9032.1 The purpose of this section is to establish standards governing Medicaid eligibility for speech, hearing, and language services for persons enrolled in the IFS Waiver and to establish conditions of participation for providers of speech, hearing, and language services.

9032.2 Speech, hearing, and language services are therapeutic interventions to address communicative and speech disorders to maximize a person's expressive and receptive communication skills.

1. (a) These services may be delivered at a person's home, day service setting, and/or in the community.
2. (b) These services are available as an individual service based upon the recommendation of the person's support team as reflected in the person's ISP. A person may use individual services, subject to the service limitations described in § 9032.16.

9032.3 To qualify for Medicaid reimbursement, speech, hearing, and language services shall be:

1. (a) Ordered by a physician, if the person has a medically-related condition such as a history of aspiration, swallowing problems, tube feeding, or a tracheotomy;
2. (b) Recommended by the Support Team, if the person has a non-medical condition such as a receptive or expressive speech delay or disorder;
3. (c) Delivered to a person that is over the age of twenty-one (21), except that services may also be provided to a person enrolled in the Waiver who is between the ages of eighteen (18) and twenty-one (21) years old, in accordance with § 9032.15;
4. (d) Reasonable and necessary to treat the person's medical or non-medical communicative disorder; and
5. (e) Included in the person's ISP and Plan of Care.

9032.4 In order to be eligible for Medicaid reimbursement, speech, hearing and language services shall be used to address the following conditions:

1. (a) Swallowing and feeding disorders;

(b) Receptive and expressive communication disorders;

(c) Voice impairments; and

(d) Articulatory and motor speech disorders.

9032.5 In order to be eligible for Medicaid reimbursement, each individual providing speech, hearing and language services shall comply with the following service delivery requirements:

(a) Conduct a comprehensive assessment, within the first four (4) hours of service delivery, which shall include the following:

(1) A background review and current functional review of communication capabilities in different environments;

(2) An environmental review of communication in places of employment, residence, and other sites as necessary;

(3) The potential for use of augmentative and alternative speech devices, methods, or strategies;

(4) The potential for sign language or other expressive communication methods; and

(5) A needs assessment for the use of adaptive eating equipment.

(b) Develop and implement a speech, hearing, and language treatment plan, within the first four (4) hours of service delivery, that describes treatment strategies, including direct therapy, training of caregivers, monitoring requirements and instructions, and the anticipated and measurable, functional outcomes, based upon what is important to and for the person as reflected in his or her Person-Centered Thinking tools and the goals in his or her ISP;

(c) Assist persons with voice disorders to develop proper control of vocal and respiratory systems for correct voice production, if applicable;

(d) Conduct aural rehabilitation by teaching sign language and lip reading to people who have hearing loss, if applicable;

(e) Participate in ISP and Support Team meetings to provide consultative services and recommendations specific to the expert

content with a focus on how the person is doing in achieving the functional goals that are important to him or her;

(f) Record progress notes on each visit and submit quarterly reports;

(g) Verify that the speech, hearing, and language assessment and treatment plan, and daily notes and quarterly reports, are delivered to the person, family or other caregiver, physician, and the DDS Service Coordinator prior to the person's Support Team meeting;

(h) Assess the need for the use of adaptive equipment;

(i) Routinely assess (at least annually and more frequently as needed) the appropriateness and quality of adaptive equipment to ensure it addresses the person's needs;

(j) Conduct periodic examinations to modify treatments, as appropriate, for the person receiving services and ensure that the speech pathologist's or audiologist's recommendations are incorporated into the ISP; when necessary; and

(k) Complete documentation required to obtain or repair adaptive equipment in accordance with insurance requirements and Medicare and Medicaid guidelines, including required timelines for submission.

9032.6 In order to be eligible for Medicaid reimbursement, each individual providing speech, hearing, and language services shall:

(a) Be employed by a home health agency or a Waiver provider;

(b) Be a speech pathologist or audiologist in a private practice; or

(c) Be an assistant working under the direct supervision of a licensed speech pathologist or audiologist.

9032.7 In order to be eligible for Medicaid reimbursement, each individual providing speech, hearing, and language services shall also comply with the following requirements:

(a) Be a speech-language pathologist or audiologist licensed pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1201 et seq.) and implementing rules;

