AAC AAC Funding, Insurance & Advocacy 1 — Questions and Answers
Question 1: Which federal program is the primary payer for AAC devices for eligible adults over age 65 in the United States?
- Medicaid
- Medicare Part B (Correct answer)
- CHIP
- TRICARE
Correct answer: Medicare Part B
Medicare Part B covers SGDs (speech-generating devices) as durable medical equipment for eligible beneficiaries aged 65 and older.
Question 2: What documentation is typically required by Medicare to justify funding for a speech-generating device (SGD)?
- A written request from the caregiver only
- A physician's order and a comprehensive AAC evaluation by an SLP (Correct answer)
- A school IEP and teacher recommendation
- A letter from the device manufacturer
Correct answer: A physician's order and a comprehensive AAC evaluation by an SLP
Medicare requires a physician's order combined with a comprehensive AAC evaluation completed by a qualified SLP to justify medical necessity for an SGD.
Question 3: Under IDEA, which document legally mandates the provision of AAC devices and services for eligible students with disabilities?
- 504 Plan
- Individualized Education Program (IEP) (Correct answer)
- Behavior Intervention Plan (BIP)
- Transition Plan only
Correct answer: Individualized Education Program (IEP)
The IEP legally specifies all special education services, including AAC devices and related supports, required for eligible students under IDEA.
Question 4: Which advocacy principle asserts that all individuals, regardless of disability severity, have the right to use AAC?
- Candidacy model
- Presumption of competence (Correct answer)
- Facilitated communication standard
- Communication hierarchy
Correct answer: Presumption of competence
The presumption of competence assumes that every individual has the capacity to communicate and learn, supporting unconditional access to AAC.
Question 5: When an insurance company denies coverage for an AAC device, what is the recommended next step for the AAC team?
- Accept the denial and seek a lower-cost alternative
- File a formal appeal with additional medical necessity documentation (Correct answer)
- Wait six months and reapply
- Purchase the device out of pocket without appealing
Correct answer: File a formal appeal with additional medical necessity documentation
Filing a formal appeal with thorough medical necessity evidence is the standard recommended course of action when an initial insurance claim is denied.
Question 6: What is the primary role of an SLP in the AAC funding process?
- Negotiate pricing directly with manufacturers
- Complete the evaluation report demonstrating medical necessity (Correct answer)
- Submit billing claims on behalf of the insurance company
- Approve or deny funding requests
Correct answer: Complete the evaluation report demonstrating medical necessity
The SLP's key funding role is to conduct and document a thorough AAC evaluation that establishes medical necessity for the requested device or system.
AAC AAC Funding, Insurance & Advocacy 1
Which federal program is the primary payer for AAC devices for eligible adults over age 65 in the United States?