AAC: Medicare/Medicaid Funding and Documentation

 This text-based course is a transcript of the event, “AAC: Medicare/Medicaid Funding and Documentation” presented by Pat Ourand, M.S., CCC-SLP.Introduction>> Pat Ourand:  Let’s start with a brief background.  The reality is that, historically - and this is going back almost two decades - the process of going through a funding request for augmentative alternative communication was really just perceived as a tangled web.  It seemed that there were too many options out there.  It was either based on the disability or on the setting, etc., etc., and there was no perceived rhyme or reason.  Well I am hoping that things have gotten a little bit better.  Berry and Ignash (2003) have told us that even though we have had significant improvements in AAC as well as medical technology and mainstream technology, the number of individuals with disabilities also continues to increase as do their AAC needs.  That is happening for some very good reasons and we have some very good solutions out there.  So, how to make sure that individuals can access technology, purchase resources or procure technology – that is what we are going to discuss?One thing that is critical for those of us in the field -OTs, speech language pathologists, assistive technology service providers - is that we need to continue with our formal and informal training.  Whether it is through literature that is peer-reviewed, evidence-based research or continuing education, we need to stay current on what is in the field of AAC with regard to the technology and the funding sources.  So that is why we are here today.  We want to make sure that even though you come to the AAC team as an individual who has the necessary credentials from whatever profession you are in, whether it is OT, Speech-Language, Rehabilitation Engineering or Assistive Technology itself, you must be able to demonstrate that you can apply skills that will directly impact the assessment for AAC.  It is not something that just anyone can do and document and then get an insurance company or a funder to necessarily cover.  We need to keep that in mind. We Can All Agree That…The field of AAC is heavily dependent upon the actual equipment, whether we get that equipment off the shelf by going to the Apple Store and getting an iPad or it is configured in a lab, etc. We need to make sure that we always have accurate and updated documentation to necessitate what it is that we are asking for.  For example, I attended an IEP meeting that will most likely be going to due process.  The attorney and all the folks from headquarters were there.  In discussing the AAC assessment that had been completed, there were a host of things that I needed to bring forward to the team, the family and the educators so that we could decide what was going to be not only the best instrument for the student, but  how to also meet his/her educational needs. AAC is an extremely dynamic field.  We have many new products and improved features that are always being introduced.  We need to make sure that we can support why ‘Suzie Q’ needs this device and ‘Johnny’ needs that device based on what the setting is and who the funding source is.  We are going to be more specific in a while. Sarah Blackstone shared, as far back as 1996, that given that a growing demand exists world-wide for AAC, funding requests have grown consistently and those requests are for additional devices and services.  Therefore, because we have many new AAC options out there and because we have more individuals that can benefit from the technologies and services, the funding sources are going to want to make sure that what is being asked for is really necessary for the priorities of that funding source.  We are going to talk about those priorities in a little while. The Roadmap to Get ThereWe know that there is a host of funding sources available.  The road map just means identifying the different sources that are out there, understanding the general processes that they use, recognizing the features and aspects of writing a successful report for that funding source, and the setting that it is being used in.  By that I mean, if it is a medical funding source such as private insurance, public insurance, Medicare or medical assistance at the state level, that you are not writing to a medical funder and asking for a piece of equipment that is going to be used for educational purposes.  If, conversely, you are using school-based funding, you are not going to be asking for technology to meet medical needs.  The same is true with vocational funding sources - that you will not be asking for home, recreational, leisure, medical, etc.  Know who your funding source is when you are writing the report because the funding source has to keep the purchases and procurements within the mission of the agency or the group. Five Essential RulesWe basically have five rules to follow.  First, make sure to conduct a full and comprehensive assessment.  (It is a whole different discussion as to what would be included in a comprehensive assessment.) Next we need to look at the data clinically. For example, I was recently using various applications on some tablets and looking at the ability to make visual associations and categorizations, to identify by label, to identify by function, to do a whole host of skills that are necessary for using AAC.  By looking at the data, that is going to help me, as the clinician, bring forward a software program or an application that will closely align with the individual’s abilities.  A very obvious example is if we have someone who is very literate, we are not going to put that individual on an icon-based or picture-based system. Conversely, if you have someone who has poor literacy skills, you are not going to put them on a text-based system.  Really look at the data to help you decide...