AAC Evaluations and the Medicare

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					A.A.C. Evaluations and the
     Medicare Model

      Presented by Professor Thomas Rosati
              St. John’s University
Medicare evaluations require a
specific format that highlights
specific characteristics

• They are not specifically created for a
  school based evaluation
• They may be done as a supplement, or a
  stand alone depending on the client
             A.A.C. Evaluation
              should be a part
                   of an
     Assistive Technology Evaluation
• The overall potential use of A.A.C. should
  be evaluated, not just the ability to access
  an A.A.C. device.
• Because of the type of evaluation
  requested, a report might only include the
  evaluation of A.A.C. skills, but the overall
  evaluation should reflect how a device will
  fit into the fabric of the clients life
Commissioners Decisions

• In New York State one of the ways that a
  regulation is defined is through Due
  Process hearings to the Commissioner of
  Educations’ Office
• A few Assistive Technology decisions have
  been rendered which establish the New
  York Standards for enactment of the
  federal legislation
          The State Education Department
              State Review No. 98-67
•        A board of education must provide an assistive technology
    device to a child if it is required as part of the child's special
    education or related services, or it is a supplementary aid or
    service which is necessary for the child to be educated in the
    least restrictive environment (Application of a Child with a
    Disability, Appeal No. 95-2).

• State regulation requires that a child's IEP describe any
    specialized equipment or adaptive device needed by a child to
    benefit from instruction (8 NYCRR 200.4 [c][2][vii]).
    The State Education Department
        State Review No. 98-67

• There is no real dispute about the
 child's need for an assistive technology
 device to assist him to communicate.

• The child could communicate by sign
 language or the use of sign boards, in
 addition to having a device such as the
 modified laptop computer.
Evaluation types

• Team Assessment
• Maximal/Full Scale
• Criteria Based
• Predictive
  – Through Observation and Interview
Predictive A.A.C. evaluation
• Evaluate the individuals Communication needs
  and their communication environments

• Evaluate the individuals ability to use existing
  expressive communication modes

• Determine a direct selection method that the
  individual can use to respond during the
  assessment process
    Educational Evaluation Questions
    C.S.E.s should ask
•   What can the student do now with and without assistive technology
    devices and services?

•   What does the student need to be able to do?

•   Can assistive technology devices and services facilitate student
    success in a less restrictive environment?

•   Does the student need assistive technology devices and services to
    access the general curriculum or to participate in nonacademic and
    extracurricular activities?

•   What assistive technology services would help the student participate
    in the general curriculum and/or classes?

•   Does the student need assistive technology devices and services to
    benefit from educational/printed materials in alternative formats?
    Educational Evaluation Questions
    C.S.E.s should ask
• Does the student need assistive technology devices and services to access auditory

• Does the student need assistive technology devices and services for written
   communication/computer access?

• Does the student need an assistive technology device or service for communication?

• Does the student need assistive technology devices to participate in State and
   districtwide testing?

• Will the student, staff and/or parents need training to facilitate the student’s use of
   the assistive technology devices?

• How can assistive technology devices and services be integrated into the student’s
   program across settings such as work placements and for homework?
Assessing Range and Accuracy of Movement

      Computerized tracking

 Hands                        All potential
 Head                         switch
 Eye Gaze
   Overall Student Assessment


Linguistic Capabilities
                    7.    Confused-agitated
                    8.    Confused, inappropriate, non-agitated
                    9.    Confused-appropriate
                    10.   Automatic-appropriate
                    11.   Purposeful & appropriate

                    Example for Aphasia:
                    Mr. Smith's attention, memory, and nonverbal problem-solving skills are within functional limits. He sustained
                         attention for a two-hour evaluation, recalled how to turn on and off a SGD (after initial instruction), and
                         independently navigated between two pages on a SGD.

