Cheat Sheet for Applying for an AAC in Arizona
- sagetherapyaz
- Jan 28, 2024
- 10 min read
Steps to follow when requesting an AAC:
When a parent would like to request an AAC eval, the process can begin by having the parent take this form to the doctor and specifically requesting a script for “evaluation for a speech generating device”:
Once completed, the family should also have a copy of the most recent ISP, copies of all insurance cards (front and back) and the prescription from the doctor. At that point, the family can contact one of these agencies based on health plan to schedule the evaluation:
Should the family choose Therapy One, the treating SLP will then be asked to complete a form like this:
Therapy One AAC Referral Printable:
Therapy One AAC Referral Fillable:
Download File Fillable AAC Referral Questionnaire.pdf
Should the family choose NAU, the treating SLP will then be asked to complete a form like this:
Therapy One and NAU will get these packets to you (The SLP), but they are attached above for your information.
Families can also be referred to arsha.org and find helpful information under the “Resources” tab.
How do I refer clients/students who need AAC systems?
(That depends on which health plan the client has.)
Step One: Secure a Prescription from the Client’s PCP
1. Both MercyCare and United Health Care need a prescription for AAC assessments
2. Prescriptions valid one year from date they are signed by PCP
3. Treating therapists should document client’s need for AAC in a letter the family can take to the physician
Step Two: Family Requests Evaluation from a contracted provider
1. Family chooses a contracted provider from Mercy Care or United Health Care website.
2. Family calls AAC agency/SLP listed on the site to make an appointment Augmentative and Alternative Communication Provider Training
• Member's physician writes a prescription/referral for an assessment from an innetwork, licensed and registered speech-language pathologist (SLP). Valid for 12 months.
• Mercy Care will accept assessments completed by a school SLP however as a best practice we ask that schools coordinate evaluations with a Mercy Care contracted SLP. We want to make sure that all settings are taken into consideration (Schools, Home etc.). The school and contracted SLP can work with MedOne on getting a device. The member still needs to get a prescription from the doctor for the device.
• Member contacts their DDD Support Coordinator, Mercy Care or DDD Liaison for an in network, licensed and registered speech language pathologist (SLP), In-network, licensed and registered speech language pathologist (SLP) point of contact.
Agencies:
Northern Arizona University -
Institute for Human Development
Room 101 Bld 27A
Flagstaff, AZ 856011
928-523-5590
Counties Served: Statewide
Therapy one
108 W University Drive
Mesa, AZ 85201
480-668-1917
Counties Served: Statewide
Advanced Therapy Solutions
690 E Warner Rd #105
Gilbert, AZ 85296
480-820-6366
Counties Served: Maricopa, Pinal, Gila,
Yavapai, Cochise, Pima and Yuma
District Medical Group CRS
3141 N 3rd Ave, Suite 100
Phoenix, AZ 85013
602-470-5532
Counties Served: Maricopa
United Cerebral Palsy of Central Arizona
1802 West Parkside Lane
Phoenix, AZ 85027
602-682-1893
Counties Served: Maricopa
In network Preferred Provider for AAC Management
MedOne
2330 W. University Dr. Ste. 20
Tempe AZ 85281
Phone: 480-835-9100
Fax: 480-835-9104
To assist with the management of the AAC device systems Mercy Care has chosen MedOne as the preferred vendor for these devices.
Mercy Care also contracts directly with PRC-Saltillo, Tobii Dynavox
High Tech Devices available within Mercy Care's network QuickTalker by AbleNet Lincare Smartbox PRC Eyetech Mitalk Tobii Dynavox Boundless
• SLP receives request and coordinates assessment and notifies MedOne
SLP in conjunction with other health professionals such as a Physical Therapist (PT) and/or Occupational Therapist (OT) will conduct the
assessment
Up to three devices and/or apps can be reviewed/trialed for up to 30 days
• When the formal assessment is completed, SLP will send all documents including to MedOne who will then submit request for prior authorization to Mercy Care
• If the SLP determines that a device not provided by MedOne is needed the SLP will send all documents including a request for prior authorization to Mercy Care for review.
