Funding & Medical Reimbursement

Various sources of funding and medical reimbursement have specific funding requirements. Most plans will pay for purchase of the device or for monthly rental. Coverage for device rental usually has a limit on the number of months allowed. A formal communication assessment performed by a speech-language pathologist and a physician's prescription is also usually required.

The following are brief descriptions of funding options. Refer to the specific funding source for details. Some of these options can be combined.
Private Insurance
Some private insurance companies will fund SGD equipment. Prior authorization is usually required and coverage depends on the policy. The insurance company may need an explanation of what the SGD does. The insurance company may also need to be convinced of the medical necessity of the device. A consultation with an experienced speech-language pathologist is highly recommended.

Schools
Legally, schools are required to provide appropriate assistive technology services for students. The Individuals with Disabilities Education Act (IDEA, P.L. 101-476) and the 1997 amendment specifically address the inclusion of assistive technology in the Individualized Education Plan (IEP). Services must be provided at no cost to the parents if the IEP team determines that a student requires this type of assistive technology in order to receive a free and appropriate public education and designates the assistive technology as either part of special education or a related service.

Medicaid
The purchase of SGD equipment is typically covered for individuals up to age 21 in most states. Many states cover the purchase of equipment for individuals of all ages. However, each state varies as to its submission and coverage guidelines. Equipment manufacturers should be familiar with specific state funding practices and can assist in determining the documentation necessary for funding.

Division of Vocational Rehabilitation
The Individualized Plan for Employment (IPE), or comparable plan of action, outlines the services provided through VR for the purpose of seeking employment. If an SGD is required to meet established goals, funding may be available.

Medicare
SGDs are funded by Medicare for Medicare Part B enrollees who live in their own home or in an assisted living facility. Medicare requires that a speech-language pathologist perform an evaluation that meets the guidelines according to the regional medical review policies.

Tricare
Formerly known as CHAMPUS, Tricare is a health benefits program for dependents of active duty military service members and military retirees. It now covers SGDs for all program enrollees who require them. Congress explicitly directed the expansion of Tricare SGD coverage in the FY 2002 military reauthorization bill, signed by the President on December 28, 2001.

Telecommunication Equipment Distribution Programs (TEDP)
Many states have a TEDP that offers SGDs to individuals to enable access to home telephone equipment. These programs typically have eligibility requirements and specific equipment lists. States are not required to have a TEDP, not every program covers SGDs, and each state structures its TEDP differently.

Devices range in price anywhere between several hundred dollars to $10,000 or more. Devices with more functions, messages and other options cost more. Medicare has set cost guidelines for sale or monthly rental of predefined device categories.

• Devices with digitized speech and eight minutes or less of recording time = $410.61 purchase, $307.95 used or $41.07 rental
• Devices with digitized speech and greater than eight, but less than or equal to 20 minutes of recording time = $1,255.59 purchase, $941.70 used or $125.57 rental
• Devices with digitized speech and greater than 20, but less than or equal to 40 minutes of recording time = $1,656.29 purchase, $1,242.60 used or $165.65 rental
• Devices with digitized speech and greater than 40 minutes of recording time = $2,428.61 purchase, $1,821.42 used or $242.85 rental
• Devices with synthesized speech, message formulation by spelling and physical contact with the device to access messages = $3,755.44 purchase, $2,816.59 used or $375.55 rental
• Devices with synthesized speech, multiple message formulation methods and multiple access methods = $7,106.66 new, $5,329.99 used or $710.66 rental

The selection of a communication device can be a challenging decision. It is helpful to seek the assistance of an experienced speech-language pathologist and/or assertive technology practitioner for a complete and thorough evaluation. Be sure to investigate the features, support, and warranty of several devices before purchasing one. Additionally, research the funding options in your area and, if possible, arrange to try the particular device before purchasing. Rental programs may also be available. Your supplier should be willing to assist you in obtaining reimbursement for your SGD.

Symbols can vary in size and may be in color or black and white depending on the device. Symbols can represent entire messages such as a picture of a toilet to represent "I have to use the bathroom," phrases, single words or letters. Some symbols must be combined with other symbols to create words, sentences, or complete messages.

Augmentative Communication, Inc. (ACI) - Publications, information and links to resources on augmentative communication.

International Society for Augmentative and Alternative Communication - The Mission of ISAAC is to promote the best possible communication for people with complex communication needs.

RERC on Communication Enhancement - NIDRR Rehabilitation Engineering Research Center (RERC) at Duke University. The project focuses on innovative communications (AAC) technologies.

RERC on Hearing Enhancement - Addresses accessibility problems of hard-of-hearing individuals by developing and evaluating cost-effective technological aids for the various groups of people with hearing loss according to their needs (e.g., people with moderate hearing losses, people with severe or profound hearing losses, young children, older adults and people with both vision and hearing loss).

RERC on Hearing Enhancement - This Rehabilitation Engineering Research Center (RERC) develops and evaluates technology to accommodate the needs of people with hearing loss. Located at Gallaudet University and funded by NIDRR.