016-06-06 Ark. Code R. § 40
Current through Register Vol. 49, No. 6, June, 2024
Rule 016.06.06-040 - Occupational, Physical, Speech Therapy Services Update Transmittal #63215.000Augmentative Communication Device (ACD) EvaluationArkansas Medicaid covers evaluations for augmentative communication devices (ACDs) under the following conditions.
A. Prior authorization by the Division of Medical Services Utilization Review Section is required for approval of the ACD evaluation. (See section 231.000 of this manual for prior authorization procedures for ACD evaluations.)B. A multidisciplinary team must conduct the ACD evaluation. The evaluation team must meet the following requirements: 1. A speech-language pathologist who has earned a Master's Degree in speech-language pathology must lead the team. The individual is also required to have a Certification of Clinical Competence from the American Speech-Language and Hearing Association.2. The team must also include an occupational therapist who is licensed by the Arkansas State Medical Board.3. Both the speech-language pathologist and occupational therapist must have verifiable training and experience in the use and evaluation of ACD equipment. Their knowledge must include, but not be limited to, the equipment's use and its working capabilities, mounting and training requirements, warranties and maintenance.4. A physical therapist may be added to the team if it is determined that there is a need for assistance in the evaluation as it relates to the positioning and seating in utilizing specific ACD equipment.5. The team may include regular and special educators, caregivers and parents. Vocational rehabilitation counselors may be included for beneficiaries of all ages.6. The team must use an interdisciplinary approach in the evaluation, incorporating the goals, objectives, skills and knowledge of various disciplines.7. The team must evaluate at least three ACD systems, with written documentation of each usage included in the ACD assessment.C. After the team has completed the evaluation, the evaluation report must be submitted to the prosthetics provider who will request prior authorization for the ACD. The evaluation report must meet the following requirements.
1. The report must indicate the medical reason for the ACD.2. The report must give specific recommendations of the system and justify why one system is more appropriate than another.3. The speech-language pathologist must sign the ACD evaluation report. Refer to section 216.000 of this manual for benefit limits and section 260.000 of this manual for procedures code and billing instructions.
230.000 PRIOR AUTHORIZATION231.000Prior Authorization Request Procedures for AugmentativeCommunication Device (ACD) Evaluation
To perform an evaluation for the augmentative communication device (ACD), the provider must request prior authorization from the Division of Medical Services, Utilization Review Section, using the following procedures.
A. A primary care physician (PCP) written referral is required for prior authorization of the ACD evaluation. If the beneficiary is exempt from the PCP process, then the attending physician must make the referral.B. The physical and intellectual capabilities (functional level) of the beneficiary must be documented in the referral. The referring physician must justify the medical reason the individual requires the ACD.C. If the beneficiary is currently receiving speech therapy, the speech-language pathologist must document the prerequisite communication skills for the augmentative communication system and the cognitive level of the beneficiary.D. A completed Request for Prior Authorization and Prescription Form (DMS-679) must be used to request prior authorization. View or print form DMS-679 and instructions for completion. Copies of form DMS-679 can be requested using the Medicaid Form Request, EDS-MFR-001. View or print the Medicaid Form Request EDS-MFR-001.E. Submit the request to the Division of Medical Services, Utilization Review Section. View or print the Division of Medical Services, Utilization Review Section contact information. When the PA request is received in Utilization Review, it is given to the Medical Director to review and make a decision.F. For approved requests, a PA control number will be assigned and entered in item 10 on the DMS-679 and returned to the provider. For denied requests, a denial letter with the reason for denial will be mailed to the requesting provider and the Medicaid beneficiary.NOTE: Prior authorization for therapy services only applies to the augmentative communication evaluation. Refer back to section 215.000 for additional information.
231.100Reconsideration of Prior Authorization DeterminationReconsideration of a denial may be requested within thirty (30) calendar days of the denial date. Requests must be made in writing and must include additional documentation to substantiate the medical necessity of the ACD evaluation.
232.000 Appealing an Adverse ActionPlease see section 190.003 for information regarding administrative appeals.
262.120Augmentative Communication Device (ACD) EvaluationThe following procedure codes require prior authorization before services may be provided.
Procedure Code | Description |
92607 | Augmentative Communication Device Evaluation |
92608 | |
262.400Special Billing ProceduresServices may be billed according to the care provided and to the extent each procedure is provided. Occupational, physical and speech therapy services do not require prior authorization with the exception of ACD evaluations. ACD evaluations do require prior authorization. Refer to section 215.000 for information about the augmentative communication device evaluation.
Extension of benefits may be provided for all medically necessary therapy services for beneficiaries under age 21. Refer to sections 216.000 through 216.310 of this manual for more information.
016.06.06 Ark. Code R. § 040