Chapter 14 Durable Medical Equipment (DME)

Durable Medical Equipment (DME)Medicaid requires the following recipient information with the prior authorizationrequest:TopicIdentifyinginformationSensory status(As observed byphysician)Postural, Mobility& Motor StatusDevelopmentStatusFamily/Caregiverand CommunitySupport SystemsCurrent Speech,Language andExpressiveCommunicationStatusCommunicationNeeds InventorySummary ofRecipientLimitationsACDAssessmentComponentsIdentification ofthe ACDsConsidered forRecipient-MustInclude at LeastTwo (2)Information required for the PA• Name• Medicaid RID number• Date(s) of Assessment• Medical diagnosis (primary, secondary, tertiary)• Relevant medical history• Vision• Hearing• Description of how vision, hearing, tactile and/or receptivecommunication impairments affect expressive communication(e.g., sensory integration, visual discrimination)• Motor status• Optimal positioning• Integration of mobility with ACD• Recipient’s access methods (and options) for ACD• Information on the recipient’s intellectual/cognitive/developmentstatus• Determination of learning style (e.g., behavior, activity level)A detailed description identifying caregivers and support, the extentof their participation in assisting the recipient with use of the ACD,and their understanding of the use and their expectations• Identification and description of the recipient’s expressive orreceptive (language comprehension) communication impairmentdiagnosis• Speech skills and prognosis• Communication behaviors and interaction skills (i.e. styles andpatterns)• Description of current communication strategies, including useof an ACD, if any• Previous treatment of communication problems• Description of recipient’s current and projected (for example,within 5 years) speech-language needs• Communication partners and tasks, including partner’scommunication abilities and limitations, if any• Communication environments and constraints which affect ACDselection and/or featuresDescription of the communication limitationsJustification for and use to be made of each component andaccessory requested• Identification of the significant characteristics and features of theACDs considered for the recipient• Identification of the cost of the ACDs considered for therecipient (including all required components, accessories,peripherals, and supplies, as appropriate)• Identification of manufacturer• Justification stating why a device is the least costly, equallyeffective alternative form of treatment for recipient• Medical justification of device preference, if any14-16 April 2005