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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 19NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION
SUBCHAPTER AAVENDOR PAYMENT
RULE §19.2613Augmentative Communication Device Systems

(a) A specialized augmentative communication device system (ACD), also referred to as a speech-generating device system, is reimbursable if purchased by a facility for a Medicaid recipient and all criteria defined in this section are met. A physician and a licensed speech therapist must determine a recipient needs the ACD, and the facility must obtain DADS' approval of the request for reimbursement.

(b) A facility must request and receive prior authorization from DADS before purchasing the ACD. The request for prior authorization must include:

  (1) an evaluation and recommendation from a licensed speech therapist to purchase the ACD;

  (2) an attestation from the recipient's attending physician that the ACD is medically necessary for the recipient to maximize his functional communication within the facility's environment; 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 only available through one vendor.

(c) The evaluation from the licensed speech therapist must include:

  (1) a description of how the ACD will specifically meet the need of the recipient;

  (2) detailed instructions for training on the use of the ACD for the recipient, facility staff, and 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 will facilitate an independent speech language review, at DADS' expense, to determine necessity for the ACD.

(e) After receiving prior authorization from DADS, the facility must purchase the ACD.

(f) To obtain reimbursement from DADS, a facility must submit to DADS the receipt for payment for the ACD and a copy of the approved prior authorization.

  (1) A facility must fully explore and use other 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 ACD expense, the facility may request reimbursement for the balance if the requirements in subsections (b) and (c) of this section are met. If another funding source is available, DADS reimburses only up to the remaining balance after other sources are fully utilized.

  (2) A facility must submit the request for reimbursement within one year after the date of purchase.

  (3) DADS reimburses the amount of the authorized bid or the remaining balance after all other sources are fully utilized.

(g) If DADS denies a request for reimbursement because the facility failed to obtain prior authorization or submit the necessary documentation for the ACD, the facility is responsible for the cost of the ACD.

(h) If DADS denies a prior authorization request, the recipient may request a Medicaid fair hearing in accordance with 1 TAC Chapter 357, Subchapter A.

(i) Only the recipient can use the ACD, and it must be identified as the personal property of the recipient.

  (1) Upon discharge from the facility, the recipient retains the ACD. If the recipient dies, the ACD must be transferred to the recipient's estate. If it is donated or sold to the facility by the recipient or the recipient's estate, the transaction must be documented. (See §19.416 of this title (relating to Personal Property)).

  (2) The facility is responsible for the repair and maintenance of the ACD while the recipient resides in the facility.


Source Note: The provisions of this §19.2613 adopted to be effective July 1, 2007, 32 TexReg 3857

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