Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers › Section 5160-10-24 - DMEPOS: speech-generating devices

Current through all regulations passed and filed through July 1, 2024
(A) Coverage.
(1) Separate payment may be made for a
			 speech-generating device (SGD) furnished to a resident of a long-term care
			 facility (LTCF).
(2) The default
			 certificate of medical necessity (CMN) form is the ODM 02924, "Certificate of
			 Medical Necessity: Speech-Generating Devices" (rev. 7/2018). The CMN
			 
									includes the following elements:
(a) A formal, written report of a
			 face-to-face evaluation of the individual's communication abilities performed
			 by a speech-language pathologist (SLP);
(b) Exact specifications for a SGD and the
			 rationale for selection;
(c)
			 Clinical documentation that the individual's cognitive and physical abilities
			 will enable effective use of the specified SGD;
(d) Full disclosure of any SGD equipment
			 currently in the individual's possession and an explanation of why that
			 equipment does not meet the individual's needs;
(e) Documentation of the medical necessity of
			 any accessory or add-on equipment, supplies, or SGD features being requested;
			 and
(f) An explanation of the
			 necessity or functional benefit of any requested upgrade, modification, or
			 replacement.
(3) The
			 formal, written evaluation report 
									includes all of the following
			 components:
(a) A description of the
			 individual's current communication impairment, including the type, severity,
			 and prognosis;
(b) An assessment of
			 the individual's speech skills and capacity for receptive and expressive
			 language;
(c) An explanation, as
			 applicable, of how the individual's cognition, emotions, physical abilities,
			 and behaviors affect the communication of basic needs;
(d) Identification of the persons with whom
			 the individual communicates most frequently and any associated limitations and
			 needs;
(e) Identification of the
			 environments in which the individual communicates most frequently (including
			 vocational and educational settings);
(f) A description of the types of messages
			 the individual generally needs to convey and the range of vocabulary
			 used;
(g) An assessment of the
			 extent to which the individual's daily communication needs could be met by a
			 SGD incorporating less complex technology or by a means of communication other
			 than a SGD;
(h) A description of
			 the functional communication goals expected to be achieved with a
			 SGD;
(i) Recommendations for the
			 following SGD features and functions:
(i)
			 Representational systems (symbols);
(ii) Vocabulary encoding (e.g., icon,
			 level-plus-location, traditional orthography);
(iii) Vocabulary expandability and message
			 generation (e.g., programmed or programmable words or parts of sentences,
			 additional memory);
(iv)
			 Rate-enhancement techniques (e.g., simple symbol selection, symbol sequencing,
			 key linking, dynamic display, abbreviation-expansion, word lists, word
			 prediction, icon prediction, macros);
(v) Access techniques and
			 strategies;
(vi) Keyboard
			 organization (e.g., key size and spacing, overlay size and number, key
			 guard);
(vii) Device output modes
			 (e.g., speech synthesis, printed output, character display, auditory and visual
			 prompting, auditory and visual feedback); and
(viii) Portability;
(j) A description of a comprehensive
			 treatment plan that includes a training schedule for the selected SGD;
			 and
(k) The signature and license
			 number of the SLP and any other member of the evaluation team.
(4) Payment will not be made for a
			 SGD until the individual has used the device for a period of at least four
			 weeks, during which the prescriber determines that the device satisfactorily
			 meets the individual's needs. If the device does not meet the individual's
			 needs, then the provider may choose to submit a request for payment of one
			 month's rental.
(5) The department
			 will consider coverage of SGDs in any of several forms, including but not
			 limited to the following examples:
(a) A
			 standalone unit running dedicated, proprietary software;
(b) Commercially available software and, if
			 necessary, hardware to run it (e.g., a portable or tablet computer);
(c) A software application that may be loaded
			 onto devices already owned by an individual; or
(d) A combination of components that provides
			 functionality for the user.
(6) Separate payment may be made for the
			 following items and services:
(a) A
			 face-to-face evaluation performed by a SLP;
(b) Brackets and mounting hardware;
			 and
(c) An adaptive interface or
			 other accessory if the evaluating SLP provides documentation that the item is
			 necessary for the independent use of a SGD by a particular
			 individual.
(7) Payment
			 for the upgrade, modification, or replacement of a fully functional SGD during
			 its useful life may be made only if the SGD no longer meets the individual's
			 basic communication needs.
(a) Replacement during the useful life of a
			 SGD will be considered only when it is more cost-effective than
			 modification.
(b) Repair does not
			 extend the useful life of a SGD.