Augmentative and Alternative Communication (AAC) is any form or method of communicating, which assists an individual who has difficulty speaking. AAC methods include electronic devices, gestures, sign language, symbols, or communication boards. Individuals diagnosed with a developmental disability such as autism, cerebral palsy, and Down syndrome, may require the use of augmentative communication systems.
Low-technology or manual communication AAC system options include tangible systems, e.g. real objects, remnants (souvenirs of experiences). Manual systems can include non-electronic boards or books which require a person to select or exchange vocabulary to convey messages to a communication partner.
A communication device or Speech Generating Device (SGD) is a device that is similar to a notebook computer, which is designed to assist an individual in communicating. These devices may have touch screens, keyboards or switches that are used to select symbols, letters or words, allowing an individual to create messages to convey their thoughts and needs. Several funding agencies including Medicare use the term Speech Generating Device (SGD) in place of AAC device.
The process is slightly different based on the age of the user.
Birth to three years: consideration for AAC assessment should be brought to the early intervention team. Please visit New Jersey’s early intervention website: www.njeis.org for more information.
School age children: consideration for AAC assessment should be brought to the student’s educational team at an IEP meeting. For more information, please visit view the following website: www.state.nj.us/education/.
Adults with developmental disabilities: consideration for AAC assessment should be brought to the DDD case manager, day program staff (if appropriate) and service providers (if any) at an IHP meeting. For additional information, view the New Jersey DDD website: www.state.nj.us/humanservices/ddd.
Adults with acquired disabilities will typically secure funding through third party funding agency: Please refer to funding section below.
Only ASHA certified speech language pathologists with AAC experience providing augmentative communication services should perform an AAC evaluation. This is required by Medicare, Medicaid, and private insurance to obtain a Speech Generating Device (SGD).
For children, ages 3 – 21, if it is written into the IEP, the school district may be responsible for funding an AAC evaluation. Currently Medicare and private insurance will only cover the evaluation when an SGD is recommended (i.e., CPT Codes 92607 and 92608). AAC evaluations that result in a recommendation for a manual communication board (i.e., CPT Code 92605) are currently not covered by the medical model. In either case, the individual’s policy is the primary determinant as to whether or not the evaluation will be covered. Medicaid will cover an AAC evaluation; however, a facility that accepts Medicaid must be identified to perform the evaluation.
There are several funding sources that can be used to acquire a Speech Generating Device. These include Medicaid, Medicare, private insurance, School districts, and various other agencies (e.g., V.A., Vocational Rehabilitation, Head Injury Association). Selecting the best option may not be a simple task. Consideration should be given to the individual’s age and communication abilities. Since many agencies will only fund a device once every 3-5 years, it may be optimal to secure funding through the educational model for younger children, as they will likely require a new device more quickly than an older child or an adult whose skills and performance are more stable. Pursuing funding through the medical model requires a justification that the device meets the requirements for a medical necessity. That infers that the individual will be able to use the device upon acquisition as opposed to learning to use the device at a basic level. Medicare Part B will cover AAC devices to those over 65, and also for individuals who have been diagnosed with ALS. Those choosing to secure funding through the medical model will require both a comprehensive evaluation completed by an ASHA certified speech-language pathologist along with a prescription from the physician. For further information in New Jersey call the State Agency Locator number, 609-292-2121, and supportive websites include: www.aacfundinghelp.com, www.empowermentzone.com/funding
For children, therapy services can and should be provided by the school district, but it is imperative that the speech-language pathologist (SLP) providing these services should be experienced in programming and teaching language through use of an AAC device. Therapy services to teach use of an SGD may be covered by insurance and are covered by Medicare. Typically services to teach use of a manual communication board will be billed as “Speech Therapy”. These services should also be provided by an SLP experienced in the field of AAC.
Using a speech generating device or SGD for expressive communication requires the attainment of specific skills that are learned over time. Therapy and training services are needed for the child to learn the language, operational and social communication skills to utilize an SGD as an expressive communication modality. Family members, educational staff, and other individuals that the child interacts with on a daily basis should also receive training on how to support the child’s communication skills using an SGD.
This is a common fear parents have when contemplating the use of augmentative communication with their children. However, the purpose of an AAC device or system is not to replace functional communication/speech the child may already have but to enhance it. In fact, there currently is no research-based evidence that AAC systems impede the development of natural speech. There is, on the contrary, evidence that has supported that AAC may actually foster or stimulate speech production in many users. It should be noted that it is not uncommon to sometimes see a decline in the use of natural speech when a child first gets a new AAC system because they are using their energy and cognitive resources to learn the layout and vocabulary within the system. Once these things become more automatic, you should see a return in these skills.
You have the right to have your child fully assessed by a qualified speech language pathologist with AAC experience to determine the most appropriate AAC device for your child. Only an evaluation can completely assess your child’s capabilities and provide input into the most appropriate AAC system option.