Relevant Medicaid Definitions for Funding Assistive Technology
1. Speech-Language Therapy
2. Physical Therapy
3. Occupational
Therapy
4. Preventive
Services
5. Home Health
Services
6. Durable
Medical Equipment
7. Rehabilitative
Services
8. Prosthetic Device
9. Medical Necessity
Services for individuals with speech, hearing and language disorders means diagnostic, screening, preventive and corrective services provided by or under the direction of a speech pathologist or audiologist, for which a patient is referred by a physician. It includes any necessary supplies or equipment.
Services prescribed by a physician and provided to a recipient by or under the direction of a qualified physical therapist. It includes any necessary supplies and equipment.
Services prescribed by a physician and provided by or under the direction of a qualified occupational therapist. It includes any necessary supplies and equipment.
Services provided by a physician or other licensed practitioner of the healing arts within the scope of his practice under State Law to --
(1) prevent disease, disability, and other health conditions or their progression;
(2) prolong life; and
(3) promote physical and mental health and efficiency.
The services in paragraph (b) of this section that are provided to a recipient -
(1) at his place of residence, and
(2) on his physician's orders as part of his written plan of care that the physician reviews every 60 days.
(b) Home health services include the following services and items. Those listed in paragraph (b)(1)m (2) and (3) are required services; those in paragraph (b)(4) are optional.
(1) nursing services, as defined in the state nurse practice act, that are provided on a part time or intermittent basis by a home health agency. . .
(2) home health aide services provided by a health agency.
(3) medical supplies and equipment, and appliances suitable for use in the home; and
(4) physical therapy, occupational therapy or speech pathology and audiology services provided by a home health agency or by a facility licensed by the state to provide medical rehabilitative services.
Equipment other than prosthetics or orthotics which can withstand repeated use by one or more individual, is primarily and customarily used to serve a medical purpose, is generally not useful to a person in the absence of an illness or injury, is appropriate for use in the home, and is reasonable and necessary for the treatment of an illness or injury.
Any medical or remedial services recommended by a physician or other licensed practitioner of the healing arts, within the scope of his practice under state law, for maximum reduction of physical or mental disability and restoration of a recipient to his best possible functional level. A federal policy letter explained that states may cover supplies and equipment under this option that are medical in nature if state regulations allow.
Replacement, corrective, or supportive devices prescribed by a physician or other licensed practitioner of the healing arts within the scope of his practice as defined by state law to --
(1) artificially replace a missing portion of the body;
(2) prevent or correct physical deformity or malfunction; or
(3) support a weak or deformed portion of the body.
A service is medically necessary if it is reasonably calculated to prevent, diagnose, or treat conditions in the client that endanger life, cause pain, or cause functionally significant deformity or malfunction; and
There is no other equally effective course of treatment available or suitable for the client requesting the service which is more conservative or substantially less costly.