Assistive Technology (AT) Forward

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Assistive Technology (AT)

AT must be considered for each and every student with an IEP.

Individuals with Disabilities Education Act (IDEA):

• The term “assistive technology device” means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability.
• The term “assistive technology service” means any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device.

Wisconsin State Statute:

• “Assistive technology service" means any service that directly assists a child with a disability in the selection, acquisition or use of an assistive technology device, including all of the following: (see web page).

Community of Practice Focus Areas

Goal: Improve student autonomy in using assistive technology tools to support access, engagement, and progress in learning.

1. Focus on underserved students.
2. Bridge support to families.
3. Build capacity of educators and CoP members.
4. Develop sustainable systems for ensuring equitable access to assistive technology.

Achieving Community of Practice Focus Areas

To achieve our focus areas we will . . .

1. Share current information from AT experts including those with lived experiences.
2. Share ideas and foster collaboration among community of practice members.
3. Focus on actionable information and resources that can be used by a wide variety of audiences and skill levels.

Assistive Technology Forward Resources

The Community of Practice provides members with. . .

• Free virtual learning and networking
• Access to AT Forward Video Library
• Monthly AT email updates
• Micro-credentials in assistive technology
• To join or refer a friend, click on the AT CoP Registration Form.
• More information and resources including legal guidance and best practices on the DPI AT Forward webpage.

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Additional Resources

• AAC assessment support from CASC
• Access to AT lending centers around the state
• Support from the Wisconsin AEM Center
• Assistive Technology Lending Center ATLC

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Partners in Assistive Technology

• Wisconsin Assistive Technology Network (WATN)
• State Leaders in Assistive Technology Education (SLATE)
• Assistive Technology Council
• Wisconsin AT4All
• UDL Forward!

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Quality Indicators for Assistive Technology (QIAT)

1. Consideration of AT Needs
2. Assessment of AT Needs
3. AT in the Individualized Education Program (IEP)
4. AT Implementation
5. Evaluation of Effectiveness of AT
6. AT in Transition
7. Administrative Support for AT
8. AT Professional Development

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Augmentative and Alternative Communication (AAC)

Funding Tips & Considerations

Abygail Marx, MS, CCC-SLP

Speech Language Pathologist

Augmentative and Alternative Communication (AAC) Specialist

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Waisman Center AAC Program

University of Wisconsin – Madison

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Communication Aids & Systems Clinic (CASC)

AAC Partnership Program (AAC-PP)

Communication Development Program (CDP)

ECHO AAC

Learning Objectives

1. Understand the evaluation and funding process for obtaining a Speech Generating Device (SGD) in Wisconsin.

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1. Describe at least 2 pitfalls and ethical considerations for SLPs completing the AAC funding process and interdisciplinary teams collaborating in that process.

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1. Identify at least 3 resources from AAC vendors and/or other sources that will help you complete the AAC funding process within your own practice.

Agenda

AAC Funding Process

Obtaining a Device: Funding Process

Assessment

Trials

Rental

Purchase

Implementation

Obtaining a Device: Tasks Outside AAC Session (non-billable)

Anderson et al., 2015

Baxter et all., 2012

Clarke et al., 2001

Swanson & Nanof, 2018

AAC Assessment: Feature Matching

Feature Matching = ”Gold Standard”

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Includes:

• Review of Records (e.g., IEP, other reports)
• Interview
• Dynamic assessment and trials of at least 3 systems
• Opportunity for additional rental period

AAC Assessment: �Before the Evaluation

Complete record review and consider beginning the interview

• Intake forms available through vendors OR create your own

Can help “narrow down” devices to trial by asking yourself:

• Need for accessories?
• Potential access method?
• Vision / hearing concerns?
• History of certain symbol set?
• Might they need… Motor planning? Full phrases? Dynamic branching?

Requirements for AAC Assessment

Trial of at least 3 different speech generating devices within evaluation

• Not required to complete a rental of all 3 devices
• Rental often required for first-time SGD users; typically not for updated devices

Centers for Medicare & Medicaid Services (CMS)

• Set requirements for AAC evaluation, trials, documentation, and prior authorization (details on upcoming slides)
• Many private insurances / HMOs also follow similar requirements

Requirements for SGD to be considered Durable Medical Equipment (DME)

SGDs are DME when they…

• Provide an individual with a severe speech impairment the ability to meet functional communication needs
• Dedicated | Used solely by an individual with severe speech impairment for communication purposes
• May use digitized (recorded) or synthesized (computerized) speech output

SGDs are not…

• Non-dedicated computers capable of running software for other purposes
• A device that is useful to someone without severe speech impairment

CMS Pub. 100-03, (Medicare National Coverage Determinations Manual), Chapter 1, Section 50.1

Requirements for �Prior Authorization of SGD

Medical Necessity is demonstrated, and SGD is covered when all 7 criteria are met:

