Fundamentals of funding an AAC device.

Obtaining funding for an assistive technology device should not be difficult, but it can be a more time-consuming and lengthy process than you may expect. The family, physician, Speech Language Pathologist, school staff, and manufacturer must all work together to achieve the goal--to obtain the most appropriate device for the child. The steps outlined here discuss the funding process: selecting a funding source, finding an evaluator, preparing and submitting the paperwork, and what to do if the funding source denies your request.

Step 1. Find the most appropriate funding source

You'll need to do some homework to find the most appropriate source for funding and the best way to approach that funding source. Some commonly used funding sources are school systems, state Medicaid programs, private insurance companies, charitable organizations, and foundations. Also, Medicare now approves Speech-Generating Devices (SGDs) for adult users. Sometimes you can combine more than one resource.

Public school systems can be a great resource to either fully or partially pay for an Augmentative and Alternative Communication (AAC) device. The drawback to this funding source is that the school will own the device and some may not allow the system to follow the student outside of the school environment. In addition, it may pay for a system that meets only the student's most basic communicative needs.

Most state Medicaid programs pay for AAC devices; however, the policies and regulations of coverage vary greatly from state to state. State Medicaid agencies require a great deal of paperwork and can take a considerable amount of time, anywhere from two to six months, to approve an AAC system.

Another funding source can be a private insurance company. Whether or not you can obtain an AAC system from this source depends on the policy you hold; it also depends on whether an AAC system is a covered benefit. The fastest and most direct method of determining if your insurance company will fund an AAC system is to contact the insurer and confirm that Durable Medical Equipment (DME) is a covered benefit. If it is, then submitting the appropriate completed paperwork for review will increase the chances of obtaining an approval.

Charitable organizations such as Lions clubs will at times have funds to donate to families in need of AAC devices. You can easily find these organizations in just about any city. Some of these clubs develop wish lists of donations or gifts that they would like to contribute and are always looking for new and helpful options.

Private foundations and grants exist in every state, each with its own strict guidelines for distribution of funds. A

== Web search or visit to your local library's reference section may uncover foundations whose mission includes providing needed equipment to people with disabilities. You may wish to start your search at www.foundationcenter.org.

In many cases you will be able to combine more than one of these sources to help fund the AAC system. For example, your insurance company may pay 80 percent of the cost of the system, leaving you 20 percent to pay. Some families are able to accommodate this 20 percent co-pay in their budget; others are able to receive assistance from their school, a charitable organization, or a foundation. Most AAC manufacturers will also offer some form of payment plan to help families stretch out the payments.

Step 2. Find the right qualified professionals

In most cases, you will need the assistance of professionals who can attest to the need for an assistive device. These professionals include doctors, clinicians, therapists, and teachers. This multidisciplinary team will assess the individual and recommend the appropriate AAC device as part of a complete and comprehensive AAC evaluation.

The Speech Language Pathologist (SLP) is probably the most important and influential professional that will be involved with the selection and acquisition of the AAC device. It is the SLP who will evaluate your child's language needs and then select the most appropriate AAC device. This professional will also be key in setting up and establishing the best language matrix.

Your child's physician will write a prescription for the need of an AAC device and may write a letter of support to include in the funding packet, depending on the funding source.

For a thorough evaluation, an occupational therapist (OT) may need to address fine motor skills and AAC access points as well as position of the device. In addition, a physical therapist (PT) may need to discuss mobility, mounting of the AAC device, and positioning of the child.

The child's teacher will also play a role in this evaluation. The teacher will be responsible for evaluating the child's cognitive abilities as well as classroom and school-based communicative needs.

Step 3. Collect the paperwork for submittal

Be prepared for lots of paperwork. You need to be a strong advocate to make the paperwork process run smoothly. Gather all the necessary information, including the SLP's AAC evaluation to support the need for the assistive technology, the physician's prescription, and a client information form. You will also need to complete an insurance claim form. Submit these documents together to the AAC device manufacturer who will forward the funding package to the funding source for authorization/approval. Below is a list of the major documents that most insurance-based funding sources require before they will review the request.

1. Client's name, address, date of birth, Social Security Number, and a clear copy of both the front and the back of the insurance card.

2. The AAC device manufacturer's order form listing all items needed (be specific regarding product options, accessories, input devices, batteries, etc.). Note that Medicaid does not cover extended warranties and often does not cover shipping, handling, and shipping insurance. It is important to include all items in the order, as many insurers will make only one payment if the device is approved.

3. A written AAC evaluation by a Speech Language Pathologist. This important document describes the communication issues the child faces, how the child will need to communicate, results of trials of various devices, and the name of the recommended device.

4. A doctor's prescription that specifically names the device that the client needs. (The prescription should state "MiniMerc," not simply "communication device.") If any accessories are requested, these should also appear on the prescription. If the client is in a managed care program, the prescribing doctor should be his or her Primary Care Physician.

5. A letter or certificate of medical necessity from the physician.

Device manufacturers can easily provide you and your therapist with sample evaluations, forms, and letters of medical necessity.

Some funding sources may require that the individual needing a device rent one for a period of time (one to three months) to prove that the device meets his or her needs before approving it for funding. Device manufacturers often offer a preview program so that therapists can try various devices with users and a rental program so that users can trial a device for insurance purposes.

By John Standal, MS/CCC-SLP, and Tara Rudnicki