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TITLE 40SOCIAL SERVICES AND ASSISTANCE
PART 1DEPARTMENT OF AGING AND DISABILITY SERVICES
CHAPTER 9INTELLECTUAL DISABILITY SERVICES--MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES
SUBCHAPTER EINTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS (ICF/IID) PROGRAM--CONTRACTING
DIVISION 4PROVIDER SERVICE REQUIREMENTS
RULE §9.228Augmentative 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.


Source Note: The provisions of this §9.228 adopted to be effective August 1, 2009, 34 TexReg 4741

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