1. Formal evaluation completed by an SLP (see next slide for minimum required elements to include in written evaluation)
2. Medical condition results in a severe expressive speech impairment
3. Speaking needs cannot be met using natural communication methods
4. Other forms of treatment have been considered and ruled out
5. Speech impairment will benefit from the recommended device
6. Treating practitioner (e.g., MD, DO, APNP) receives and agrees with SLP’s written evaluation and recommendation
7. Recommending SLP may not be employed by or have a financial relationship with the supplier of the SGD

CMS Pub. 100-03, (Medicare National Coverage Determinations Manual), Chapter 1, Section 50.1

Requirements for Documentation

Formal, written SGD evaluation must include:

1. Current communication impairment (type, severity, language skills, cognitive ability, anticipated course of impairment)
2. Assessment of whether daily communication needs can be met using other natural modes of communication
3. Description of functional communication goals and treatment options
4. Rationale for selection of a specific device and accessories (feature matching)
5. Treatment plan for teaching use of selected device
6. Cognitive and physical abilities to effectively use selected device and accessories to communicate
7. For updating/replacement devices: functional benefit of the upgrade compared to the initially provided SGD (e.g., change in status, outdated, broken and unrepairable)

CMS Pub. 100-03, (Medicare National Coverage Determinations Manual), Chapter 1, Section 50.1

Funding Considerations: �Medical / Insurance coverage

Insurances that cover Dedicated Speech Generating Devices (SGD):

• Medicare (national program, rules the same for every state)
• Medicaid (state program, rules different across states)
• Medicaid Managed by an HMO (required to follow state’s Medicaid requirements)

Variable coverage of SGD:

• HMO Only in Wisconsin often means no coverage (also varies by state and HMO)

ASHA’s 2018 Medicare Fee Schedule for SLPs

Anderson et al., 2015

Baxter et al., 2012

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Funding Considerations: �Alternative Funding Sources

Alternative funding sources may purchase AAC:

• Telecommunications Equipment Purchase Program (TEPP)
• Children’s Long-Term Support (CLTS) Waiver
• Philanthropic Organizations (e.g., Lions or Kiwanis Clubs)
• School Districts (not required to fund SGD, more information on next slides)

Funding Considerations: �Schools

School Responsibilities for funding:

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• B-3 and IDEA are “payers of last resort”

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• Medicaid is responsible before schools

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Forward Health Update 2004-02: Medicaid as payer of last resort |�https://www.forwardhealth.wi.gov/kw/pdf/2004-02.pdf

Financial Responsibility Form

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• Signed by parents to acknowledge schools are not required to cover recommended devices if denied by insurance

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Example courtesy of Tobii Dynavox

Funding Considerations: �Schools

Pitfalls and Ethical Considerations in AAC Assessment

Pitfalls with Speech Generating Apps (SGAs)

Use caution with free communication apps that lack evidence-base and are not created by communication specialists

Apps with Dedicated SGD Counterpart:

• Touch Chat HD
• TD Snap
• Compass
• LAMP Words For Life
• Grid for iPad
• Predictable

Apps without Dedicated SGD Vendor:

• Go Talk Now
• Proloquo2Go
• Cough Drop
• Quick Talk AAC
• Avaz
• Sounding Board

Pitfalls with SGD Vendors

• Be cautious about primarily relying on vendors who are most responsive
• Trying 3 devices within the same company doesn’t really count
• Never sign a report written by someone else
• Ask for a second opinion or additional support from other professionals if you need it

Other Pitfalls / Ethical Considerations

• Maintaining the integrity of the language system vs. customization for motivation, user preference, style, and personality

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• Effective interprofessional practice is essential to leverage different expertise and scopes of practice within the AAC assessment

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• Watch out for any “Conflict of Interest” when working with vendors, funding sources, etc.
• ASHA Code of Ethics | https://www.asha.org/code-of-ethics/

SGD Vendor Resources

SGD Vendor Resources:�Prentke Romich Company (PRC)

Website�https://www.prentrom.com

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Find Your Rep

(search by zip code or interactive map)

https://www.prentrom.com/prc_�advantage/prc-regional-consultants

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Wisconsin Rep

Christopher Yensan

christopher.yensan@prc-saltillo.com

SGD Vendor Resources:�Saltillo

Website�http://saltillo.com

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Find Your Rep

(search by zip code or interactive map)

https://saltillo.com/reps

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Wisconsin Rep

Christopher Yensan

christopher.yensan@prc-saltillo.com

SGD Vendor Resources:�SmartBox Assistive Technology

Website�https://thinksmartbox.com

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Request In-Person or Virtual Rep Support

(complete online form)

https://thinksmartbox.com/what-we-do/request-a-visit/

SGD Vendor Resources:�Talk To Me Technologies

Website�https://www.talktometechnologies.com

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Find Your Rep

(complete online form)

https://www.talktometechnologies.com/pages/contact-a-speech-language-pathologist-aac-consultant

