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AAC Evaluating 101:From Evaluation to Submission

Jennifer Thomas is an ASHA certified speech-language pathologist (SLP) and Regional Consultant for Prentke Romich Co. (PRC).

Financial Disclosure:

I am an salaried employee of the Prentke Romich Company (PRC). PRC is 100% employee owned. I am an employee-owner of PRC.

Non-financial Disclosure:

ASHA member and ASHA SIG 12 member.

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Your presenter today…

Housekeeping

Today’s Learning Outcomes

• Identify the role of a speech-language pathologist who is evaluating for speech generating devices (SGD).

• Determine at least three different diagnoses which may indicate the need for augmentative and alternative communication (AAC).

• List at least three different funding sources for the purchase of an SGD.

• Name the main components of an SGD evaluation.

Today’s Agenda

• SLPs ROCK!

• Completing an AAC evaluation

• Check funding sources

• Complete the evaluation

• Submit the paperwork

• The device arrives!

ASHA’s Thoughts:

AAC involves attempts to compensate for temporary or permanent impairments, activity

limitations, and participation restrictions of individuals with severe disorders of speech-

language production and/or comprehension, including spoken and written modes of

communication.

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ASHA’s Thoughts:

It is the position of the American Speech-Language-Hearing Association (ASHA) that

communication is the essence of human life and that all people have the right to communicate to the fullest extent possible. No individuals should

be denied this right, irrespective of the type and/or severity of communication, linguistic, social, cognitive, motor, sensory, perceptual, and/or other disability(ies) they may present.

SLPs ROCK!

• SLPs…

• Recognize a need

• Organize a team

• Complete the evaluation

• If warranted, complete an evaluation for trial or purchase of a speech generating device

• Know the resources

Recognize a Need

• CVA

• Parkinson’s

• TBI

• Cancer

• Developmental Disabilities

• ALS

• MS

• Autism

• Vocal Impairments

• Cerebral Palsy

Signs & Signals

• Diagnosis indicates significant speech impairment

• Diagnosis indicates significant language impairment which impacts expressive communication

• No or limited intelligibility

• Low tech board a good start but not enough!

• Frustration and/or negative behaviors

• Becoming withdrawn or depressed due to difficulties associated with communicating with others

• Individual is missing key communicative opportunities on a regular basis

Frequently Asked Question

When should I consider a

high-tech AAC system?

Benefits of High-Tech AAC

• Access to the alphabet, single words, phrases, and sentences to provide maximum flexibility and efficiency

• Alternative access method such as switches, head mouse, or eye gaze

• Access to word completion, next word prediction, and abbreviation expansion

• Accommodates a wide range of communication functions, from responding to initiating

• Communicate over the phone or via the internet

• Speak with someone in the next room

• Ability to communicate their own unique thoughts across environments and communication partners

• Pre-compose lengthier stories or messages in preparation for company

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Pop Quiz!

• Name 3 diagnoses that routinely require AAC intervention.

• Name 3 signs or signals that AAC might be required.

• Name 3 benefits of high-tech AAC.

Organize a Team

• Necessary team members

• ASHA certified Speech-Language Pathologist

• Physician

• Reviews recommendations

• Provides a prescription for the DME

• Client

• Other team members

• OT/PT

• Teacher

• Rehabilitation counselor

• Family/caregiver/staff

Pop Quiz!

• Name the 3 mandatory team members.

• Name 3 other parties that may be involved.

Complete the evaluation

Check funding sources

Conduct the evaluation

Submit the paperwork

Main Funding Sources

• Medicaid Managed Care Organizations

• Medicare Managed Care Organizations

• Private insurance/Tricare

• Veteran’s Administration

• Maybe one or more funding sources

• Alternative Sources: local civic organizations, charities, fundraisers, grants, (www.disabilityresources.org), Go Fund Me, etc.

Check funding

sources

The evaluation

process

Submit the

paperwork

Check Funding Source(s)

• Always check funding source(s) before initiating an AAC evaluation

• Leads to extensive frustration if insurance is not an option

• Place of residence can significantly affect 3rd party funding• Medicare will not separately fund a device for someone in hospice

or in skilled nursing care, as they pay a facility a per diem amount for all of their care.

• State Medicaid programs and insurance companies may have similar exclusions

• Not impossible to get a device without funding, but it is a much longer journey. It is taxing on family and SLP’s time and resources.

