Chapter 14 Durable Medical Equipment (DME)

Durable Medical Equipment (DME)Scope of services includes the following elements:• Screening and evaluation• ACD, subject to limitations• Training on use of equipmentThese are inclusive in the allowable charge and may not be billed separately.NOTE:This section describes candidacy criteria, evaluation criteria, and priorauthorization and limits for ACDs.Candidacy CriteriaCandidates must meet the following criteria:AgeCandidacy CriteriaUnder age 21 • EPSDT referral by Medicaid enrolled EPSDT provider.• Referral must be within one year of application for ACD. TheEPSDT provider must obtain a referral from the Patient 1stPrimary Medical Provider where applicable• Medical condition which impairs ability to communicate asdescribed above• Evaluation required by qualified, experienced professional• Physician prescription to be obtained after the evaluation andbased on documentation contained in evaluation.Adults, age21+• Referral from a primary care physician (Patient 1 st PMP whereapplicable).• Referral must be within one year of application for ACD• Medical condition which impairs ability to communicate asdescribed above• Evaluation by required qualified experienced professionals• Physician prescription to be obtained after the evaluation andbased on documentation provided in the evaluation.Evaluation CriteriaQualified interdisciplinary professionals must evaluate the candidate. Evaluation byinterdisciplinary professionals must include a speech-language pathologist and aphysician. Qualifications for a speech-language pathologist include:• Master’s degree from accredited institution• Certificate of Clinical Competence in speech/language pathology from theAmerican Speech, Language, and Hearing Association• Alabama license in speech/language pathology• No financial or other affiliation with a vendor, manufacturer or manufacturer’srepresentative of ACDs• Current continuing education in the area of Augmentative CommunicationEvaluations by interdisciplinary professionals should also include, but may not belimited to, a physical therapist, social worker, and/or occupational therapist.A physical therapist must possess the following qualifications:14-14 April 2005