PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 98-23-091.
Title of Rule: Repealing WAC 388-86-098 Speech therapy services and new 388-545-700 Speech/audiology services.
Purpose: The department is establishing new chapter 388-545 WAC to combine all medical therapy rules. Therefore, WAC 388-86-098 is being repealed and WAC 388-545-700 is being established. The new chapter clarifies program requirements to comply with the Governor's Executive Order 97-02, adds criteria for speech/audiology services, and combines speech therapy with audiology services in one place.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.
Statute Being Implemented: RCW 74.08.090, 74.09.520.
Summary: The department is establishing new chapter 388-545 WAC to combine all medical therapy rules. Therefore, WAC 388-86-098 Speech therapy services, is being repealed and WAC 388-545-700 is being established. The new chapter adds the following criteria: Adds a second diagnosis for when a second evaluation is allowed. It also combines speech therapy and audiology services into one WAC. Rewritten sections clarify program requirements to comply with the Governor's Executive Order 97-02, which mandates that all rules be reviewed for clarity, necessity, fairness, etc.
Reasons Supporting Proposal: To comply with the Governor's Executive Order 97-02. To combine all medical therapy rules in one chapter to promote ease of use.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Patty Balestra, DOSS, 623 8th Avenue S.E., Olympia, WA 98501, (360) 586-3745.
Name of Proponent: Department of Social and Health Services, Medical Assistance Administration, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: New chapter 388-545 WAC is being established to combine all medical therapies into one chapter, necessitating the repeal of the existing chapter. The new rule reorganizes sections and uses clear writing standards to clarify program requirements. The new rule adds coverage for a diagnosis in those circumstances when a second evaluation is allowed. The new rule combines the requirements for speech therapy services and audiology services into one chapter.
The purpose of the new rule is to make it easier for readers to understand the department's policy and to be able to find all available information in one place.
The anticipated effect of the clarification and consolidation is to make the rule easier to understand and to find.
Proposal Changes the Following Existing Rules: The proposal repeals the existing rule and combines it with other rules (speech/audiology services and occupational therapy services) into one new chapter.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rule amendments and concludes that no new costs will be imposed on the small businesses that are affected by them.
RCW 34.05.328 does not apply to this rule adoption. The rule does not fit the definition of a significant legislative rule.
Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on June 22, 1999, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Paige Wall by June 11, 1999, phone (360) 902-7540, TTY (360) 902-8324, e-mail pwall@dshs.wa.gov.
Submit Written Comments to: Identify WAC Numbers, Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 902-8292, by June 22, 1999.
Date of Intended Adoption: August 1, 1999.
May 13, 1999
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit
2574.1(1) The following providers are eligible to enroll with medical assistance administration (MAA) to provide, and be reimbursed for, speech/audiology services:
(a) A speech-language pathologist who has been granted a certificate of clinical competence by the American Speech, Hearing and Language Association;
(b) A speech-language pathologist who has completed the equivalent educational and work experience necessary for such a certificate;
(c) An audiologist who is appropriately licensed or registered to perform audiology services within their state of residence; and
(d) School districts or educational service districts. Services must be noted in the client's individual educational program or individualized family service plan as described under WAC 388-86-022.
(2) Clients in the following MAA programs are eligible to receive speech/audiology services described in this chapter:
(a) Categorically needy, children's health, general assistance unemployable, and alcoholism and drug addiction treatment and support act (ADATSA) programs within Washington state or border areas only; or
(b) Medically needy program only when the client is either:
(i) Twenty years of age or under; or
(ii) Receiving home health care services as described under WAC 388-86-045;
(c) Medically indigent program only for emergency hospital-based services.
(3) MAA pays only for covered speech/audiology services listed in this section when they are:
(a) Within the scope of an eligible client's medical care program;
(b) For conditions which are the result of medically recognized diseases and defects; and
(c) Medically necessary, as determined by a health professional.
(4) The following speech/audiology services are covered per client, per calendar year, per provider:
(a) Unlimited speech/audiology program visits for clients twenty years of age and younger;
(b) One medical diagnostic evaluation. The medical diagnostic evaluation is in addition to the twelve program visits allowed per year;
(c) One second medical diagnostic evaluation at the time of discharge for any of the following:
(i) Anoxic brain damage;
(ii) Acute, ill-defined, cerebrovascular disease;
(iii) Subarachnoid, subdural, and extradural hemorrhage following injury; or
(iv) Intracranial injury of other and unspecified nature;
(d) Twelve speech/audiology program visits for clients twenty-one years of age and older;
(e) Twenty-four additional speech/audiology visits if the speech/audiology service is for any of the following:
(i) Medically necessary conditions for developmentally delayed clients;
(ii) Neurofibromatosis;
(iii) Severe oral or motor dyspraxia;
(iv) Amyotrophic lateral sclerosis (ALS);
(v) Multiple sclerosis;
(vi) Cerebral palsy;
(vii) Quadriplegia;
(viii) Acute, infective polyneuritis (Guillain-Barre' syndrome);
(ix) Acute, but ill-defined, cerebrovascular disease;
(x) Meningomyelocele;
(xi) Cleft palate and cleft lip;
(xii) Down's syndrome;
(xiii) Lack of coordination;
(xiv) Severe aphasia;
(xv) Severe dysphagia;
(xvi) Fracture of the:
(A) Vault or base of the skull;
(B) Multiple fracture involving skull or face with other bones;
(C) Cervical column;
(D) Larynx and trachea; or
(E) Other and unqualified skull fractures;
(xvii) Head injuries as follows:
(A) Cerebral laceration and contusion;
(B) Subarachnoid, subdural, and extradural hemorrhage following injury;
(C) Other and unspecified intracranial hemorrhage following injury;
(D) Injury to blood vessels of the head and neck; or
(E) Intracranial injury of other second unspecified nature;
(xvii) Burns of:
(A) The face, head, and neck, when severe;
(B) Multiple, specified sites; or
(C) Internal organs;
(xix) Cervical spinal cord injury without evidence of spinal bone injury; or
(xx) Other speech disturbances (e.g., severe dysarthria).
(f) Additional medically necessary speech/audiology program visits beyond the initial twelve visits and additional twenty-four visits if approved by MAA.
(5) MAA limits:
(a) Caloric vestibular testing to four units for each ear, and
(b) Sinusoidal vertical axis rotational testing to three units for each direction.
(6) MAA does not cover speech/audiology services that are included as part of the reimbursement for other treatment programs. This includes, but is not limited to, hospital inpatient and nursing facility services.
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The following sections of the Washington Administrative Code are repealed:
| WAC 388-86-098 | Speech therapy services. |