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Check Funding Source(s)

• Before you call… https://www.aacfunding.com/insurance-tips

• Call to check on coverage for Durable Medical Equipment (DME) for these codes for a Speech Generating Device (SGD):

• E2510 (SGD)

• E2599 (SGD Accessories)

• E2512 (Mounts) Hello, does my policy

cover DME? And more

specifically does it cover

SGDs?

Pop Quiz!

• Name 3 funding sources.

• True or false: Check for funding sources after you complete the evaluation.

Conduct the Evaluation

• Consists of Client/Family Interview

• Speech and Language Testing (formal and informal, plus observation)

• Device Trials

• Explore Alternative Access Methods as Needed

Check funding

sources

The evaluation

process

Submit the

paperwork

RMRP Guidelines

Regional Medical Review Policy (RMRP) Guidelines require that the following information

be documented in the SGD evaluation report. Medicare and most funding sources follow these

guidelines.

Conduct the Evaluation

1. Client's Background Info

2. Speech and Language Abilities: Receptive and Expressive

3. Cognitive Abilities

4. Physical Abilities/Mobility Status

5. Hearing and Vision

6. Daily Communication Needs

7. Rationale for Device Selection

8. SGDs Considered and/or Tried

9. Recommended SGD and Accessories

10. Functional Communication Goals

11. Treatment Plan, Disclosure, and Signature

1. Client’s Background Info

• Name/Address/Phone/DOB

• Medical (primary) and Speech (secondary) Diagnoses

• Significant Medical Information

• Vocational and Educational Status

• Residential Setting

• Social History/Emotional status as it relates to communication

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2. Speech & Language Abilities

Speech

• Prognosis for Speech

• Degenerative condition

• Rate of speech declining

• Decreased breath support

• Vocal impairment

• Make a statement about intelligibility

• Based on severity of deficits, a full recovery may not be likely

Language

• Receptive• May or may not have formal test

scores

• Expressive• Indicate how client currently

communicates

• speech, gestures, written communication, pictures etc.

• Indicate why client currently communicates

• greetings, expressing wants/ needs, states opinion, asks questions etc.

• Prognosis for written communication

Prognosis for speech is poor

secondary to having a

diagnosis of ALS.

Uses low volume single words

that are 50% intelligible to

familiar listeners.

Receptive language within

normal limits.

Uses head nods and shakes to

indicate yes or no.

Communicates for a variety of

reasons, with a variety of

partners in a variety of places.

Additional Tips

• Describe what client can’t do

• Describe current SGD or other AAC

• Clearly describe why an SGD is needed

• Requires an SGD to speak in intelligible words, phrases, and sentences

• With familiar and unfamiliar partners

• Face-to-face, room-to-room, and over-the-phone

• Provide enough information to make funders understand need for device.

3. Cognitive Abilities

• Cognitive Status

• Insurance typically funds if fair, good, or excellent

Client has the cognitive ability

to use the SGD appropriately.

4a. Physical Abilities

• Physical abilities

• Comment on Activities of Daily Living

• For example - client requires maximum assistance with feeding and dressing

• Comment on fine motor abilities that affect access of device

• For example- client cannot use hands or fingers to touch keys on the screen

• Describe optimal access techniques

• Direct selection using hands, head, or eyes

• Indirect selection using switches

• Describe method by which optimal access technique was selected

• Involve PT/OT when necessary

4b. Mobility Status• Statement of mobility

• Information about how client ambulates

• For example - client walks with assistance for short distances.

• For example - client uses a power wheelchair 80% of the day.

• Integration of mobility and positioning with the SGD.

• For example - client needs access to SGD while in his power wheelchair.

• Need for alternative accessibility for power chair

• If yes, what access point is used for power mobility

• Involve PT/OT when necessary

• Some funding sources require separate reports or statements from PT/ OT.

5. Vision and Hearing• Make statements on vision and hearing as it

pertains to the use of the SGD

TopicTopicTopicTopic Example Example Example Example Example Example Example Example

Vision _________ wears glasses, but

does not have any visual deficits

that would negatively impact

his/her use of SGD.

_________ has visual deficits that

require the key size to be X by X

and the key background to be

dark.

Hearing _________’s hearing is within

functional limits and has no

impact on his/her use of SGD.

