Medicare Funding of AAC Technology

I. Demographic Information

Patient Name
Medicare Number
Date of Birth
Medical Diagnosis
Date of Onset

Other helpful information includes:
Patient's contact information
Physician's contact informaiton
SLP's contact information
Patient's primary support contact information
Date of SLP evaluation

II. Current Communication Impairment

A. General Statements

B. Comprehensive Assessment

III. Daily Communication Needs

A. Specific Daily Functional Communication Needs

This section should list the person's daily functional communication needs in areas described.

Document specific, daily functional communication needs in any of the three areas listed below.

1. Communication to enable person to get physical needs met.
Click Here for Examples
2. Communication to enable person to carry out family and community interactions.
Click Here for Examples
3. Communication to enable person to obtain necessary medical care and participate in medical decision-making.
Click Here for Examples

Note: It is reasonable to supplement the categories by considering daily communication situations, environments, partners, and specific messages.

This section should document why the patient is unable to fulfill daily functional communication needs using natural speech (or speech aids) and non-SGD treatment approaches.

The report should state, "The patient's daily functional communication needs cannot be met using natural communication methods or low-tech/no-tech AAC techniques because of                             (be specific).

1. Discuss success of speech therapy (to date and future prognosis) without a SGD.
2. Discuss the individual's ability to use low-tech strategies and natural modes of communication to meet daily functional communication needs.
3. Discuss why a SGD is required in addition to, or instead of low-tech strategies and natural speech?
4. Show explicitly that other forms of treatment have been considered and ruled out.
5. Mention issues related to communicating with primary partners and caregivers in specific contexts.

IV. Functional Communication Goals

This section should explicitly state the daily functional communication treatment goals that will be met using a SGD.

NOTE: This is a very important section. Functional goals are key to demonstrating the need for ongoing treatment. They are also key to demonstrating positive outcomes with SGD use and why a particular SGD will benefit the individual and enable him / her to achieve functional communication goals. SLPs should prepare immediate term, short-to-mid term and long-term functional goals.

1. List immediate, short term and long term functional communication goals and a timetable for completion of these goals.
2. Goals should correspond to specific daily functional communication needs (including specific contexts and communication partners as well as communication functions: e.g. needs, greetings, etc.) and illustrate how the patient will benefit from the acquisition of and training on the SGD.

Click Here For Examples Of Functional Communication Goals

V. Rationale for Device Selection

This section will explain why certain device features are required. The rationale will relate the person's skills and abilities as described in Section II . This section provides data that leads first to the selection of a specific device code and second, to a specific device within that code, as well as specific accessories.

The report should state, "This individual requires a speech generating device with (list specific features) to meet the person's functional communication goals."

In order to make these decisions, SLPs may work with OTs, PTs and Rehab Engineers and use AAC devices, computer or manual simulations to gather pertinent data.

A. General Features of Recommended SGD and Accessories

Note: There are coverage limitations and issues related to whether a manufacturer/supplier will accept assignment

Click Here For Frequently Asked Questions To Learn More About Considerations related to Coverage Issues .

C. Description of equipment and procedures used during any demonstrations of the recommended SGD and any other SGDs and accessories.

Include evidence that the individual was present and actively participated in the assessment process. Discuss assessment outcomes that demonstrate the person's ability to use the SGD and recommended accessories.

The report should state, "The individual's ability to achieve his/her functional communication goals requires the acquisition and use of the (name the device) and (name the specific accessories)." This SGD represents the clinically most appropriate device for (name of beneficiary).

List the specific SGD and accessories and include rationale for why this SGD and any accessories being requested will enable the patient to achieve functional communication goals, as stated earlier in the report.

Discuss participation of the family/caregiver/advocate and state that they agree to the selected SGD and will support the equipment and its use for daily communication.

The report should say, "This report was forwarded to the treating physician (Name, address, phone number) on ______(date). so that (he/she) can write a prescription of the recommended SGD and accessories."

Note. The date that the SLP forwards the AAC device assessment report should be BEFORE the date on the doctor's prescription.

VI. Treatment Plan

Address all functional communication goals previously stated for the beneficiary and identify the plan for achieving these goals using the SGD and accessories.

a) Frequency of Speech-Language Pathology Treatment
b) Schedule for Functional Goal Achievement

VII. Functional Benefit of Upgrade

This section is required only if the SLP is requesting an upgrade of equipment.

To upgrade a previously issued SGD, provide information regarding:

a) the features or capabilities of the upgrade as compared to existing equipment

b) the additional daily functional communication goals the patient can achieve with the upgrade as compared to existing equipment and

c) the importance of the patient's ability to achieve functional communication goals.

VIII. SLP Assurance of Financial Independence and Signature

The report should state, "The Speech-Language Pathologist performing this evaluation is not an employee of and does not have a financial relationship with the supplier of any SGD."