Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter II - Specific Policies By Service › Section 144-101-II-109 - Speech and Hearing Services › Subsection 144-101-II-109.07 - COVERED SERVICES

Current through 2024-29, July 17, 2024
A covered service is a service for which the member is
						eligible and payment can be made by the Department. All covered services
						provided under this Section must be ordered or requested in writing by a
						practitioner of the healing arts as allowed by the respective licensing
						authority and his or her scope of practice. Covered services are also limited
						to the following:
109.07-1
Covered Services for All Members
The following services are covered for all
						members:
A.
Speech, Voice and
					 Language Evaluation, Diagnosis and Plan of Care by Speech-Language
					 Pathologist
A direct encounter between a licensed speech-language
						pathologist and the member to determine the status of both receptive and
						expressive communication skills.
B.
Speech, Voice and Language Therapy
					 and/or Aural Rehabilitation, Individual
The process of producing behavioral change in the member
						with a communication disorder involving a one-to-one relationship by a licensed
						speech-language pathologist or a registered speech-language pathology assistant
						and following a plan of care.
C.
Speech, Voice and Language Therapy
					 and/or Aural Rehabilitation, Group
The process of producing behavioral change in the member
						with a communication disorder involving other than a one-to-one relationship by
						a licensed speech-language pathologist or a registered speech-language
						pathology assistant and following a plan of care.
D.
Speech and Language Periodic
					 Re-Evaluation
A direct encounter between member and speech-language
						pathologist to determine current status with periodicity determined by plan of
						care. At minimum, re-evaluations will occur and plans shall be updated within
						six (6) months of the date of the plan of care.
E.
Speech Pathology Diagnostic Services
					 at Physician or PCP's Request
Specialty testing by speech-language-pathologist to
						assist in diagnosis and development of a medical plan of care. Report will
						include speech-language pathologist's recommendations. Currently acceptable
						medical tests and procedures are to be utilized as medically necessary.
F.
Hearing Screening by a
					 Speech-Language Pathologist
Pure tone air conduction testing by a speech-language
						pathologist as part of a hearing screening program.
G.
Speech, Voice and/or Language
					 Screening
Speech, voice and/or language screening performed by a
						licensed speech-language pathologist or a registered speech-language pathology
						assistant as part of screening.
H.
Augmentative and Alternative
					 Communication Evaluation Services
The scope of augmentative and alternative communication
						evaluation services including: diagnostic, screening, preventive, and
						corrective services provided by a licensed speech-language pathologist or, as
						appropriate, a registered speech-language pathology assistant. Specific
						activities include: evaluation for, recommendations of, design, set-up,
						customization, reprogramming, maintenance, and training related to the use of
						an AACD. Refer to Chapter II, Section
						60, "Durable Medical Equipment",
						of the
MaineCare Benefits Manual
for criteria for augmentative
						communication devices.
I.
Therapeutic Adaptations and Set-Up for Assistive/Adaptive
					 Equipment
This shall include customizing the operational
						characteristics of an AACD in order to meet the needs of the individual member
						and to maximize the use and effectiveness of the device.
This service shall be performed by a licensed
						speech-language pathologist who is familiar and has experience with
						augmentative communication devices.
J.
Reprogramming
This shall include any necessary reprogramming of AACD
						equipment when performed by a licensed speech-language pathologist or
						registered speech-language pathology assistant who is familiar and has
						experience with augmentative communication devices.
K.
Audiologic Evaluation, Diagnosis and
					 Plan of Care, by Audiologist
A direct encounter between a member and an audiologist to
						determine the member's hearing status.
L.
Audiologic Evaluation for Persons
					 Difficult to Test
Based on a written plan of care serial evaluation for
						persons difficult to test in order to obtain reliable audiologic information
						necessary for case management.
M.
Audiologic Evaluation for Site of
					 Lesion
A direct encounter between a member and an audiologist
						which determines site of lesion; this may include, but is not limited to, the
						following tests: pure tone air, pure tone bone, speech audiometry, Bekesy,
						tonedecay, short increment sensitivity index (SISI), impedance, alternate
						binaural loudness balance tests (ABLB).
N.
Audiologic Evaluation as a Result of
					 Change in Hearing Status Because of Disease, or Trauma
Audiologic evaluation necessitated by an observed or
						suspected change in a member's hearing status because of disease or injury, on
						referral from a physician or PCP.
O.
Audiologic Diagnostic Services at
					 Physician or PCP's Request
Specialty testing performed by an audiologist to assist
						in diagnosis and developing a medical plan of care. The report shall include
						audiologist's recommendations.
P.
Aural or Language Rehabilitation
					 (including speech reading), Individual, by Audiologist
The process of producing behavioral change in the member
						presenting communication disorders related to auditory function, involving a
						one-to-one relationship, and following a plan of care. This includes cochlear
						implant follow-up aural rehabilitation services.
Q.
Aural or Language Rehabilitation
					 (including speech reading), Group, by Audiologist
The process of producing behavioral change in the member
						presenting a communication disorder related to auditory function involving
						other than a one-to-one relationship and following a plan of care.
R. *
Hearing Aid Evaluation
					 and Related Procedures, by Audiologist
Covered services must be provided by an audiologist, and
						include evaluating members for hearing aid and demonstrating the basic features
						of hearing aids to the member. For each evaluation of a member, the audiologist
						will write a written report.
Members are eligible for one hearing aid or one
						replacement hearing aid every five years, through Section
						60 (Medical Supplies and Durable
						Medical Equipment). Providers must submit prior authorization request and
						documentation for hearing aids, as required in Section 60.
S. * Hearing and/or Hearing Aid Periodic
					 Recheck
Covered services must be provided by an audiologist and
						include re-evaluating members in accordance with a written plan of care.
T. * Ear Molds
NOTE
: "Group" is defined as two to four
						individuals with one clinician. When services are provided, a brief notation
						must be made for each individual in his/her medical record.
*The Department is seeking and anticipates receiving
						approval from the federal Centers for Medicare and Medicaid Services of these
						changes.