However, spouse has hearing loss;

therefore, the device needs to

have adequate volume.

_________ wears hearing aids

bilaterally, and is able to

understand conversational speech

with his communication partners

and hear the SGD.

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6. Daily Communication Needs

Topic Example Example

Who does the person

communicate with?

Family, doctors, friends, co-

workers etc.

Where does the

person

communicate?

At home, at an appointment,

out to dinner, at work etc.

Face-to-face, room-to-room,

over-the-phone, email etc.

What does the

person

communicate?

Comments, requests, asks

questions, states opinions etc.

Topic Example Example Example

Size (Screen Size)

800 – small 1000 - medium 1400 – large

Language

Representation

Method

(indicate all that apply)

Spelling

Word completion

Next word prediction

Abbreviation expansion

Single words

(core and fringe)

Text only

Text with symbols

Unity Family of

Vocabularies

Pre-stored messages

Sentence starters

Routine messages

Access method(Accessories)

Touch

Keyguard

TouchGuide

Mouse

NuEye

NuPoint

Joystick

Track pad etc.

Switches

Type

1 or 2

Voice Synthesized

Ivona Joey

Nuance Susan

Digitized

Recorded speech

Voice banking

Mount(make, model, clamp)

Table Floor stand Wheelchair

7. Rationale for Device Selection

For example…

smallmediumlarge

Hello, this is the

Ivona Joey voice.

Step 1: Size

Large Accent 1400

Step 2: Language Representation Method

Spelling & Pre-stored messages - Essence

Step 3: Access Method

Nueye

Step 4: Voice

Ivona Joey

Step 5: Mount

Daessy Folding Mount

7. Rationale for Device Selection

• Portability • Easy to carry

• Easy to mount to a wheelchair

• Weight

• Volume

• Battery life

• Backup options

• Price

• Customer support

Reach out to your consultant!

8. SGDs Considered or Tried

• Easy as Toast!

• Comparison of SGD specifications

• Most funding sources require that you consider 3 different SGDs

• Generally from at least 2 different companies

• Some require you trial one for a period of time

• Need to provide documentation of why non-requested SGDs did not meet recipient’s communication needs

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Client is allergic to

peanut butter.

This one is too

sweet.

This one is perfect.

For example…

DevicesDevicesDevicesDevices

ConsideredConsideredConsideredConsidered

ProcedureProcedureProcedureProcedure

UsedUsedUsedUsed

OutcomeOutcomeOutcomeOutcome

Accent 1000

PRC

One hour consultation with evaluation team and PRC regional consultant

Due to the client’s need for eye gaze technology and a large screen, the Accent 1000 was ruled out because key size decreased with a smaller screen resulting in decreased accuracy.

Accent 1400

PRC

One hour consultation with evaluation team and PRC regional consultant

The Accent 1400 with NuEyemet all of the client’s communication and access needs.

Nova chat 12

Saltillo

One hour consultation with evaluation team and Saltillo regional consultant

The Saltillo line of products were ruled out because they do not support eye gaze.

Device Trial Resources

• Contact the device manufacturer or their local company representative

• Local Assistive Technology lending libraries

9. SGD Recommendation

• Confirm if request for purchase or rental• If rental, the individual will need to have someone be

responsible for the loaner

• If rental, plan for transition to purchase

• If recommending purchase, ensure no rental/trial period is required

• Typically Medicare and private insurance DO NOT require a rental prior to purchase

• Many state Medicaids DO require a 30 day rental

9. Recommended SGD and Accessories

• Statement explaining why this SGD and applicable accessories/mount are the appropriate alternative that will meet the client’s physical, cognitive and language abilities, and basic communication needs

• State how this system will provide the necessary rehabilitative, prosthetic, and preventative goals of communication

• Include manufacturer/vendor information

10. Functional communication

• At least 2 long-term & 3 short-term communication goals

Topic Example Example

Long-term ______ will make requests

and provide information to

unfamiliar listeners

_______ will participate in family

planning decisions

Short-term ______ will make requests

and provide information to

familiar listeners

_______ will communicate physical

needs and emotional status to family

member/support person on a daily

basis

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11. Support/ Treatment Plan/ Signature

• Statement of Client/ Family support of SGD: • XX’s spouse/ parents/ children were present and are supportive of the necessity of the SGD for

meeting his communication needs.

