Current through Register Vol. 63, No. 9, September 1, 2024
(1) Speech-language
pathology, audiology, and hearing aid providers are subject to PPR or shall
obtain PA for services exceeding 30 habilitative and 30 rehabilitative visits
in a calendar year.
(2) Providers
shall request PA as follows (see the SLP, Audiology and Hearing Aid Services
Program Supplemental Information booklet for contact information):
(a) For Medically Fragile Children's Unit
(MFCU) clients, from the Authority's MFCU;
(b) For clients enrolled in the
fee-for-service Medical Case Management program, from the Medical Case
Management contractor;
(c) For
clients enrolled in an MCE, from the MCE;
(d) For clients requiring visits in excess of
30 habilitative visits and 30 rehabilitative visits per calendar
year.
(3) For services
requiring PA, providers shall contact the responsible unit for authorization
within five working days following initiation or continuation of services. The
FAX or postmark date on the request shall be honored as the request date. It is
the provider's responsibility to obtain PA.
(4) For services subject to PPR and to ensure
reimbursement of SLP services, beyond the initial evaluation, the SLP provider
must submit all required supporting documentation:
(a) Upon submission of the first claim in a
series of claims in each therapy plan of care as established by prescribing
practitioner per OAR 410-129-0020 for claims subject
to PPR;
(b) Request a PA within
five working days following 30 rehabilitative or 30 habilitative visits within
a calendar year if additional visits are necessary:
(A) PA requests dated within five working
days may be approved retroactively to include services provided within five
days prior to the date of the PA request;
(B) PA requests dated beyond five working
days may not be authorized retroactively and if authorized shall be effective
the date of the PA request. The Division recognizes the facsimile or postmark
as the PA date of request.
(c) All claims subject to PPR or that
requires PA must include a therapy plan of care; and
(d) A PA is not required for Medicare-covered
SLP services provided to dual-eligible clients (Medicare clients who are also
Medicaid-eligible).
(5)
If the service or item is subject to PPR or requiring PA, the provider shall
follow and comply with PPR or PA requirements in these rules and the General
Rules (OAR chapter 410, division 120) including but not limited to:
(a) The service is adequately documented (see
OAR 410-120-1360 Requirements for
Financial, Clinical and Other Records). Providers shall maintain documentation
in the provider's files to adequately determine the type, medical
appropriateness, or quantity of services provided;
(b) The services provided are consistent with
the information submitted when authorization was requested;
(c) The services billed are consistent with
those services provided;
(d) The
services are provided within the timeframe specified on the authorization of
payment document; and
(e) Includes
the PA number on all claims for services that require PA, or the Division shall
deny the claim.
Publications referenced are available from the
agency.
Statutory/Other Authority: ORS
413.042
Statutes/Other Implemented: ORS
414.025 & ORS
414.065
