Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter II - Specific Policies By Service
Section 144-101-II-109 - Speech and Hearing Services
Subsection 144-101-II-109.09 - POLICIES AND PROCEDURES
Current through 2024-38, September 18, 2024
109.09-1 Records
The provider will maintain an individual record for each member eligible for MaineCare reimbursement, including but not limited to:
Members' records will be kept current and available to the Department as documentation of services included on invoices.
109.09-2 Audiology Reports and Plan of Care
The report of hearing evaluation or specific audiology procedures will include a plan of care based on audiologic and other data obtained. The plan of care is a prerequisite to aural rehabilitation and speech-language therapy, and should include but not be limited to: Diagnosis with severity rating, short and long-term goals(s) and objectives, method of evaluating member change, estimated time to achieve goal(s) and objectives, frequency and duration of therapy contacts, and periodicity of review.
109.09-3 Qualified Professional Staff
A speech-language pathology assistant must be supervised by a licensed speech-language pathologist.
109.09-4 Division of Program Integrity
Members under the age of twenty-one (21) may get the speech and hearing services for which they qualify, and which are covered in the MaineCare Benefits Manual. However, the Department or its authorized agent will review speech and hearing services for children under the age of twenty-one (21) for medical necessity as outlined in Chapter I of this Manual.
See Chapter I of this Manual for additional information on Division of Program Integrity activities.
109.09-5 Procedure to Request Prior Authorization
To request prior authorization of adult services, the request must be made in writing to:
Prior Authorization Unit
Division of Health Care Management
Office of MaineCare Services
11 State House Station
Augusta, Maine 04333-0011