1. (1) Augmentative Communications System or Device and the necessary attachment equipment to bed or wheelchair are a covered benefit of the Division.
2. (2) The requested system or device shall be approved, registered, or listed as a medical device with the Food and Drug Administration.

3. (3) Criteria for coverage: Providers shall meet each of the following components and submit documentation to the Division with claims subject to PPR and with PA request for review:

   1. (a) A physician’s statement of diagnosis and medical prognosis (not a prescription for an augmentative device) documenting the inability to use speech for effective communication as a result of the diagnosis;

   2. (b) Reliable cognitive ability and a consistent motor response to communicate that can be measured by standardized or observational tools:

      1. (A) Object permanence – ability to remember objects and realize they exist when they are not seen; and
      2. (B) Means end – ability to anticipate events independent of those currently in progress – the ability to associate certain behaviors with actions that will follow.

   3. (c) The client shall be assessed by a SLP and when appropriate an occupational therapist or physical therapist. The evaluation report shall include:

      1. (A) A completed OHA 3047 form: Augmentative Communication Device Selection Report Summary (page 1) and required elements of the Formal Augmentative/Alternative Communication Evaluation (page 2). Attach additional pages required to complete information requested;
      2. (B) An explanation of why this device is best suited for this client and why the device is the lowest level that will meet basic functional communication needs;
      3. (C) Evidence of a documented trial of the selected device and a report on the client’s success in using this device; and
      4. (D) A therapy treatment plan with the identification of the individual responsible to program the device and monitor and reevaluate on a periodic basis.
   4. (d) Providers send requests for augmentative communications systems or devices to the Division; and
   5. (e) The manufacturer’s MSRP and the vendor’s acquisition cost quotations for the device shall accompany each request including where the device is to be shipped.
4. (4) The Division shall reimburse for the lowest level of service that meets the medical need.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 413.042 & ORS 414.065

History

DMAP 44-2019, amend filed 11/06/2019, effective 11/14/2019
DMAP 18-2019, temporary amend filed 06/18/2019, effective 07/01/2019 through 12/27/2019
DMAP 49-2016, f. 7-26-16, cert. ef. 8-1-16
DMAP 3-2011, f. 3-23-11, cert. ef. 3-25-11
DMAP 26-2010(Temp), f. 9-24-10, cert. ef. 10-1-10 thru 3-25-11
OMAP 59-2003, f. 9-5-03, cert. ef. 10-1-03
OMAP 38-2000, f. 9-29-00, cert. ef. 10-1-00
OMAP 36-1999, f. & cert. ef. 10-1-99
HR 36-1994, f. 12-30-94, cert. ef. 1-1-95
HR 11-1992, f. & cert. ef. 4-1-92
HR 5-1991, f. 1-18-91, cert. ef. 2-1-91
HR 40-1990(Temp), f. & cert. ef. 11-15-90