Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.140 - Speech and Hearing Disorders-Definitions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule defines certain terms to ensure
				  their uniform application in group health insurance and other designated
				  coverage. This rule is promulgated pursuant to section
				  376.781,
				  RSMo.
(1) The purpose of this
				rule is to set forth the terms and definitions which must be utilized in a
				policy, certificate, contract or plan document which provides speech and
				hearing benefits.
(2) Definitions.
				For the purposes of this rule-
(A) Loss or
				impairment of speech or hearing shall include communicative disorders resulting
				from genetic defects, birth defects, injury, illness, disease, developmental
				disabilities or delays or other causes whether of organic or nonorganic
				etiology and whether or not the person suffering from that loss or impairment
				had the capacity for speech, language or hearing before the loss or impairment
				occurred;
(B) Necessary care and
				treatment shall include services to identify, assess, diagnose and consult
				about the need for treatment and to evaluate and monitor the effectiveness of
				treatment whether by instrumental, perceptional or standard procedures as well
				as the provision of treatment for any of the previously mentioned communicative
				disorders. These services shall include, but not be limited to:
1. Diagnostic and extended evaluation of
				hearing, which may include pure tone air conduction thresholds, speech
				thresholds, bone conduction thresholds, prediction of hearing loss from
				acoustic reflex, reflex eliciting auditory test, communication handicap
				inventories, word/sentence recognition tests and evoked potential monitoring
				and testing;
2. Determining range,
				nature and degree of hearing function related to a patient's auditory
				efficiency;
3. Comprehensive
				behavioral evaluation for sensorineural site which includes advanced acoustic
				reflex tests, tests of auditory adaptation, tests of frequency discrimination
				and tests of intensity discrimination;
4. Testing, adjusting and evaluating auditory
				prosthetic devices which may include sound field tests, such as aided
				word/sentence recognition, real ear measures, warble tone thresholds, narrow
				band noise thresholds, and comfortable and uncomfortable loudness levels while
				wearing an auditory prosthesis;
5.
				Differentiation between organic and nonorganic hearing disabilities through
				evaluation of total response pattern and use of acoustic tests;
6. Planning, directing, conducting or
				participating in conservation, habilitative and rehabilitative programs
				including hearing aid selection and orientation, counseling, guidance, auditory
				training, speech reading, language habilitation and speech
				conservation;
7. Coordinating and
				consulting with educational, medical and other professional groups, and with
				patients and their families;
8.
				Diagnosing and evaluating speech and language competencies of individuals,
				including assessment of speech and language skills as related to educational,
				medical, developmental, social and psychological factors;
9. The services enumerated in paragraphs
				(2)(B)1.-8. shall be designed to evaluate and treat individuals to develop or
				utilize speech, language and other communicative skills to the maximum extent
				possible to remedy any loss or impairment for which services are being
				provided. However, nothing in this rule shall be construed to require services
				to improve public speaking, care of the professional voice or accent
				reduction;
10. Cognitive training
				secondary to open or closed head injury, regardless of cause;
11. Assisting individuals with voice
				disorders to develop proper control of the vocal and respiratory systems for
				correct voice production;
12.
				Evaluating and treating children with delayed or impaired speech or language
				disorders;
13. Determining the need
				for augmentative/prosthetic communication systems whether or not that system or
				that device replaces a body part. These systems or devices may include, but are
				not limited to, sign language, gesture systems, communication boards,
				electronic automated devices, mechanical devices, alaryngeal prosthesis,
				palatal prosthesis and synthetic voice systems; and
14. Planning, directing, or conducting
				habilitative and rehabilitative treatment programs to restore or provide
				communicative efficiency to individuals with communication problems of organic
				and nonorganic etiology, such as partial to total glossectomy, partial to total
				laryngectomy, or both; and
(C) Other covered services shall mean any
				other medically necessary medical or health care services, or both, for which
				coverage is provided whether or not for acute conditions, provided while a
				patient in a hospital, or provided by or in a rehabilitation center, skilled
				nursing facility, clinic, home health agency or community-based program. This
				means that limitations on coverage may not be specific to speech, language and
				hearing disorders or for services rendered by speech language pathologists and
				audiologists.