AAC System Assessment and Trial process
• For devices not provided by MedOne
○ AAC Devices and accessories will need Prior Authorization
○ Please complete the prior authorization request form located on the Mercy Care website and fax to 800-217-9345.
○ Documents needed:
o Member’s medical records
o Practitioner's office records
o Therapy service records
o Other records from healthcare professionals
o Test reports relevant to the request should be submitted or may be requested to support/demonstrate that the coverage criteria for an AAC device
For Devices provided by MedOne
○ MedOne will gather documentation and request prior authorization
• Mercy Care has 14 days to review the request and may take an additional 14 days if they need additional information.
• If more time is needed, the member will receive a letter called Notice of Extension (NOE). This will allow an additional 14 days for Mercy Care to review additional documents.
• Total time should not exceed 28 days.
• DDD Support Coordinator (SC) or Speech Language Pathologist (SLP) that need further assistance about authorizations, please contact our PA department at 800-624-3879.
• If Mercy Care approves:
▪ Mercy Care faxes out approval to DME vendor, the SLP and the DDD Support Coordinator
▪ DDD Support Coordinator notifies the member of the approval
▪ Device will be delivered to the member’s home
▪ SLP will coordinate the training hours with the member/family member, includes ongoing training if need be
▪ No separate prior authorization required for training hours
• If Mercy Care denies, Notice of Adverse Determination letter is issued with instructions about the appeal process
Patient Hub enables “push” notifications to a pc, tablet, or mobile phone every time there is progress or action is needed in the process of getting a Speech Generating Device. You will always know what has just happened and what needs to happen next. From the initial request for an eval, to the scheduled training after your device is received.
You can also use the app to communicate with MedOne and ask questions, update insurance, and even provide documents.
Members with other primary insurance
• Mercy Care is always the payer of last resort
• If the primary insurance requires authorization you will want to follow their authorization requirements
• If member/caregiver does not agree with Mercy Care’s PA decision, he/she can file an appeal
• Appeals must be filed within 60 calendar days from the date of the Notice of Adverse Benefits Determination letter
• Mercy Care has 30 calendar days to issue a resolution
• Expedited appeal decisions are issued by Mercy Care within 72 hours from the date the expedited appeal request is received
• To file an appeal, member/caregiver must mail, call or fax the request using the following: Mail: Mercy Care Appeals Department 4755 S. 44th Place Phoenix, AZ 85040
o Phone: 602‑453‑6098 or 1‑800‑624‑3879 Fax: 602‑230‑4503
• The fastest way to report a grievance is to call Member Services at 602-263-3000 or toll-free 1-800-624-3879(TTY/TDD 711).
• Once the device has been received, the SLP will schedule time for the member and family to set up the device and train on the device, and mount the device, if appropriate.
• It can take up to 90 days from the request of the AAC device to when the 1st training is conducted.
• The family will be advised to outreach to the provider for training as soon as the device is delivered. AAC device training
• All repairs require prior authorization.
• Repairs may be covered if the device is the current medically necessary device.
• All repairs out of warranty should to go our preferred DME vendor, MedOne at 480-835-9100.
• Repairs under warranty should go direct to manufacturer or MedOne Mercy Care will cover one device repair every 12 months per member due to normal wear and tear unless device is under warranty.
• When loss, stolen or irreparable damage has occurred.
• It has been 3 years since the initial prescription, and the AAC system is no longer functional.
• There is a change in the member’s condition that affects the use of the current AAC system.
• The no – we current AAC system is not meeting the member’s needs despite adequate training.
• There is documentation, from the manufacturer, that the SGD can no longer be repaired.
• If a replacement is needed, the member must reach out to their physician to obtain a prescription/referral. If the member needs assistance they can reach out to the DDD Support Coordinator.
• PA is needed for replacement devices.
• There may be loaners available through MedOne. Please contact MedOne for more questions. 480-835-9100If device is sent for repairs or replacement, are there loaner devices available?
UHC Process Part One: Setup up the Evaluation
1. Member receives from their physician a prescription/referral for an AAC assessment by a Speech Language Pathologist (SLP). This prescription is good for 12 months.