• Physician Involvement Statement: • This report was forwarded to the treating physician, NAME/ CONTACT INFO, on DATE. The

physician was asked to write a prescription for the recommended equipment.

• Treatment Plan:• Upon receipt of the equipment, it is recommended that CLIENT receive XX treatment

sessions to address the functional communication goals described earlier in this report. XX’s treatment goals will best be met in an (Individual or group?) setting.

• SLP assurance of financial independence/ signature:• The SLP performing this evaluation is not an employee of and does not have a

financial relationship with the supplier of any SGD.

• Need SLP name/ ASHA certification number and state license number

• Don’t forget to sign!!

Helpful AAC Evaluation Websites

• https://www.prentrom.com/funding

• www.prentrom.com/training/go/on_demand

• www.aacinstitute.org

• www.aacfundinghelp.com

• www.aacPartners.com

• www.aacproducts.org

• www.asha.org

• www.assistivetech.com

Pop Quiz!

• True or false: When writing medically-based SGD evaluation reports follow the RMRP guidelines.

• True or false: Paint a clear picture of your client for the reader.

• True or false: Accessories do not need to be justified.

Submitting the paperwork • All funding sources require that the following items be

compiled as part of a funding packet1. A physician’s prescription and/or a Certificate of Medical Necessity for

the SGD https://www.aacfunding.com/forms

2. Legible copies of the front and back of ALL the client’s insurance cards (Medicare/Medicaid/Private Insurance Cards)

3. An Assignment of Benefit and Patient Release Form/Client Information Sheet (AOB/CIF) form https://www.aacfunding.com/forms

4. The SLP's SGD evaluation that supports the need for the assistive technology

5. Equipment Selection Sheet(s) to ensure proper equipment configuration is ordered

6. If requesting a device rental, a signed trial evaluation contract.

7. State Medicaid requirements may dictate other forms. See website for these state specific forms https://www.aacfunding.com/forms

Check funding

sources

The evaluation

process

Submit the

paperwork

Where do I send the packet?

Submit a complete funding packet to the vendor

• Fax: 330-263-4829

• Mail:

PRC Funding Department1022 Heyl RdWooster, OH 44691

• Secure Upload: https://www.aacfunding.com/submit_documents

• Email: funding@prentrom.com• Emailed documents must be physically signed by necessary team members.

• Packets should be sent using an encrypted email service to meet HIPAA requirements. Packets sent via regular email are not secure at this time.

• Regardless of how you submit the packet, it is best to follow up with an email or phone call to make sure PRC received the funding packet.

What Happens Next?

When PRC receives the packet…• PRC will verify the client’s eligibility to ensure the submission is

forwarded to the proper funding source(s).

• PRC will review all documentation and contact the SLP or family for missing information.

• A PRC Funding Specialist will submit the paperwork to the appropriate funding source(s).

• If the device is approved, PRC will confirm the order with the family.

• If the device is denied/ deferred, PRC will contact the evaluator with information on appealing the decision.

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How can I help expedite the process?

• Ensure that all paperwork is filled out completely. • Common issues

• Missing policy holder signature on AOB

• Missing SLP signature on evaluation

• Different items being requested across equipment selection sheet, prescription, and report. Needs to be the same in all three places.

• Cc your consultant in any email correspondence to the funding department.

• Be patient, but persistent. Don’t hesitate to check with your consultant on the status. If you have specific questions on missing information, contact our funding department.

Contact Us

• A funding specialist can assist you

• Call: (800) 268-5224

• Email: funding@prentrom.com.

• Also, progress of the case can be tracked through the PRC Funding Submission Assistant by the SLP if he/she submitted a report and documents through PRCs website at https://www.aacfunding.com/

Know the Resources

• Once the device arrives

• Schedule an appointment to help the client get the device set up

• Contact your regional consultant for help

• Once the device is properly configured, backup your work and begin therapy

Pop Quiz!

• True or false: Missing funding packet information slows down the funding process.

• True or false: PRC regional consultants and the funding department are there to help you.

Today we covered…

• SLPs ROCK!

• Recognize a need

• Organize a team

• Complete the evaluation

• Know the resources

One final thought…

• Once you feel comfortable with the AAC evaluation process, let people know!

• Contact neurologists both within hospital networks and private practice

• Contact other AAC evaluators and let them know you are a resource

• General Practitioners

• ENT’s

• Adult service providers in the area

• Organizations that serve adults with developmental disabilities

• People who need AAC need your help!

