This section will provide an overview of the funding process for Augmentative Communication Devices. There are numerous funding options available to AAC users, so it is important to understand and explore all options. Because the funding process may differ depending on your own policy or state of residence, this information is by no means definitive. However, it should serve as a good guide to help you get started.

As always, feel free to contact us with questions or concerns you may have and we will try our best to help. Email us, give us a call at 800-268-6070, or visit our Cyrano Communicator User Forum.

To apply for any kind of funding or reimbursement, most state agencies and programs require a complete, detailed evaluation by a licensed speech pathologist (SLP) and a signed letter from your physician indicating the medical justification of the AAC device.

To explore the various funding options for Cyrano Communicator™ and other AAC devices, click the links below.

Some of the information contained in this guide was taken from the AAC-RERC web site. Medicare Funding of AAC Technology. Information obtained on February 9, 2005. Supported in part by the National Institute on Disability and Rehabilitation Research (NIDRR).

Although most Speech-Language Pathologists (SLP) will be familiar with conducting and writing evaluations, some funding sources require very specific information and wording. Make certain to check with the funding source for exact requirements.

A complete evaluation will contain all of the following information:

• Demographic Information / Background Data -

Name, Date of Birth, Contact Information, Medical Diagnosis, etc.

• Current Communication Impairment

General Statements

Impairment Type and Severity
Anticipated Course of Impairment
Comprehensive Assessment
Hearing Status
Vision Status
Physical Status
Language Skills
Cognitive Skills

• Daily Communication Needs

Specific Daily Functional Communication Needs
Ability to meet communication needs with non SGD treatment approaches

• Functional Communication Goals

• Rationale for Device Selection

General Features of the Recommended SGD and Accessories

Input and Output features
Message Characteristics and other features

Recommended Medicare Device Category and Accessory Codes
Description of Trials with SGDs and Accessories
Recommended SGD and Accessories
Patient and Family Support of SGD
Physician Involvement Statement

• Treatment Plan

Frequency and type of treatment and schedule for goal achievement as described above in section 4

• Functional Benefit of Upgrade (If Applicable)

• SLP Assurance of Financial Independence

Statement that evaluator does not have financial interest in supplier of recommended SGD

• Signature of Evaluator

Include Certification (ASHA) and (State) License information

The completed evaluation must be submitted to the beneficiary’s physician. After reading the evaluation, the doctor will write a prescription for the device based on the recommendations of the SLP. The prescription letter, called a Certificate of Medical Necessity, will outline the communication diagnosis, and state that the recommended communication device is being prescribed as treatment for that diagnosis.

The SLP will then submit all of the paperwork to the vendor for processing. However, it will be in the best interest of both the vendor and the beneficiary to make sure the funding paperwork is submitted promptly and accurately to ensure appropriate reimbursements and product deliveries.

Note: The SLP evaluation itself may be eligible for funding. Schools are legally required to provide the appropriate technology and services for a child to actively participate in class and complete homework assignments. If the school cannot provide these services, an outside evaluation should be conducted at the expense of the school. Regardless, the SLP must meet the requirements to be a provider of Medicare speech-language pathology services.

Out of Pocket

Of course, you always have the option to purchase augmentative communication devices with your own money. Some devices, like basic messaging devices, can be found for under $100. Devices that are more complex will easily reach a few thousand dollars. The Cyrano Communicator™ has a retail price of $1199 and features two methods of input- a dynamic, picture-based interface with touch screen display, and a text-to-speech interface with five lifelike voices.

Schools

Schools are required by law to provide appropriate assistive technology services for students. If the student’s Individualized Education Plan (IEP) calls for the use of assistive technology, the school must provide that service at no cost to the parents.

Private Insurance

Some private insurance companies are beginning to fund AAC devices, but prior authorization may be required- make sure you check your policy and coverage. Obtaining a copy of the SLP evaluation and Certificate of Medical Necessity will help tremendously when dealing with insurance companies (It is very likely that your insurance provider will not be familiar with AAC devices, so they may need an explanation of what the AAC device does. They will also need to be convinced of the medical necessity of the device). We recommend talking with your insurance company before pursuing funding for an AAC device.

Other Interested Parties

Many advocacy groups, public agencies, and philanthropic organizations will provide you with varying levels of funding towards the purchase of augmentative communication devices. You may also explore local churches, synagogues, Easter Seals, rotary clubs, and fraternal organizations in your community.

• Muscular Dystrophy Association (MDA)

The Muscular Dystrophy Association will help pay for communications technology for people whose neuromuscular disorders have robbed them of the ability to speak. MDA will allow up to $2000 for the one-time purchase of a communication device such as a speech generator or speech synthesizer. These aids, known as alternative and augmentative communication devices, must be prescribed by MDA clinic physicians. Their purchase is covered by Medicare and by some private insurance policies, and MDA will assist with costs not covered by these programs.

• Tricare

Tricare is an insurance program for active duty and retired military personnel plus their dependents. They will provide funding for AAC devices to those that need them, and their policy and procedures closely resemble those of Medicare.

