C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-109, subsec. 144-101-II-109.08
If such an evaluation has already been performed by another audiologist within the previous four (4) months, prior authorization (PA) by the Department is required. Refer to Section 109.09-5, below, for procedure to request PA.
The member must also receive an initial evaluation by a speech-language pathologist that supports the physician or PCP's determination that the member meets the eligibility criteria described in Section 109.04, "Specific Eligibility for Care". If speech-language pathology services are to be continued beyond a period of six (6) months, a re-evaluation by a speech-language pathologist must be completed every sixth month from the initial determination of rehabilitation potential, in order to determine that eligibility continues to exist. A report of the results of the speech-language pathologist's six-month re-evaluation must be sent to the member's physician or PCP, who will use that information to decide if eligibility continues to exist. If the physician or PCP agrees in writing that eligibility continues to exist, the member may continue to receive speech-language pathology services for an additional six (6) month period.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-109, subsec. 144-101-II-109.08