Current through Register Vol. 63, No. 9, September 1, 2024
(1) Augmentative Communications System or
Device and the necessary attachment equipment to bed or wheelchair are a
covered benefit of the Division.
(2) The requested system or device shall be
approved, registered, or listed as a medical device with the Food and Drug
Administration.
(3) Criteria for
coverage: Providers shall meet each of the following components and submit
documentation to the Division with claims subject to PPR and with PA request
for review:
(a) A physician's statement of
diagnosis and medical prognosis (not a prescription for an augmentative device)
documenting the inability to use speech for effective communication as a result
of the diagnosis;
(b) Reliable
cognitive ability and a consistent motor response to communicate that can be
measured by standardized or observational tools:
(A) Object permanence - ability to remember
objects and realize they exist when they are not seen; and
(B) Means end - ability to anticipate events
independent of those currently in progress - the ability to associate certain
behaviors with actions that will follow.
(c) The client shall be assessed by a SLP and
when appropriate an occupational therapist or physical therapist. The
evaluation report shall include:
(A) A
completed OHA 3047 form: Augmentative Communication Device Selection Report
Summary (page 1) and required elements of the Formal Augmentative/Alternative
Communication Evaluation (page 2). Attach additional pages required to complete
information requested;
(B) An
explanation of why this device is best suited for this client and why the
device is the lowest level that will meet basic functional communication
needs;
(C) Evidence of a documented
trial of the selected device and a report on the client's success in using this
device; and
(D) A therapy treatment
plan with the identification of the individual responsible to program the
device and monitor and reevaluate on a periodic basis.
(d) Providers send requests for augmentative
communications systems or devices to the Division; and
(e) The manufacturer's MSRP and the vendor's
acquisition cost quotations for the device shall accompany each request
including where the device is to be shipped.
(4) The Division shall reimburse for the
lowest level of service that meets the medical need.
