D.C. Mun. Regs. tit. 29, r. 29-9905

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-9905 - SPEECH PATHOLOGY AND AUDIOLOGY SERVICES

9905.1

Medicaid reimbursable Speech Pathology and Audiology services are skilled therapeutic interventions to address communicative and speech disorders to maximize a beneficiary's expressive and receptive communication skills and are intended to treat the beneficiary's medical or non- medical communicative disorder.

9905.2

Medicaid reimbursable Speech Pathology and Audiology services shall be provided in accordance with the beneficiary's plan of care as described in Subsection 9900.4.

9905.3

In accordance with the District of Columbia Medicaid State Plan, Speech Pathology and Audiology services shall be limited to beneficiaries eligible through the Early Periodic Screening Diagnostic Treatment (EPSDT) benefit.

9905.4

In accordance with the District of Columbia Medicaid State Plan, Speech Pathology and Audiology services shall only be provided by a facility licensed to provide medical rehabilitation services or a Home Care agency.

9905.5

In order to be eligible for Medicaid reimbursement, a Home Care agency providing Speech Pathology and Audiology services shall meet the requirements under Subsection 9901.2.

9905.6

Medicaid reimbursable Speech Pathology and Audiology services shall be provided by a speech language pathologist or audiologist with at least two (2) years of experience that is licensed in accordance with the District of Columbia Health Occupations Revision Act of 1985, as amended, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01et seq.) and implementing rules.

9905.7

Medicaid-reimbursable Speech Pathology and Audiology services shall consist of the following duties:

(a) Conducting a comprehensive assessment, which shall include the following:

(1) A background review and current functional review of communication capabilities in different environments, including employment, residence, and other settings in which normal life activities take place;

(2) An evaluation of the beneficiary's potential for using augmentative or alternative speech devices, methods, or strategies;

(3) An evaluation of the beneficiary's potential for using sign language or other expressive communication methods; and

(4) A needs assessment for the use of adaptive eating equipment.

(b) Developing and implementing the treatment plan that describes treatment strategies including, direct therapy, training caregivers, monitoring requirements, monitoring instructions, and anticipated outcomes;

(c) Assisting beneficiaries with voice disorders to develop proper control of vocal and respiratory systems for correct voice production, if applicable;

(d) Conducting aural rehabilitation by teaching sign language and/or lip reading to people who have hearing loss, if applicable;

(e) Recording daily progress notes and summary notes at least quarterly, or more frequently as needed;

(f) Conducting periodic examinations, modifying treatments for the beneficiary receiving services and ensuring that the recommendations are incorporated into the Plan of Care; when necessary; and

(g) Conducting discharge planning.

9905.8

In accordance with Subsection 9900.14, Speech Pathology and Audiology services shall only be reimbursed by Medicaid with prior authorization and approval by DHCF.

9905.9

Speech Pathology and Audiology services shall be reimbursed pursuant to the District of Columbia's Medicaid fee schedule, available at www.dc-medicaid.com. [File Link Not Available]

D.C. Mun. Regs. tit. 29, r. 29-9905

Final Rulemaking published at 64 DCR 418 (1/19/2018)