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Wisconsin Rep

Christie Witt

christie@talktometechnologies.com

SGD Vendor Resources:�Tobii Dynavox

Website�https://www.tobiidynavox.com

https://www.mytobiidynavox.com

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Find Your Rep

(search by zip code)

https://us.tobiidynavox.com/pages/find-a-solutions-consultant

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Wisconsin Reps

Bob Penshorn | Western WI

bob.penshorn@tobiidynavox.com

Kellie Bews | Eastern WI�kellie.bews@tobiidynavox.com

Other Evaluation Resources

Finding AAC Resources by State

Assistive Technology Act of 1998, Revised 2004

• Federal grants that support each state in addressing the assistive technology needs of individuals with disabilities (including AAC)

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National Assistive Technology Act Technical Assistance and Training (AT3) Center

• Information about state AT Program(s), device loans, demos, and reutilization, and financial information and supports
• https://www.at3center.net, Click: “State / Territory AT Programs”

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Wisconsin’s AT Center:

• Wisconsin Assistive Technology Program (WisTech)�https://www.dhs.wisconsin.gov/wistech/index.htm

Assistive Tech Lending Center (ATLC)

The ATLC library’s new website:

https://wisconsinat4all.com/

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To access communication equipment:

• Register by clicking “Create account”
• Login with newly created account
• Click on Speech Communication (Program field should fill in as ATLC)

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Questions or problems?�Contact donna.hutson@cesa2.org or call 262.473.1449

ASHA Resources for AAC

Practice Portal�https://www.asha.org/Practice-Portal/Professional-Issues/Augmentative-and-Alternative-Communication/

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Continuing Education�https://www.asha.org/ce/

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SIG 12: Augmentative and Alternative Communication (AAC)�https://www.asha.org/SIG/12/About-SIG-12/

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Perspectives�https://perspectives.pubs.asha.org

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Penn State AAC Learning Center

https://aac-learning-center.psu.edu

Educational Resources for AAC:

• Webcasts
• Moodle
• Publications

AAC Assessment Resources for Schools

CESA or District Assistive Technology Specialists / Teams

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Find Your CESA

https://dpi.wi.gov/cst/data-collections/school-directory/directory-data/published-data/dist-by-cesa

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CESA Contact Information

https://dpi.wi.gov/cesa

Feature Matching Resources

Feature Matching Comparison Chart

https://praacticalaac.org/praactical/praactical-resources-feature-match-chart/

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Vendors (Caution: Limited to single company’s products)

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CESA and State Lending Libraries (Sometimes may be older versions)

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iPad Apps (Non-dedicated, limited access methods, restricted options)

Feature Matching Resources:�Tele / Remote Assessments

PRC-Saltillo AAC TeleTips�https://www.prc-saltillo.com/classes/aacteletips/

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Tobii Dynavox Virtual Assessments�https://www.tobiidynavox.com/en-US/aac-virtual-assessments/

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Talk To Me Technologies Remote Support

https://www.talktometechnologies.com/pages/remote-aac-and-speech-therapy

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Forbes AAC Teletherapy Assessment Program

https://www.forbesaac.com/teletherapy-assessment-programs

Feature Matching Resources:�AAC Partnership Program

Waisman Center AAC Partnership Program

https://ucedd.waisman.wisc.edu/aac-partnership-program/

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Collaboration with local school / outpatient SLP in process:

• AAC Partnership Program Agreement between family/client, SLP, and CASC
• Pre-evaluation phone consultation or intake form
• Attendance at evaluation (in-person or virtually)

Questions & Discussion

References

Anderson, K.L., Balandin, S., & Stancliffe, R.J. (2015). Alternative service delivery models for families with a new speech generating device Perspectives of parents and therapists. International Journal of Speech-Language Pathology, 17(2), 185-195.

Baxter, S., Enderby, P., Judge, S., Evans, P. (2012). Barriers and facilitators to use of high technology augmentative and alternative communication devices: a systematic review and qualitative synthesis. International Journal of Language and Communication Disorders, 47(2), 115-129. ISSN 1368-2822

Clarke M, McConachie H, Price K, Wood P. Views of young people using augmentative and alternative communication systems. Int J Lang Communication Disorders 2001 Jan-Mar;36(1):107-15. PMID: 11221427.

CMS Pub. 100-03, (Medicare National Coverage Determinations Manual), Chapter 1, Section 50.1

Forward Health Update 2004-02: Medicaid as payer of last resort |�https://www.forwardhealth.wi.gov/kw/pdf/2004-02.pdf

Swanson, N. & Nanof, T. (2018). Device Documentation: Follow these guidelines when documenting�and billing for speech-generating device evaluation and treatment. The ASHA Leader, 23, 32-33.

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