• Vocational Rehabilitation

Every state has an office of Vocational Rehabilitation Services. Services through VR are typically tied directly to a plan of action (Individualized Plan of Employment, or IPE) that has been developed by an individual with their VR counselor in order to seek employment. This is similar to an Individual Education Plan (IEP) that students develop in school with their SLP. If the use of an augmentative communication device is required to accomplish established goals and objectives, funding will be available through the VR office.

• Information for Small Business Owners: Small Business Tax Credit is Available

IRS Code Section 44, Disabled Access Credit

Small businesses may take an annual tax credit for making their businesses accessible to persons with disabilities. Eligible businesses will have earned a maximum of $1 million in revenue or had 30 or fewer full-time employees in the previous year. The credit is 50% of expenditures over $250, not to exceed $10,250, for a maximum benefit of $5,000. The credit amount is subtracted from the total tax liability. The credit is available every year and can be used for a variety of costs such as:

• Sign language interpreters for employees or customers who have hearing impairments
• Readers for employees or customers who have visual impairments
• The purchase of adaptive equipment or the modification of equipment
• The production of print materials in alternative formats (e.g. Braille, audio tape, large print)
• The removal of barriers, in buildings and transportation, that prevent a business from being accessible to, or usable by, individuals with disabilities.

Where can I obtain additional information?
Office of Associate Counsel, IRS
Passthrough & Special Industries
1111 Constitution Avenue, NW
Washington, DC 20224
(202) 622-3110

Medicare

Medicare is the nation’s largest health insurance program, giving coverage to people aged 65 years or older, disabled people receiving Social Security Disability Insurance (SSDI), and people with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant).

Medicare refers to AAC devices as “Speech Generating Devices”, or SGDs. Medicare classifies SGDs as “durable medical equipment”, and they are available to Medicare beneficiaries when the following four (4) criteria are met:

1) The beneficiary is enrolled in Medicare Part B

2) The beneficiary lives in his/her family home, or an assisted living facility (but not in a hospital, skilled nursing facility, or hospice)

3) The beneficiary is determined, following an assessment by a speech-language pathologist, to require an SGD to meet daily functional communication needs

4) The beneficiary's physician prescribes the SGD

There are two (2) Medicare guidelines that govern AAC device coverage:

1) Regional Medical Review Policy (issued March 4, 2001), which states the SLP assessment and reporting requirements to support a Medicare claim for an SGD, SGD software and/or accessories, and

2) National Coverage Decision, #50.1 (issued November 30, 2000), which describes the scope of Medicare coverage of SGDs.

The requirements of both guidelines must be met for a Medicare claim to be approved.

View the Medicare RMRP and NCD web site for more details.

Medicare requires that a speech-language pathologist (SLP) conduct, write, and sign the recommendations for specific AAC equipment and forward it to your physician for the agreement of medical necessity.

There is a particular way SLPs should conduct the evaluation. Medicare created a SGD Assessment Protocol as a guide so that speech language pathologists will conduct complete assessments and prepare written reports that address all of the points identified in the RMRP.

Medicare utilizes one of four (4) Durable Medical Equipment Regional Carrier (DMERC) to process their claims.

Although the vendor submits the paperwork to Medicare, it is in the best interest of both the vendor and the beneficiary to make sure the funding paperwork is submitted promptly and accurately to ensure appropriate reimbursements and product deliveries.

Note: Even when you submit the necessary paperwork clearly and accurately, your local DMERC will most likely deny your claim. Without getting too technical, it is because the DMERC follows an interpretation of the National Coverage Decision (NCD) which views AAC devices as “convenience” items. To pursue an appeals process, you will request Reconsideration or Review and a Carrier Hearing. However, both of these appeals are under the jurisdiction of the DMERC, and will most likely result in additional denials.

Do not get discouraged! The good news is that the next appeal level is the Administrative Law Judge (ALJ) Hearing. Administrative Law Judges are not associated with the DMERC, and therefore not required to follow their guidelines. Instead, the judge will decide whether the AAC device is an item of durable medical equipment and if the device being sought is “reasonable and necessary” for treatment of a communication disability. To date, the ALJ hearing has been the place where all Medicare AAC device appeals have stopped; they have all received favorable decisions. We still encourage everyone pursuing an ALJ hearing have an advocate or attorney available to help answer questions about hearing procedures and strategy.

To read more about the appeals process, visit the Neighborhood Legal Services or AAC-RERC web sites for complete Medicare information.

State Medicaid

Medicaid funding can become quite confusing because each state varies as to their submission and coverage guidelines. Most states will cover the purchase of AAC devices for individuals up to age 21, but many states will cover the purchase of equipment for individuals of all ages. It is also possible to qualify for coverage under both Medicaid and Medicare. The Medicaid submission process (SLP evaluation and letter of medical necessity) is quite similar to that of its national counterpart, Medicare.

An important fact to remember is that Medicaid generally requires recipients to first use other funding sources to obtain needed care. Only if no other sources exist or after benefits from those other sources are exhausted will Medicaid provide its services. This philosophy is referred to as the “Payer of Last Resort”. Medicaid may even require proof of denial from other funding sources before they process your claim.

Complete listing of all 50 state Medicaid offices