Funding Information (for SLPs)



Augmentative Communication Evaluation and Funding | Funding Responsibility | Who Funds Devices? | Steps for completing the funding request | Examples of Paperwork | Speech-generating device (SGD) funding report | Device Trials









~~This page is designed for speech-language pathologists' use. For information related to consumers or families, see Funding page.~~

Augmentative Communication Evaluation and Funding

As the speech-language pathologist with an expertise in communication and language, consumers may come to you for your assistance in acquiring a communication device. While the consideration and feature matching process for which to speech-generating device will best meet the needs of your student/client/patient, the format and wording of the report may vary based on the agency you are seeking funding from (i.e., medical insurance will look for justification of medical need/necessity, Department of Vocational Rehabilitation will want to know how their consumer will use this in the 'work' setting, schools are legally required to provide what is necessary for ensuring a free and appropriate public education).

Funding Responsibility

The process of funding communication supports, services and systems can appear to be a daunting task. Recognizing that the package is a compilation of different individuals input and tasks to be completed, this section is meant to delineate some basic responsibilities of team members, family members and consumers when seeking funding for an AAC system and supports and services. Also, make sure that you download any funding packets or materials from device manufacturers' websites, as most have already organized the information into manageable tasks and/or checklists.

Who Funds Devices?

Devices should be fundable through:
  • PA Medical Assistance (including managed care: Keystone, Mercy or Gateway)
  • Medicaid (including ODP, LTL, and BAS waivers)
  • Medicare
  • Private insurance (depending on durable medical equipment exceptions)
  • Office of Voc Rehab
  • School-based Access program, with the parent/caregiver consent

NOTE: If the device is required for the student to participate in his/her free, appropriate public education than the local education agency (LEA; e.g., ChildLink, ELWYN, school district) must provide the equipment. Use of the device should be included in the service plan (IFSP, IEP). The equipment is the property of the LEA, unless they were given permission by the family to tap into School-based ACCESS program funding.


Steps for completing the funding request

Most funding sources follow the guidelines from Center for Medicare and Medicaid Services (CMS), as the national standard. The description below is based on the Medicare funding process.

  1. Evaluation reports must be completed by licensed speech-language pathologists and include required categories
  2. Determine the HCPCS Code for the requested device; or ask the SGD manufacturer. This is based off the federal CPT codes, which take into account various features of the device (e.g., digitized vs. synthesized speech, recording time, access methods).
  3. Acquire a prescription from a physician, verifying that this is medically necessary equipment. ~ depending on the funding source, your client may need to have gone to their physician within the last 6 month
  4. Gather all above information into a funding packet, including any paperwork required by the specific company.
  5. Submit funding packet to the 3rd party payer (MA, insurance, etc.). For details, please contact the vendor's funding department (if available) and whether they have an "assignment of benefits" form for them to act on behalf of your client during the funding process (i.e., contact and/or follow-up with the 3rd party payer). It is also recommended to request a Special Needs case manager (title may vary) be assigned by the insurance. This person helps coordinate the funding request, and can provide updates and information about the status of the claim.

Examples of Paperwork

For examples of funding reports and paperwork, see the links below (Coming Soon):
  • SGD funding report (see an example below; the funding department for many SGD manufacturers have examples too)
  • Physician prescription
    • Letter requesting prescription
    • Blank prescription form


Speech-generating device (SGD) funding report

(NOTE: ALL AAC devices are called SGDs and fall under the category of durable medical equipment (DME) for insurance funding purposes)

The SGD funding report documents the results of the full evaluation. The report must be written by a licensed speech-language pathologist (required by insurance, medicaid, etc.), but the evaluation should include multiple team members (e.g., PT or ATP for access/mounting considerations, vision specialist, audiologist for hearing) for best practice standards.

There are sample reports and letters are available through AAC-RERC and manufacturer / vendor websites (e.g., Dynavox, PRC, or Tobii Funding). Another resource is the AAC Report Coach, which should be customized to describe needs and abilities.

