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Speech, Language, and Hearing Services

Speech, Language, and Hearing Services shall mean medically necessary diagnostic, therapeutic, and corrective services which are within the scope of state licensure which are provided to assess and treat functional limitations involving speech, language, or chewing/swallowing and the initial training of provider staff on the appropriate implementation of the therapy plan of care.  Speech, Language, and Hearing Services provided to improve or maintain current functional abilities as well as prevent or minimize deterioration of chronic conditions leading to a further loss of function are also included within this definition.

Services must be provided by a licensed speech language pathologist or by a licensed audiologist.  Speech, Language, and Hearing Services must be ordered by a physician, physician assistant, or nurse practitioner and must be provided face to face with the waiver participant except for that portion of the assessment involving development of the plan of care.  Speech, Language, and Hearing therapeutic and corrective services shall not be ordered concurrently with Speech, Language, and Hearing assessments (i.e., assess and treat orders are not accepted).

Speech, Language, and Hearing Services shall be provided in accordance with a treatment plan developed by a licensed speech language pathologist or a licensed audiologist based on a comprehensive assessment of the waiver participant’s needs and shall include specific functional and measurable therapeutic goals and objectives.  The goals and objectives shall be related to provision of Speech, Language, and Hearing Services to prevent or minimize deterioration involving a chronic condition which would result in further loss of function.  Continuing approval of Speech, Language, and Hearing Services shall require documentation of reassessment of the waiver participant’s condition and continuing progress of the waiver participant toward meeting the goals and objectives.

Speech, Language, and Hearing Services shall not be billed when provided during the same time period as Physical Therapy, Occupational Therapy, Nutrition Services, Orientation and Mobility Services for Impaired Vision, or Behavior Services, unless there is documentation in the waiver participant’s record of medical justification for the two services to be provided concurrently.

Speech, Language, and Hearing Services are not intended to replace services that would normally be provided by direct care staff or to replace services available through the Medicaid State Plan/TennCare Program.  To the extent that such services are covered in the Medicaid State Plan/TennCare Program, all applicable Medicaid State Plan/TennCare Program services shall be exhausted prior to using the waiver service.  Speech, Language, and Hearing Services shall not be covered for children under age 21 years (since it would duplicate TennCare/EPSDT benefits).

The unit of reimbursement for a Speech, Language, and Hearing Services assessment with plan development shall be per day.  The unit of reimbursement for other Speech, Language, and Hearing Services shall be per 15 minutes.

Reimbursement for a Speech, Language, and Hearing Services assessment with development of a Speech, Language, and Hearing Services plan based on such an assessment shall be limited to a maximum of one assessment with plan development per month with a maximum of 3 assessments per year per waiver participant per provider.  Speech, Language, and Hearing Services other than such assessments (e.g., waiver participant-specific training of caregivers; provision of therapeutic services; monitoring progress) shall be limited to a maximum of 1.5 hours per waiver participant per day.  Speech, Language, and Hearing Services assessments shall not be billed on the same day with other Speech, Language, and Hearing Services. 

Reimbursement shall not be made for telephone consultations.  A provider shall not receive reimbursement for Speech, Language, and Hearing Services unless provided by a licensed speech language pathologist or by a licensed audiologist.

Applicable limits, if any, on the amount, frequency, or duration of this service:

  • 1 assessment with plan development per month
  • 3 assessments per year per provider
  • 1.5 hours per day for services other than assessment

 

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