Review Section contact
information.
When the PA request is received
in Utilization Review, it is given to the Medical Director to review and make a
decision.
F. For
approved requests, a PA control number will be assigned and entered in item 10
on the DMS-679 and returned to the provider. For denied requests, a denial
letter with the reason for denial will be mailed to the requesting provider and
the Medicaid beneficiary.
NOTE: Prior authorization for therapy services only
applies to the augmentative communication evaluation. Refer back to section
215.000 for additional
information.
231.100
Reconsideration of Prior Authorization Determination
Reconsideration of a denial may be requested within thirty (30)
calendar days of the denial date. Requests must be made in writing and must
include additional documentation to substantiate the medical necessity of the
ACD evaluation.
232.000
Appealing an Adverse Action
Please see section
190.003 for information regarding
administrative appeals.
262.120
Augmentative Communication
Device (ACD) Evaluation
The following procedure codes require prior authorization
before services may be provided.
|
Procedure Code |
Description |
|
92607 |
Augmentative Communication Device
Evaluation |
|
92608 |
262.400
Special Billing
Procedures
Services may be billed according to the care provided and to
the extent each procedure is provided. Occupational, physical and speech
therapy services do not require prior authorization with the exception of ACD
evaluations. ACD evaluations do require prior authorization. Refer to section
215.000 for information about the
augmentative communication device evaluation.
Extension of benefits may be provided for all medically
necessary therapy services for beneficiaries under age 21. Refer to sections
216.000 through
216.310 of this manual for more
information.