Required components include:
1. CURRENT COMMUNICATION IMPAIRMENT
  • General Statements
    • Impairment Type and Severity
      • EX: (ICD-9 Diagnostic Codes: 784.51 / 343.2) Patient has moderate-severe dysarthria (ICD-9 Code 784.51) due to quadriplegic cerebral palsy (ICD-9 Code 343.2) and reduced breath support. Given the severity of her expressive communication impairments, the patient is functionally non-speaking.
      • For examples of relevant International Classification of Diseases (ICD) Diagnostic Codes, see the World Health Organization website here (hint - use keywords like "autism" or "cerebral palsy" to search for relevant codes).
    • Anticipated Course of Improvement (Duration of Need)
      • EX: Patient's is stable in nature. She is anticipated to continue to demonstrate communication impairments.
        OR
      • Patient's condition is anticipated to decline with the progression of his disease. He will likely demonstrate increasingly severe communication impairments across time.
2. COMPREHENSIVE ASSESSMENT
  • Hearing Status
    • Use results of hearing screening or audiological assessment to ensure that patient's hearing is functional for using the recommended SGD
  • Vision Status
    • Use results of patient/family report, vision screening, or eye exam to ensure that patient's sight is functional for using the recommended SGD
  • Physical Status
    • Describe patient's physical status, as relates to device access.
      • EX: Patient displays motor involvement in all extremities, with a diagnosis of quadriplegic cerebral palsy. Patient utilizes a power wheelchair for mobility, and requires full support (e.g., top-bottom manual lift or hoyer lift) to transfer between positions (e.g., wheelchair to bed). Patient drives her power wheelchair with a joystick control using her right hand.
        During the assessment period, Patient effectively accessed the SGD using direct selection with either upper extremity (primarily the right hand) while seated upright in her wheelchair. She demonstrates adequate movement and pressure to activate both a membrane keyboard and touch screen. Patient requires a mounting system attached to her wheelchair to position her speech-generating device within range while allowing adequate view of her path for safe driving.
        With the above considerations, the patient possesses the physical abilities to effectively use an SGD to communicate and direct support personnel to carry, mount, and maintain an SGD to communicate.
        OR
      • Patient displays motor skills within functional limits. He is ambulatory and exhibits appropriate fine and gross motor skills to perform all basic activities of daily living.
        During the assessment period, Patient effectively accessed the SGD using direct selection with either upper extremity (primarily the right). He demonstrated adequate movement and pressure to activate membrane keyboards and touch screens. The patient successfully transported and used the SGD with a shoulder-strap tote.
        The patient possesses the physical abilities to effectively carry, maintain, and use a SGD to communicate.
  • Language Skills
      • EX: Patient's overall language abilities are considered functional as it relates to using an SGD. Based on past reports, observations, and testing of her language and literacy skills during the evaluation, Patient possesses the following skills/abilities:
    • Receptive (Oral and Written)
      • EX: Patient demonstrates understanding of spoken speech within functional limits. According to formal (describe testing completed) and informal measures as well as observations, Patient's receptive language skills are adequate to support communication during activities of daily living. She understands and appropriately responds to questions; including yes/no questions, responses about personal information (e.g., relevant dates for medical history, past family events) and general information / current events (e.g., news items, weather). Notably, Patient responds appropriately to requests for clarification or repetition when her partner is unable to understand her speech during comprehension tasks.
    • Expressive (Oral and Written)
      • EX: Patient’s verbal expression is nonfunctional for a variety of environments (e.g., unfamiliar partners, telephone), influenced by her impaired motor control for speaking (related to cerebral palsy), her reduced respiratory support, and concomitant health conditions. (Describe intelligibility testing completed). Due to Patient’s severely impaired speech intelligibility, she is functionally nonspeaking for a variety of communicative situations (i.e., her speech is unable to be understood, therefore completely ineffective).
        OR
      • Patient’s verbal expression is nonfunctional, influenced by his autism spectrum disorder, articulation disorder, and areas of impaired language. Patient does not spontaneously produce verbal speech. Prompted speech attempts are typically short (1-2 word) approximations, with impaired articulation and vocal quality.
  • Cognitive Skills
      • EX: Patient demonstrates the necessary cognitive abilities (i.e., attention, memory, and problem-solving) to learn and use a SGD to achieve functional communication goals. She exhibits strengths in her working memory for information and functional tasks. During the assessment, Patient navigated within and between dynamic display pages to locate prestored content. He searched for and selected appropriate messages (e.g., found “hello” under “Greetings” category) with increasing independence. He also demonstrated the ability to generate novel messages using a text-based on-screen keyboard.
3. DAILY COMMUNICATION NEEDS
  • Specific Daily Communication Needs
    • Description of daily communication needs (e.g., physical wants/needs, family/community/social interactions, directing medical care/decision-making, emergency situations). Include ability to meet these needs with current communication system (e.g., speech only, outdated SGD, etc).
  • Ability to Meet Communication Needs with non SGD Treatment Approaches
    • Explain history and progress/success of traditional speech-language therapy to-date. Describe why the patient is unable to meet needs without an SGD (using speech and non SGD approaches). Discuss low-tech strategies used/tried to meet daily needs.
