| (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.
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| Source Note: The provisions of this §554.2613 adopted to be effective July 1, 2007, 32 TexReg 3857; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871 |