2. Member may contact the DDD Support Coordinator, UHCCP’s member services, and UHCCP DD liaisons to get contact information for an in-network UHCCP licensed and registered SLP. Or the member can do a provider search using UHCCP’s member website and use the Provider Lookup feature. Use provider search - add link
UHC Process Step Two: Schedule Evaluation
1. Once the member chooses an SLP, the member calls the SLP to schedule an assessment.
2. The assessment requires a Prior-Authorization (PA). The SLP will send to UHCCP the member’s ISP, IEP, therapy progress notes, and other documentation to support the need for an assessment.
3. Per the UHCCP member handbook, a specialty appointment is to be scheduled within 45 days of when the member calls and asks for the assessment.
4. Once UHCCP receives the PA, a decision must be made within 14 days.
5. If the assessment is approved, the SLP will contact the member to schedule the assessment.
UHC Process Part Three: AAC Evaluation
1. Prior to the assessment, the SLP will determine the appropriate AAC device(s) for the member to try during the assessment visit.
2. The SLP will bring to the assessment up to three AAC devices for the member to try during the visit. Other therapy providers besides the SLP may also contribute to the assessment.
3. During the assessment, a family may choose to trial one of the AAC devices up to 30 days. During the trial period, the SLP will help make sure that the device is meeting the member’s needs.
4. After an AAC device has been trialed and the treatment team, member and family agree on the AAC device, the SLP will send the assessment report to the referring physician for signature.
UHC Process Step Four: Post Evaluation
What happens after the AAC assessment?
1. Once the physician signs off on the device, the SLP will send the documentation of the eval, script and details of the needed device equipment and accessories to the AAC DME manufacturer.
2. The AAC DME manufacturer will submit the prior-auth for approval to UHCCP and will include supporting documentation from the assessment, expected training hours, and the list of the necessary
accessories for the proper use of the AAC system. Once UHCCP receives the PA, a decision must be made within 14 days.
3. Once the decision has been made on the device and it meets medical necessity, the AAC DME manufacturer is notified by phone and the SLP is also notified so that prior auth for training may be submitted.
What if the AAC System needs a repair?
1. All repairs require Prior Authorization by UHCCP.
2. DDD will allow UHCCP to cover one device repair every 12 months due to normal wear and tear unless the device is under warranty.
3. The member can work with the DDD Support Coordinator, the original treating SLP or UHCCP to confirm if the device is under warranty.
4. UHCCP will assist member and DDD Support Coordinator in returning device if under warranty.
5. UHCCP will not cover the replacement of applications that or cannot be accessed due to loss of username and password.
How will members receive the device?
1. The AAC device will be mailed directly to the member’s home.
2. Once the member receives the AAC device, the member should contact the SLP to schedule training for the AAC device.
3. UHCCP expects the first training to be completed no later than 90 days from when the AAC device was approved by the health plan.
What if the member needs an AAC replacement?
The device and accessories are expected to last up to 36 months.
The replacement of an AAC system or its components will be considered in the following circumstances:
1. When loss or irreparable damage has occurred.
2. It has been 3 years since the first prescription, and the AAC system is no longer functional.
3. There is a change in the member’s condition that affects the use of the current AAC system.
4. The current AAC system is not meeting the member’s needs despite adequate training.
UnitedHealthcare Community Plan Contacts
UHC Member Services: 1-800-348-4058 UHC Provider Services: 1-800-445-1638
Rosemarie San Nicolas, AAC Coordinator/DD Liaison (Member Last Names: A-L)
602-255-1608
Ryan Lange, DD Liaison (Member Last Names: M-Z)
602-255-8306
Laurie Ganzermiller, Director Special Programs
602-255-1675
AAC IS an AHCCCS Covered Service! According to the AHCCCS website, “All AHCCCS health plans provide the same covered medical services.”
● Each health plan may have their own process
● Prior Auth may be required
● For clients who do not qualify for DDD
AAC IS an AHCCCS Covered Service! Appropriate for AHCCCS members who do not have a qualifying diagnosis for Arizona Long Term Care.
