aac evaluating 101 - gsha...12/4/2018 1 aac evaluating 101: from evaluation to submission jennifer...
TRANSCRIPT
12/4/2018
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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: [email protected]• 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: [email protected].
• 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.