      • EX: Patient cannot communicate her needs adequately with natural speech – she is understood 56% of the time when speaking in sentences. Using single words (e.g., to repeat a misunderstood word) Patient is understood only 14% of the time without context. Patient has previously participated in speech-language therapy (i.e., Rehab facility from 1/10-5/10) to improve her speech intelligibility using compensatory strategies (e.g., breath support, rate, pacing), which proved effective to enhance her existing verbal speech. However, despite use of compensatory strategies, Patient’s verbal speech intelligibility remains severely impaired due to both ongoing and progressive medical conditions, which are unable to be remediated further through speech therapy. Therapy to improve/increase functional speech is not a viable option to meet the patient’s communication needs.Patient is restricted in her independence as a communicator in her present situation. She has expressed difficulty being understood by less-familiar people (e.g., new people, medical staff) and by familiar partners via telecommunication. She is limited to communicating with known people in her immediate environment, or relying on a partner to interpret or convey her message. Patient’s current system is inadequate and inefficient in meeting her diverse communication needs.
        The results of the communication needs assessment as documented in the previous section indicate the majority of Patient’s daily functional communication needs cannot be met with natural speech and/or low-tech communication strategies because of the severity of her medical and communication conditions, her large vocabulary needs, and her variety of communication partners. Therefore, the patient requires a SGD to achieve and maintain functional communication ability in activities of daily living.
        OR
      • Patient cannot communicate his needs adequately with natural speech. Therapy to improve/increase functional speech is not a viable option to meet the patient’s communication needs because his condition is developmental and stable across, with no significant change expected. He received speech-language therapy throughout his education to support his effective communication, however a focus on verbal speech was discontinued due to lack of progress with this method of communication.
        Patient is restricted in his independence as a communicator in his present situation. His current mode of communication is use of no-tech or low-tech strategies and supports. He is primarily limited to communicating about basic wants and needs in his immediate environment, answering questions, and relying on others to prompt any complex or social interactions. Patient is able to use limited manual sign language and writing to communicate, however these techniques make him “partner dependent” in that they restrict him to individuals who know sign language and/or written text. Partners are also required to wait for, view, and interpret his communication attempts.
        The results of the communication needs assessment as documented in the previous section indicate the majority of Patient’s daily functional communication needs cannot be met with natural speech and/or low-tech communication strategies. Therefore, the patient requires a SGD to achieve and maintain more functional communication in activities of daily living.
4. FUNCTIONAL COMMUNICATION GOALS
    • Should include functional Immediate, Short-term (weeks/months), and Long-term (year) goals that address the areas of communication need identified under previous, "Specific Daily Communication Needs" section.
      • EX: Upon receipt of an SGD, Patient will demonstrate the following abilities:
5. RATIONALE FOR DEVICE SELECTION
  • General Features of the Recommended SGD
    • Input (Selection Techniques) / Message Characteristics & Features
    • Output
    • Other Features
  • Recommended Speech Generating Device Code
    • For assistance finding appropriate code, see below "Steps for Completing Funding Report" information.
  • Equipment and Procedures Used in Assessment
    • Speech Generating Devices and Accessories Evaluated
      • Should trial 3-5 devices from different vendors to select the best fit (feature-match) for the Patient. ~ See below for SGD vendors who provide brief trials, including the PIAT Lending Library
    • Procedures Used in SGD Trials
      • Describe tasks completed to assess device use and appropriateness during evaluation.
    • SGD Outcome
      • List why other 2-4 devices evaluated were not the most appropriate (describe which features were lacking).
      • EX: The other SGDs evaluated were ruled out for the following reasons:
  • Speech Generating Device Recommendation
    • Equipment (Name)
    • Medicare/CPT Code
    • Manufacturer/Vendor (Contact Info)
      • EX: Based on SGD trials, it is recommended that Patient be fitted with:
        This SGD represents the clinically most appropriate device for Patient.
  • Patient/Family Support of Speech Generating Device
      • EX: The patient was present and active throughout the evaluation process. The patient’s parents were present at various times during the evaluation period with the SGD. Her family and attendant care staff are supportive of the patient using the SGD and agreed to the necessity of the SGD for meeting the patient’s communicative needs in activities of daily living. With additional training and support, Patient and her family/staff will be able to independently maintain the equipment.
  • Physician Involvement Statement
      • EX: This report was forwarded to the treating physician, Dr. _Name_ on _Date_. The physician was asked to write a prescription for the recommended SGD.
6. TREATMENT PLAN
      • EX: Following receipt of the recommended SGD, it is recommended the patient receive a total of _#/frequency_ treatment sessions addressing the acquisition of the functional communication goals described in part IV of this report. The patient’s parents and any relevant support staff will be encouraged to participate in the treatment sessions to learn to assist Patient in programming, using, and maintaining his SGD as needed. Following treatment, the patient will be reevaluated as needed (at the request of the patient, physician, or family) to determine the need for updates/modifications of the SGD.
7. SLP ASSURANCE OF FINANCIAL INDEPENDENCE AND SIGNATURE
      • EX: The Speech-Language Pathologist performing this evaluation is not an employee of, and does not have a financial relationship with, any suppliers of the strategies, devices, or equipment listed above.


Device Trials

After completing a feature-matching process (matching the client's needs to the devices being considered), you must try a minimum of 3 devices for comparison. Many vendors have a brief 2-week trial period that will help fulfill this requirement, but a longer period with the device being considered may be necessary depending on the funding source. Agencies and vendors that loan SGDs and/or accessories/equipment include:


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There are sample reports and letters are available through AAC-RERC and manufacturer / vendor websites (e.g., Dynavox, PRC, or Tobii Funding).
Required components include:
demonstrate explicitly other treatments and systems have been considered and ruled out (include why you ruled them out); provide a rationale for system chosen/recommended-- why are certain features needed --skills and abilities determine this;