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DIFFERENT CLIENTS, DIFFERENT SYSTEMS

Access method

Device

Language System

5 year old female with Rett Syndrome

Access method

Device

Language System

Access method

Through trials with a PRC regional consultant, the evaluation team determined

that eye gaze is the best access method.

NuEye

PRC

Solution

Device

Given that NuEye is the access method, what line of product would you look at?

What size and why?

NuEye

PRC

Solution

Language system

Given the client is an emerging communicator that is pre-literate and requires a larger key size (28 buttons on the screen), what language system would you trial?

Accent 1400

NuEye

PRC

Solution

LANGUAGE SYSTEM

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Accent 1400

NuEyeUnity

PRC

Solution

PRC SOLUTION

PRC

Solution

Accent 1400 with NuEye and Unity

10 year old male with autism

Access method

Device

Language System

Access method

Through trials with a PRC regional consultant, the

evaluation team determined

that touching the screen with an index finger is the

client’s best access method. He can access small

buttons.

Touch

PRC

Solution

Device

Given that touch is the access method and the child and family want a portable device that can be carried, what line of product(s) would you consider? What size?

Touch

PRC

Solution

Language system

Given the child’s family primarily speaks Spanish at home and the team has decided to use the LAMP approach, what language system would you consider?

PRiO

Touch

PRC

Solution

LANGUAGE SYSTEM

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PRiO

Touch

LAMP Words for Life Sp/En

PRC

Solution

PRC SOLUTION

PRC

Solution

PRiO with LAMP Words for Life Sp/En

8 year old female with cerebral palsy

Access method

Device

Language System

Access method

Through trials with a PRC regional consultant, the

evaluation team determined

that 2 switch step scanning is the client’s best access

method.

2 switch step

scanning

PRC

Solution

Device

Given that 2 switch step scanning is the access method and the child drives a power wheelchair, what line of product(s) would you consider? What size?

2 switch step

scanning

PRC

Solution

Language system

Given the child is an emerging communicator and benefits from auditory prompts, what language system would you trial?

Accent

800/1000

2 switch step

scanning

PRC

Solution

LANGUAGE SYSTEM

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Accent

800/1000

2 switch step

scanning

Core-

Scanner

PRC

Solution

PRC SOLUTION

PRC

Solution

Accent 800/1000 with 2 Freedom Switches and CoreScanner

PRC

Solution

Accent 800/1000 with 2 Freedom Switches and CoreScanner

65 year old male with ALS

Access method

Device

Language System

Access method

Through trials with a PRC regional consultant, the evaluation team determined

that eye gaze is the best access method.

NuEye

PRC

Solution

Device

Given that NuEye is the access method, what line of product would you look at?

What size and why?

NuEye

PRC

Solution

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Language system

Given the client is a literate adult who wants to primarily spell his thoughts, what language system would you consider?

Accent 1400

NuEye

PRC

Solution

LANGUAGE SYSTEM

Accent 1400

NuEyeEssence

PRC

Solution

PRC SOLUTION

PRC

Solution

Accent 1400 with NuEye and Essence

Need additional help?

PRC Regional Consultants

• SLPs, OTs and special educators

• Demonstrations

• Client consultations

• Equipment loans

• Online and in-person training

• Field questions related to insurance funding process

• Provide general support

IN SUMMARY…

• Accent 3/4/5

• 3 sizes

• 4 device configurations

• 5 access methods

• PRiO 2/1/1

• 2 sizes

• 1 device configuration

• 1 access method

• Common Solutions for Different Clients

References

Burd, L., Hammes, K., Bornhoeft, D., & Fisher, W. (1988). A North Dakota prevalence study of nonverbal school-age children. Language, Speech, and Hearing Services in Schools, 19, 371–383.

Romski, M. A., & Sevcik, R. A. (1993). Language learning through augmented means: The process and its products. In Steven F. Warren, & Joe Reichle(Eds.), Enhancing children's communication: Vol 2. Communication and

language intervention series. Baltimore, MD: Paul H. Brookes.

Tullman, J. (1996, August). Impact of Augmentative and Alternative Communication on Natural Speech Production: Clinicians’ Perspectives. The ISAAC Bulletin, 44, 1-8.