FORMAL REQUEST FOR
NATIONAL COVERAGE DECISION FOR
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION DEVICES

Respectfully Submitted by:

American Speech-Language-Hearing Association

Amyotrophic Lateral Sclerosis Society

Brain Injury Association

Center on Disability & Health

Communication Aid Manufacturers Association

Communication Independence for the Neurologically Impaired

International Society for Augmentative & Alternative Communication

National Association of Protection & Advocacy Systems

National Multiple Sclerosis Society

RESNA

Sunrise Medical

United Cerebral Palsy Associations

United States Society for Augmentative & Alternative Communication

December 30, 1999

 

Table of Contents

Section 1: Overview of Formal Request For National Coverage Decision For Augmentative And Alternative Communication Devices

Section 2: Executive summary

I. INTRODUCTION

II. USE OF AAC DEVICES

A. Summary Of Medical Evidence Related To AAC Treatment

1. Medical Conditions Requiring AAC Devices: Dysarthria, Apraxia, And Aphasia

2. Clinical Decision Making: Matching The Device To The Individual

III. MEDICARE COVERAGE OF AAC DEVICES AS ITEMS OF DURABLE MEDICAL EQUIPMENT IS APPROPRIATE

IV. TYPES OF AAC DEVICES

A. Category # 1: AAC Devices With Digitized Speech Output

B. Category # 2: AAC Devices With Synthesized Speech Output, Which Require Message Formulation By Spelling And Device Access By Physical Contact Direct Selection Techniques

C. Category # 3: AAC Devices With Synthesized Speech Output, Which Permit Multiple Methods Of Message Formulation And Multiple Methods Of Device Access

D. AAC Accessories

V. PROPOSED NATIONAL COVERAGE DECISION

VI. CONCLUSION

VII. ORGANIZATIONS AND INDIVIDUALS INVOLVED WITH PREPARATION OF THIS REQUEST

A. AAC Professionals Who Prepared This Formal Request

B. Organizations Submitting This Formal Request

 

SECTION 3: CLINICAL ASPECTS OF AAC DEVICES

I. MEDICAL CONDITIONS ASSOCIATED WITH NEED FOR AAC DEVICES

A. Characteristics Of Speech-Language Impairments Requiring AAC Treatment: Dysarthria

1. AAC Devices As Treatment For Dysarthria

a. Use of AAC Devices for Common Conditions or Diseases Causing Dysarthria

b. Efficacy of AAC Devices as Treatment for the Dysarthrias

c. Summary of Evidence Supporting the Effectiveness of AAC Devices in Severe Dysarthria

B. Characteristics Of Speech Language Impairment Requiring AAC Treatment: Apraxia Of Speech

1. AAC Devices As Treatment For Apraxia

2. The Use And Efficacy Of AAC Devices For Treatment Of Apraxia

C. Characteristics Of Speech Language Impairment Requiring AAC Treatment: Aphasia

1. AAC Devices As Treatment For Aphasia

2. The Use And Efficacy Of AAC Devices As Treatment For Aphasia

II. CLINICAL DECISION MAKING PROCESS

A. AAC Assessment Process

1. Clinical Decisions Leading To The Selection Of An AAC Device

a. DECISION #1: Determining Current Functional Communication Levels

b. DECISION # 2: Predicting Future Levels of Communication Effectiveness

c. DECISION # 3: Identifying Functional Communication Goals and Treatment Approaches

d. DECISION # 4: Selecting Specific AAC Treatment Approaches

e. DECISION # 5: Selecting an AAC Device and Accessories

f. DECISION # 6: Determining Procurement, Training, and Follow Up

 

SECTION 4: MEDICARE COVERAGE OF AAC DEVICES AS ITEMS OF DURABLE MEDICAL EQUIPMENT IS APPROPRIATE

I. MEDICARE COVERAGE AND PAYMENT CATEGORY FOR AAC DEVICES

A. AAC Devices Meet The Medicare Statutory Standard As Reasonable And Necessary

1. AAC Devices are Safe and Effective

2. AAC Devices are not Experimental

3. AAC Devices Are Cost Effective And Appropriate

B. AAC Devices Meet the Medicare Regulatory Definition of DME

C. State Medicaid Coverage Of AAC Devices

D. Medicare ALJ Decisions Recognizing Coverage For AAC Devices

E. FDA Status Of AAC Devices

1. FDA Classification Of AAC Devices as Medical Equipment

II. CURRENT MEDICARE COVERAGE STATUS FOR AAC DEVICES

A. History Of The Medicare Augmentative Communication Device National Coverage Decision

B. Extensive Medical & Professional Information About AAC Intervention Strategies Was Available During The Development Of The NCD

SECTION 5: TYPES OF AAC DEVICES

I. CHARACTERISTICS OF AAC DEVICES

A. AAC Device Categories

1. AAC Devices With Digitized Speech Output

2. Synthesized Speech AAC Devices

a. Category #2: AAC Devices With Synthesized Speech Output, Which Require Message Formulation By Spelling And Device Access By Physical Contact Direct Selection Techniques

i. Message Generation: Spelling

ii. Access method: Direct selection

B. Category #3: AAC Devices With Synthesized Speech Output, Which Permit Multiple Methods Of Message Formulation And Multiple Methods Of Device Access.

i. Message generation: Multiple methods

ii. Access (user interface): Multiple methods

II. KEY AAC DEVICE CHARACTERISTICS

A. Methods Of Displaying Language

1. Dynamic Displays

2. Static Displays

B. Methods of Storing and Retrieving Language

1. Levels

2. Message Encoding

a. Encoding Strategies

C. Methods for Enhancing Rate

1. Message Prediction

2. Letter/Word Prediction

III. Accessories (Device Customization Components)

A. Switches/Keyboard Adaptation and Selection (Pointing) Devices

B. Mounting Systems

C. Carrying Cases

D. Power

E. AAC Software

Section 6: PROPOSED COVERAGE CRITERIA FOR AAC DEVICES

Section 7: References

I. Speech-Language Pathology & Other Professional Medical Literature

II. miscellaneous References

A. Statutes

B. Federal Regulations

C. Federal Administrative Guidelines

D. State Administrative Regulations

E. State Administrative Guidelines

F. Federal Court Decisions

G. Medicare Administrative Decisions

H. State Administrative Decisions

I. Miscellaneous Sources

Table of Appendices

Appendix I

Appendix II-A

Appendix II-B

Appendix III