Aug COMM 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 Vocational Rehabilitation
• 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.  Please see AAC Funding Help Resources for more information about HCPCS codes as well as detailed information about funding AAC.
4. 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
5. Gather all above information into a funding packet, including any paperwork required by the specific company.
6. 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

• SGD funding report AAC Funding Help Report Template
• The funding department for many SGD manufacturers also have examples.
• Physician prescription
• Letter requesting prescription
• Blank prescription form