(A) Loss or
impairment of speech or hearing shall include communicative disorders resulting
from genetic defects, birth defects, injury, illness, disease, developmental
disabilities or delays or other causes whether of organic or nonorganic
etiology and whether or not the person suffering from that loss or impairment
had the capacity for speech, language or hearing before the loss or impairment
occurred;
(B) Necessary care and
treatment shall include services to identify, assess, diagnose and consult
about the need for treatment and to evaluate and monitor the effectiveness of
treatment whether by instrumental, perceptional or standard procedures as well
as the provision of treatment for any of the previously mentioned communicative
disorders. These services shall include, but not be limited to:
1. Diagnostic and extended evaluation of
hearing, which may include pure tone air conduction thresholds, speech
thresholds, bone conduction thresholds, prediction of hearing loss from
acoustic reflex, reflex eliciting auditory test, communication handicap
inventories, word/sentence recognition tests and evoked potential monitoring
and testing;
2. Determining range,
nature and degree of hearing function related to a patient's auditory
efficiency;
3. Comprehensive
behavioral evaluation for sensorineural site which includes advanced acoustic
reflex tests, tests of auditory adaptation, tests of frequency discrimination
and tests of intensity discrimination;
4. Testing, adjusting and evaluating auditory
prosthetic devices which may include sound field tests, such as aided
word/sentence recognition, real ear measures, warble tone thresholds, narrow
band noise thresholds, and comfortable and uncomfortable loudness levels while
wearing an auditory prosthesis;
5.
Differentiation between organic and nonorganic hearing disabilities through
evaluation of total response pattern and use of acoustic tests;
6. Planning, directing, conducting or
participating in conservation, habilitative and rehabilitative programs
including hearing aid selection and orientation, counseling, guidance, auditory
training, speech reading, language habilitation and speech
conservation;
7. Coordinating and
consulting with educational, medical and other professional groups, and with
patients and their families;
8.
Diagnosing and evaluating speech and language competencies of individuals,
including assessment of speech and language skills as related to educational,
medical, developmental, social and psychological factors;
9. The services enumerated in paragraphs
(2)(B)1.-8. shall be designed to evaluate and treat individuals to develop or
utilize speech, language and other communicative skills to the maximum extent
possible to remedy any loss or impairment for which services are being
provided. However, nothing in this rule shall be construed to require services
to improve public speaking, care of the professional voice or accent
reduction;
10. Cognitive training
secondary to open or closed head injury, regardless of cause;
11. Assisting individuals with voice
disorders to develop proper control of the vocal and respiratory systems for
correct voice production;
12.
Evaluating and treating children with delayed or impaired speech or language
disorders;
13. Determining the need
for augmentative/prosthetic communication systems whether or not that system or
that device replaces a body part. These systems or devices may include, but are
not limited to, sign language, gesture systems, communication boards,
electronic automated devices, mechanical devices, alaryngeal prosthesis,
palatal prosthesis and synthetic voice systems; and
14. Planning, directing, or conducting
habilitative and rehabilitative treatment programs to restore or provide
communicative efficiency to individuals with communication problems of organic
and nonorganic etiology, such as partial to total glossectomy, partial to total
laryngectomy, or both; and
(C) Other covered services shall mean any
other medically necessary medical or health care services, or both, for which
coverage is provided whether or not for acute conditions, provided while a
patient in a hospital, or provided by or in a rehabilitation center, skilled
nursing facility, clinic, home health agency or community-based program. This
means that limitations on coverage may not be specific to speech, language and
hearing disorders or for services rendered by speech language pathologists and
audiologists.