1. (b) Have a minimum of two (2) years of experience as a licensed speech-language pathologist or audiologist;
2. (c) Have a Certificate of Clinical Competence in the area of Audiology or Speech Pathology granted by the American Speech-Language-Hearing Association; and
3. (d) Comply with Section 9010 (Provider Qualifications) and 9009 (Provider Enrollment Process) of Chapter 90 of Title 29 DCMR.9032.8 In order to be eligible for Medicaid reimbursement, a speech pathologist assistant or audiologist assistant shall meet the following requirements:- (a) Be personally supervised by the speech pathologist or audiologist. Personal supervision requires the speech pathologist or audiologist to be in the room during the performance of the service; and
4. (b) Be employed by the speech pathologist or audiologist or by the speech pathologist or audiologist's employer; and
5. (c) Comply with Section 9011 (Requirements for Direct Support Professionals) of Chapter 90 of Title 29 DCMR.9032.9 Speech, hearing and language service providers, without regard to their employer of record, shall be selected by the person receiving services, their guardian, or legal representative and shall be answerable to the person receiving services.9032.10 Any provider substituting professionals for more than a two (2) week period or four (4) visits due to emergency or availability events shall request a case conference with the DDS Service Coordinator to evaluate the continuation of services.9032.11 In order to be eligible for Medicaid reimbursement, the speech pathologist or audiologist in a private practice shall meet all of the following conditions:- (a) Maintain a private office, even if services are always furnished in the person's home;
6. (b) Meet all state and local licensure laws and rules;
7. (c) Maintain a minimum of one (1) million dollars in liability insurance;
8. (d) Ensure that speech, hearing, and language services are provided consistent

with the person's ISP and Plan of Care; and

(e) Maintain a space that is owned, leased or rented by the private practice and is used exclusively for the purpose of operating the private practice.

9032.12 In order to be eligible for Medicaid reimbursement, services shall only be authorized for reimbursement in accordance with the following provider requirements:

1. (a) DDS shall provide a written service authorization before the commencement of services;
2. (b) The provider shall conduct an assessment within the first four (4) hours of service delivery and develop a speech, hearing, and language treatment plan with training goals and techniques that will assist the careg--ivers;
3. (c) The service name and provider delivering services shall be identified in the ISP and Plan of Care;
4. (d) The ISP, Plan of Care, and Summary of Supports and Services shall document the amount and frequency of services to be received; and
5. (e) Services shall be provided consistent with the service limitations described under Section 9032.16.

9032.13 In order to be eligible for Medicaid reimbursement, each home health agency, Waiver provider, or licensed speech pathologist or audiologist shall maintain the following documents for monitoring and audit reviews:

1. (a) A copy of the speech, hearing, and language assessment and treatment plan;
2. (b) A copy of the physician's orders and other pertinent documentation of the person's progress;
3. (c) A copy of the daily progress notes, containing the following information:
4. (1) Progress in meeting each goal in the ISP;
5. (2) Any unusual health or behavioral events or change in status;
6. (3) The start and end time of any services received by the person; and
7. (4) Any matter requiring follow-up on the part of the service provider or DDS.

(d) A copy of the quarterly reports used to verify the functioning of the person’s adaptive equipment; and

(e) Any other documents required to be maintained under Section 9006 (Records and Confidentiality of Information) of Chapter 90 of Title 29 DCMR.

9032.14 In order to be eligible for Medicaid reimbursement, each provider shall comply with Section 9013 (Reporting Requirements) and Section 9005 (Individual Rights) of Chapter 90 of Title 29 of the DCMR.

9032.15 If the person enrolled in the Waiver is between the ages of eighteen (18) and twenty-one (21) years old, the DDS Service Coordinator shall ensure that Early Periodic Screening and Diagnostic Treatment (EPSDT) services under the District of Columbia State Plan for Medical Assistance are fully utilized before accessing speech, hearing and language services under the Waiver.

9032.16 Speech, hearing, and language services shall be limited to four (4) hours per day and one hundred (100) hours per year. Requests for additional hours may be approved when accompanied by a physician’s order documenting the need for additional speech, hearing, and language services or if approved by a designated staff member at DDA.

9032.17 There shall be a Medicaid reimbursement rate for a speech, hearing and language assessment. The billable unit of service shall be fifteen (15) minutes. A provider shall provide at least eight (8) minutes of service in a span of fifteen (15) continuous minutes to bill a unit of service.

9032.18 There shall be a Medicaid reimbursement rate for individual speech, hearing and language services. The billable unit of service for speech, hearing and language therapy services shall be fifteen (15) minutes. A provider shall provide at least eight (8) minutes of service in a span of fifteen (15) continuous minutes to bill a unit of service.

9032.19 Speech, hearing, and language services may be delivered through remote supports to the extent the recommended service delivery is through remote supports services and the person is able to utilize equipment/technology needed for remote supports services as assessed and determined by the support team.

9032.20 Each provider of remote speech, hearing, and language services shall comply with the requirements under Section 9036 (Remote Supports Services) of Chapter 90 of Title 29 DCMR.

9032.21 Remote speech, hearing, and language shall be issued as a separate service authorization indicating the frequency of usage. A hybrid model may be used for

in-person and remote supports services speech, hearing, and language hours where two (2) service authorizations are issued to cover the in-person service hours and the remote supports services hours.

9032.22 Remote speech, hearing and language services reimbursement rates shall reflect the same rates as professional in-person speech, hearing and language reimbursement rates.

9032.23 Speech, hearing and language services provided by HCBS Waiver professionals through remote supports services must meet the criteria specified at § 9036.12.

SOURCE: Final Rulemaking published at 69 DCR 010229 (August 12, 2022); as amended by Final Rulemaking published at 71 DCR 010475 (August 23, 2024).