       Time to Care about Medicare
e. Vision Status    •     Describe communicator’s vision relative to communicating with a SGD (may include communication
                          partners’ status). Include the following elements if/when pertinent to SGD use/selection.
                            Acuity
                            Visual tracking
                            Visual field
                            Lighting needs
                            Angle of view
                            Size of symbols
                            Contrast (color, detail)
                            Spacing

f. Hearing Status   •     Describe communicator’s hearing relative to communicating with a SGD (may include communication
                          partners status). Include (if related to SGD use/selection): acuity, localization, understanding of natural
                          speech, understanding SGD speech.
                           Medicare Request for Speech Generating Device (SGD) Funding

I. Demographic Information

II. Current Communication Impairment

a. Impairment Type & Severity

b. Anticipated Course of Impairment

c. Language Skills

d. Cognitive Ability

e. Vision Status

f. Hearing Status

III. Daily Communication Needs
a. Specific Daily Functional Communication Needs

b. Ability to fulfill these needs using low-tech strategies, natural speech and non-SGD treatment approaches:

IV. Functional Communication Goals
V. Cognitive and Physical Abilities to Use the Device
a. Cognitive

b. Physical

VI. Rationale for Device Selection
a. Describe the general features of the recommended SGD corresponding to individual needs and abilities.

Input Features

Output Features

Other Features

b. Recommended Medicare Device Category

c. Detailed description of equipment and procedures used for practice trials of the recommended SGD.

d. Other SGDs that were presented and the outcomes of the trials.

e. SGD and accessories recommended.

f. Patient/family support of SGD

g. Physician involvement statement.

VII. Intervention Schedule

VIII. Functional Benefit of Upgrade

IX. SLP Credentials & Signature
                 Daily Communication Needs
                 Document specific, daily functional communication needs.

Specific Daily   •Communication to participate in activities that promote
Functional       psychosocial well being.
Communication    Specific Examples: ability to communicate in emergency
Needs            situations, attending and participating in support groups,
                 participating in day treatment activities, directing behavior of
                 caregivers, advocating for him/herself, communicating with
                 family, friends or clergy using the telephone.

                 •Communication to fulfill family roles.
                 Specific Examples: communicating to participate in family
                 decision- making, communicating to participate in family leisure
                 activities, communicating with extended family by telephone.

                 •Communication to participate in medical decision-making.
                 Specific Examples: reporting medical status and complaints,
                 asking questions of medical providers, responding to medical
                 provider's questions, discussing choices for end of life care,
                 communicating with medical providers using the telephone.
                     Clients’ Capability Prognosis
Ability to fulfill    List assessment results.
these needs
using low-tech       Can the individual meet daily communication needs
strategies,          using natural modes of communication?
natural speech
and non-SGD          Discuss success of speech therapy (to date and future
treatment            prognosis) without SGD.
                     Discuss why SGD is required as opposed to non-SGD
                     treatment approaches.

                     Discuss the individual’s ability to use low-tech aids
                     and natural modes of communication to meet their daily
                     functional communication needs.

                     Show that other forms of treatment have been considered
                     and ruled out.
           Cognitive and Physical Abilities
                  to Use the Device

   Describe cognitive abilities to use the SGD (e.g., reading, comprehension, spelling,
   symbol skills, sequence recall, create complete messages with SGD, produce or
   formulate SGD communicative messages). Demonstrate that the patient possesses
   the cognitive abilities to effectively use the selected SGD and required accessories
   to communicate functionally.


   Describe pertinent considerations, (e.g., ambulatory status,
   position (when the individual will use the SGD), seating, description of how the
   person will access the SGD from a motor standpoint (direct selection, scanning),
   switch access requirements, and accommodations for access changes).
   Demonstrate that the patient possesses the physical abilities to effectively use the
   selected SGD and required accessories to communicate.
Functional Communication Goals

•        List communication goals and a timetable
    for completion of these goals.

