Medicaid has not indicated a specific format for the AAC evaluation report. However, the evaluation must be written by an SLP with expertise in augmentative communication and must adhere to the preferred patterns of practice established by the American Speech Language Hearing Association.

1. Attached is a sample SLP AAC Evaluation Form. Note the areas of assessment that should be contained in the report:

   • Communication status and limitations

   • Statement of candidacy

   • Speech and language abilities

   • Cognitive status (to the extent it is relevant to the AAC services recommended)

   • Communication needs of the client

   • Postural/mobility status

   • Sensory functioning: visual, auditory, tactile, etc.

   • Access technique and selection method

   • Symbol form

   • Delineated features of the communication system that meet the client's needs

   • Ability to learn and use the communication system

   • Communication systems considered and reasons rejected

   • Prescribed communication system and justification

   • Treatment plan and follow up
       

2. Pay special attention to the following statements, which need to be placed in the Prescription section of the form.

   The speech-language pathologist with current licensure and specialized skills in augmentative and alternative communication has determined that (individual)'s ability to communicate using natural speech and writing interferes with (his/her) meaningful participation in current and projected daily activities.

   An electronic communication system has been determined to be medically necessary. (expand)

   An AAC system has been determined to serve diagnostic and therapeutic purposes.

3. Connecting the AAC system and services to treatment is an essential step to obtain funding. The report must explain that, through the use of an AAC system, the consumer can meet the goal of restoring functional communication ability to the maximum degree possible. The medical condition will not improve without the prescribed treatment, that the treatment has been proven effective, that it is a correct response to the individual's needs, that there is no other form of treatment that can offer the individual comparable improvement.
     

4. Keep in mind that the AAC system is a "medical necessity" in treating the dysarthria or apraxia of speech. It should not be referred to as an item of "last resort", "for convenience", or to merely provide a "benefit" to the individual. It is medically necessary, and no alternative treatment has been found to benefit (i.e. traditional speech-language therapy).
     

5. Avoid making comments to the effect that the individual needs the device to express "emergency" or "medically-related" expressions. These statements are difficult to argue, since what is a medically related utterance vs. what is not a medically related utterance is not easily defined or determined. The fact that the AAC system treats dysarthria or apraxia is enough to establish medical necessity.
     

6. Refer to the AAC device as an "AAC system", not a "computer".
     

7. Do not print out the report on school letterhead; otherwise, it may send a message to Medicaid that perhaps the school should pay for the equipment. By the same token, do not make reference to the fact that the device may be "educationally" or "vocationally" necessary. There is no difference between medical and educational necessity, but Medicaid is interested only in what is medical necessity.
     

8. Under the section entitled "Limitations of Current Communication System", it is important to clearly justify how the individual's current means of expression cannot meet his/her communication needs, and does not allow the individual to meaningfully participate in current or projected daily activities.
     

9. Under the section "Rationale and Criteria for Selection of Prescribed System", be sure to report at least 2 AAC systems considered and why the chosen system is most effective or beneficial. The individuals reading your assessment are not familiar with the equipment you are reporting. Describe specific characteristics or features of the devices, not merely the names of the devices.
     

10. Write treatment goals that reflect the individual's total communication, not just AAC system.
      

11. Keep a copy of everything submitted to Medicaid. Maintain a dated log of all submissions and contacts with Medicaid.

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