WAC 388-545-700   Speech/audiology services.  (1) The following providers are eligible to enroll with medical assistance administration (MAA) to provide, and be reimbursed for, speech/audiology services:

     (a) A speech-language pathologist who has been granted a certificate of clinical competence by the American Speech, Hearing and Language Association;

     (b) A speech-language pathologist who has completed the equivalent educational and work experience necessary for such a certificate;

     (c) An audiologist who is appropriately licensed or registered to perform audiology services within their state of residence; and

     (d) School districts or educational service districts. Services must be noted in the client's individual educational program or individualized family service plan as described under WAC 388-537-0100.

     (2) Clients in the following MAA programs are eligible to receive speech/audiology services described in this chapter:

     (a) Categorically needy, children's health, general assistance unemployable, and Alcoholism and Drug Addiction Treatment and Support Act (ADATSA) programs within Washington state or border areas only; or

     (b) Medically needy program only when the client is either:

     (i) Twenty years of age or under; or

     (ii) Receiving home health care services as described under chapter 388-551 WAC, subchapter II;

     (c) Medically indigent program only for emergency hospital-based services.

     (3) MAA pays only for covered speech/audiology services listed in this section when they are:

     (a) Within the scope of an eligible client's medical care program;

     (b) For conditions which are the result of medically recognized diseases and defects; and

     (c) Medically necessary, as determined by a health professional.

     (4) The following speech/audiology services are covered per client, per calendar year, per provider:

     (a) Unlimited speech/audiology program visits for clients twenty years of age and younger;

     (b) One medical diagnostic evaluation for clients twenty-one years of age and older. The medical diagnostic evaluation is in addition to the twelve program visits allowed per year;

     (c) One second medical diagnostic evaluation at the time of discharge for any of the following:

     (i) Anoxic brain damage;

     (ii) Acute, ill-defined, cerebrovascular disease;

     (iii) Subarachnoid, subdural, and extradural hemorrhage following injury; or

     (iv) Intracranial injury of other and unspecified nature;

     (d) Twelve speech/audiology program visits for clients twenty-one years of age and older;

     (e) Twenty-four additional speech/audiology visits if the speech/audiology service is for any of the following:

     (i) Medically necessary conditions for developmentally delayed clients;

     (ii) Neurofibromatosis;

     (iii) Severe oral or motor dyspraxia;

     (iv) Amyotrophic lateral sclerosis (ALS);

     (v) Multiple sclerosis;

     (vi) Cerebral palsy;

     (vii) Quadriplegia;

     (viii) Acute, infective polyneuritis (Guillain-Barre' syndrome);

     (ix) Acute, but ill-defined, cerebrovascular disease;

     (x) Meningomyelocele;

     (xi) Cleft palate and cleft lip;

     (xii) Down's syndrome;

     (xiii) Lack of coordination;

     (xiv) Severe aphasia;

     (xv) Severe dysphagia;

     (xvi) Fracture of the:

     (A) Vault or base of the skull;

     (B) Multiple fracture involving skull or face with other bones;

     (C) Cervical column;

     (D) Larynx and trachea; or

     (E) Other and unqualified skull fractures;

     (xvii) Head injuries as follows:

     (A) Cerebral laceration and contusion;

     (B) Subarachnoid, subdural, and extradural hemorrhage following injury;

     (C) Other and unspecified intracranial hemorrhage following injury;

     (D) Injury to blood vessels of the head and neck; or

     (E) Intracranial injury of other second unspecified nature;

     (xvii) Burns of:

     (A) The face, head, and neck, when severe;

     (B) Multiple, specified sites; or

     (C) Internal organs;

     (xix) Cervical spinal cord injury without evidence of spinal bone injury; or

     (xx) Other speech disturbances (e.g., severe dysarthria).

     (f) Additional medically necessary speech/audiology program visits beyond the initial twelve visits and additional twenty-four visits for clients twenty-one years of age and older if approved by MAA.

     (5) MAA limits:

     (a) Caloric vestibular testing to four units for each ear, and

     (b) Sinusoidal vertical axis rotational testing to three units for each direction.

     (6) MAA does not cover speech/audiology services that are included as part of the reimbursement for other treatment programs. This includes, but is not limited to, hospital inpatient and nursing facility services.



[Statutory Authority: RCW 74.08.090. 01-02-075, § 388-545-700, filed 12/29/00, effective 1/29/01. Statutory Authority: RCW 74.08.090 and 74.09.520. 99-16-071, § 388-545-700, filed 8/2/99, effective 9/2/99.]