26 Tex. Admin. Code § 261.228 - Augmentative Communication Device System
(a) A specialized augmentative communication
device system (ACD), also referred to as a speech-generating device system, is
reimbursable if purchased by a program provider for a resident and all
requirements of this section are met.
(b) A program provider must request and
receive authorization from DADS before purchasing an ACD, referred to in this
section as "prior authorization." The request for prior authorization must
include:
(1) an evaluation and recommendation
from a licensed speech therapist to purchase the ACD;
(2) a signed statement from the resident's
attending physician that the ACD is medically necessary for the resident to
maximize his functional communication; and
(3) a minimum of two bids for the ACD or a
request for an exception to the two-bid minimum if the recommended ACD is
available through only one vendor.
(c) The evaluation and recommendation from
the licensed speech therapist must include:
(1) a description of how the ACD will
specifically meet the needs of the resident;
(2) detailed instructions for training on the
use of the ACD for the resident, program provider staff, and resident's family
(if applicable);
(3) a diagnosis
relevant to the need for the ACD; and
(4) the specific ACD being
recommended.
(d) If an
ACD costs more than $10,000, DADS facilitates an independent speech language
review, at DADS' expense, to determine necessity for the ACD.
(e) After receiving prior authorization from
DADS, the program provider must purchase the ACD.
(f) To obtain reimbursement from DADS, a
program provider must submit to DADS the receipt for payment for the ACD and a
copy of the prior authorization from DADS.
(1) A program provider must fully investigate
and use funding sources to pay for an ACD before submitting the request for
reimbursement to DADS. If another funding source will pay for part of the cost
of the ACD, the program provider may request reimbursement from DADS for the
balance of the cost if the requirements in subsections (b) and (c) of this
section are met. If another funding source is available, DADS reimburses the
program provider no more than the balance remaining after other sources are
used fully.
(2) A program provider
must submit the request for reimbursement to DADS within one year after the
date of purchase.
(3) DADS
reimburses the amount of the authorized bid or the balance remaining after all
other sources are used fully.
(g) If DADS denies a request for
reimbursement because the program provider did not receive prior authorization
or did not submit the necessary documentation for the ACD, the program provider
is responsible for the cost of the ACD.
(h) If DADS denies a prior authorization
request, the resident may request a Medicaid fair hearing in accordance with 1
TAC Chapter 357, Subchapter A.
(i)
Only the resident may use the ACD, and the program provider must identify the
ACD as the personal property of the resident.
(1) Upon discharge from the facility, the
resident must retain the ACD. If the resident dies, the ACD must be Transferred
to the resident's estate. If the ACD is donated or sold to the program provider
by the resident or the resident's estate, the program provider must document
the transaction.
(2) The program
provider is responsible for repairing and maintaining the ACD while the
resident resides in the facility.
Notes
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No prior version found.