1. (1) For initial ordering of speech generating devices (SGD), an in-person, face-to-face encounter that is related to the primary reason the client requires the medical equipment or supplies must occur no more than six months prior to the start of services:

   1. (a) The face-to-face encounter shall be conducted and documented by the treating physician (MD or DO) or an authorized non-physician practitioner (NPP);
   2. (b) Authorized NPPs for SGD are nurse practitioners, clinical nurse specialists working in collaboration with a physician, or physician associate under the supervision of a physician;
   3. (c) The physician or NPP conducting the face-to-face encounter shall document that the client is evaluated or treated for a condition that supports the need for the SGD ordered within six months prior to completing the written order for the equipment;
   4. (d) If the NPP performing the face-to-face encounter does not have prescribing authority, the NPP shall communicate the clinical findings to the ordering physician;
   5. (e) The ordering physician shall incorporate the clinical findings into a written or electronic document included in the client’s medical record.
2. (2) If a dually eligible client is evaluated for medical equipment or supplies under Medicare and transitions to Medicaid, the Medicare face-to-face encounter documentation shall meet the Medicaid face-to-face requirement.
3. (3) The durable medical equipment (DME) supplier shall maintain documentation of the qualifying face-to-face encounter and provide the documentation when the item requires PA or at the Division’s request.
4. (4) The table at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Downloads/DME_List_of_Specified_Covered_Items_updated_March_26_2015.pdf identifies the DME items subject to these face-to-face requirements.

Statutory/Other Authority

ORS 413.042 & ORS 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 11-2025, minor correction filed 01/09/2025, effective 01/09/2025
DMAP 15-2020, temporary amend filed 03/26/2020, effective 03/26/2020 through 09/21/2020
DMAP 100-2018, adopt filed 11/06/2018, effective 11/06/2018
DMAP 30-2018, temporary adopt filed 05/17/2018, effective 05/17/2018 through 11/12/2018