Current through Register Vol. 24-18, September 15, 2024
(1) The medicaid
agency covers:
(a) One artificial larynx, any
type, without prior authorization, per client in a five-year period;
and
(b) One speech generating
device (SGD), with prior authorization, per client every two years.
(2) The agency pays only for those
approved SGDs that have:
(a) Digitized speech
output, using prerecorded messages;
(b) Synthesized speech output requiring
message formation by spelling and access by physical contact with the device;
or
(c) Synthesized speech output,
permitting multiple methods of message formulation and multiple methods of
device access.
(3) The
agency requires prior authorization for SGDs and reviews requests on a
case-by-case basis. Requests to the agency for prior authorization must meet
all of the following:
(a) The client must have
a severe expressive speech impairment and the client's medical condition
warrants the use of a device to replace verbal communication (e.g., to
communicate medical information); and
(b) The request must be in writing and be
accompanied by:
(i) A completed General
Information for Authorization form HCA 13-835). The agency's electronic forms
are available online (see WAC
182-543-7000, Authorization);
and
(ii) A completed Speech
Language Pathologist (SLP) Evaluation for Speech Generating Devices (15-310)
form. The agency requires, at a minimum, the following information:
(A) A detailed description of the client's
therapeutic history;
(B) A written
assessment by a licensed SLP; and
(C) Documentation of all of the following:
(I) The client has reliable and consistent
motor response, which can be used to communicate with the help of an
SGD;
(II) The client has
demonstrated the cognitive and physical abilities to utilize the equipment
effectively and independently to communicate; and
(III) The client's treatment plan includes a
training schedule for the selected device.
(iii) A copy of the prescription for the SGD
from the client's treating physician written on an agency Prescription Form HCA
13-794) (see WAC
182-543-2000(2)
).
(4) The
agency may require trial-use rental of a SGD. The agency applies the rental
costs for the trial-use to the purchase price.
(5) The agency pays for the repair or
modification of an SGD when all of the following are met:
(a) All warranties are expired;
(b) The cost of the repair or modification is
less than fifty percent of the cost of a new SGD and the provider has submitted
supporting documentation; and
(c)
The repair has a warranty for a minimum of ninety days.
(6) The agency does not pay for devices
requested for the purpose of education.
(7) The agency pays for replacement batteries
for a SGD in accordance with WAC
182-543-5500(3).
The agency does not pay for back-up batteries for an SGD.
(8) Clients who are eligible for both
medicare and medicaid must apply first to medicare for an SGD. If medicare
denies the request and the client requests an SGD from the agency, the agency
evaluates the request according to the rules of this section.
11-14-075, recodified as §182-543-3400, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.08.090 and
74.04.050. 11-14-052, §
388-543-3400, filed 6/29/11, effective
8/1/11.