•       Goals should correspond to specific daily
    functional communication needs, and illustrate
    how the patient’s speech disability will benefit
    from the acquisition and training of the SGD.
             Rationale for Device Selection
 Describe the general   “   This individual requires a                  Type of symbols used to
features of the                 speech generating device                     represent language
recommended SGD                 to meet their functional
corresponding to                communication goals.”                      Pictures: note quality,
individual needs and    Selection Technique                                  color vs. black & white
abilities.                   Direct Selection                               Symbols: commercially
                                                                             available, individualized
                              Keyboard/Display: dynamic/static,
Input Features                  number of keys/locations                    Words, phrases, letters
                              Activation Type: touch sensitive,
                                pressure sensitive, adjustable,             Other (specify)
                                Optical pointer, eye gaze, other
                                (specify)                               Message Storage Capacity
                                                                        Vocabulary Expansion and
                            Display: number of keys, dynamic/static
                                                                             Rate Enhancement
                              Mode: visual, auditory
                            Type of Scan: linear, row-column, group-         Techniques
                                row column, directed (joystick, track       Screens or levels
                                ball), adjustable speed                     Word prediction
                            Switch: type (pressure, feedback),               Other (specify)
                                position, mount

                            Encoding Type
                               Position, Category, Semantic
                         Output Features
     Voice Output Parameters
     Digitized speech: Equal to or under 8 minutes or Over 8 minutes
     Synthesized speech: Age/gender specific, auditory scanning with
     alternate voice, etc.

Visual Display
     Type: LCD, Monochrome, Color
     Size: Number of Characters that display can accommodate, Size
     of Characters

Feedback options
     auditory (voice, click, tone)
     visual (e.g., increased size when selected)
Other Features         Portability: Size & weight, transport/mount,
     case/carrier requirements
     Battery time required
     Manufacturer Warranty
     Platform (IBM vs. Mac)
           Recommended Medicare Device Category
b.     Specify the Medicare code (K0541-K0547) after determining the parameters.

"The individual’s ability to meet daily communication needs will benefit from acquisition and use of
      the (name the specific SGD).“

c. Detailed description of equipment and procedures used for practice trials of the
       recommended SGD.
Include evidence that the individual was present and actively participated in the evaluation and trial
       processes. Discuss trial outcomes in terms relating to described functional communication needs.
       Estimate prognosis that the patient’s speech disability will benefit from the device ordered.

d. Other SGDs that were presented and the outcomes of the trials.
List all equipment tried and outcome of each trial.

e. SGD and accessories recommended.
List the specific SGD & include rationale for why this SGD will meet the patient’s communication needs
        most effectively. Include rationale for peripheral accessories.
f. Patient/family support of SGD
Discuss family/individual evaluation/trial participation, agreement and support of this equipment.
g. Physician involvement statement.
“ A copy of this report has been forwarded to (the patient’s) treating physician (Name, license #)
        prior to ordering the (name SGD).”
Significant medical diagnosis(es);

Significant treatment information and medications; medical prognosis;

Motor skills, i.e., posture/positioning, selection abilities,
range and accuracy of movement, etc.;

Cognitive skills, i.e., alertness, attention span, vigilance, etc.;

Sensory/perceptual abilities, i.e., hearing, vision, etc.;

Language comprehension;

Expressive language capabilities;

Oral motor speech status;
Use of communication/present communication abilities;

Communication needs including the need to enhance conversation,
writing and signaling emergency, basic care and related needs;

Writing impairments, if any;

Environmental, i.e., home, work, etc., describing communication barriers;

AAC recommendation, which may include symbol selection, encoding
method, selection set (physical characteristics of display), type of display,
selection technique, message output, literacy assessment, vocabulary
selection, and participation patterns.
AAC report components
• A.A.C. Report Assistant

• Report Coach
               AAC Manufacturers
AAC Connections-DME
AAC TechConnect
ABISee, Inc.                   Infogrip, Inc.
AbleLink Technologies          Laureate Learning Systems
AbleNet                        Mayer-Johnson LLC
ACCT, Inc.                     Origin Instruments Corporation
Adamlab, LLC
                               Prentke Romich Company
Adaptive Technology Services
ADAS                           Saltillo Corporation
Assistive Technology, Inc      Talk Technologies, Inc.
Attainment Company, Inc.       Talking Tabs
Blink Twice                    Tash Inc.
Daedalus Technologies, Inc.
                               The Great Talking Box Company
DynaVox Technologies
EnableMart                     Words+ Inc.
Enabling Devices               Zygo Industries, Inc.

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