Some examples include:
● Apraxia or Childhood Apraxia of Speech
● Developmental Delay
● Fluency disorder
● Other possibilities?
Services through AzIEP Remain the Same AzIEP Electronic Referral form:
Contact AzIEP:
*For the SLP
Before you Refer: Educate and Inform Client’s Family
● Discuss client progress, family expectations
● Discuss common myths of AAC
● Address family dynamics- willing to incorporate AAC into their lifestyle?
Before you Refer: Be Aware of Family/Cultural Values
● Culture affects communication
● Cultural backgrounds may affect the family’s openness to AAC
Common Myths of AAC (Romski & Sevcik, 2015)
1. AAC is a “last resort” in speech-language intervention.
2. AAC hinders or stops further speech development.
3. Children must have a certain set of skills to be able to benefit from AAC.
www.uncommonsenseblogspot,com) - used with permission
Common Myths of AAC (Romski & Sevcik, 2005)
4. Speech-generating AAC
devices are only for children with intact cognition.
5. Children must be old enough to benefit from AAC.
6. There is a representational hierarchy of symbols from objects to written words (traditional orthography)
Before You Refer: Family Gathers Documentation
● Members medical records
● Previous test reports
● Quarterly progress reports (home, school)
● Current Speech-Language evaluation within the past 12 months
● IEPs/METs, IFSPs
● OT/ PT notes
Documentation Demands of the Managed Care Model
Treating SLPs in schools, clinics, and home health settings should document clients with complex communication needs (CCN) in all areas of communication in their:
● Daily SOAP notes
● Quarterly progress reports
● Annual reports (IFSP, IEP)
● Speech-language evaluations (RED, MET)
Before Submitting a Request for an AAC Evaluation:
● It is recommended to have a current speech and language evaluation on file, completed within the twelve months and submitted along with the referral paperwork
● Document trials for light tech devices and why they are not adequateto meet client needs
Ready to Refer? Go to the ArSHA website!
● Download referral form from Arsha website
● Write a brief statement of medical necessity
● Give the client the form to take to their doctor
Lack of Thorough Documentation of Need Can Result In:
● Delays
● Denials
● Decreased confidence in the managed care system
Prior Use of AAC Must be Documented When Referring - What type of AAC was trialed:
● Light tech core communication boards
● Picture Exchange System (PECS)
● Communication books
● YES/NO apps
● Free/lite versions of apps
Prior Use of AAC Must be Documented When Referring - What type of AAC was trialed:
● Switch/switch activated toys
● Light tech eye gaze frame
● Tactile symbol book
● Choosing between real objects
● Mid tech devices
Document the Outcome of AAC Trials
● Describe the trial parameters:
● Device(s) trialed
● Length of time trialed
● What worked?
● What didn’t work?
● Level of prompting needed?
● Length of utterance(s)
● Functions of speech: requesting, protesting, describing, etc.
Assess Expressive/Receptive Communication:
● Voice
● Fluency
● Articulation/Phono.
● Pragmatics
● Semantics
● Syntax
● Morphology
● Oral Motor Exam
● Comprehension
● Literacy
● Foundational Play Skills:
■ Joint attention
■ Eye contact
■ Turn taking
■ Parallel, associative, or cooperative play
Speech and Language Assessment Tools Can Include:
● Criterion referenced assessments
● Standardized assessments
● Non-standard reporting of standardized assessments
● Language samples
● Parent/Teacher Surveys
● Communication Matrix
● Dynamic assessments: Present material, Teach, Test, Reteach, retest
● AAC Trials - Include data and rationale on any AAC trials given
Document the Client’s Functions of Language
Can your client…
● Initiate/turn take in
Conversation
● Request
● Protest
● Describe
● Direct actions of others
● Tell a story or retell an event chart used with permission, (Kate Ahern 2020)
See Non-traditional Language and Behavior as Communication
Language:
● Echolalia
● Scripting
● Jargon
● Babbling
● Vocalizations
● Consonant and/or word Inventory
Behavior as Communication:
● Use of gestures
● Response to gestures
● Facial expressions
● Other non-traditional communication, such as leading you to object
● Use of eye gaze
Need to trial a device? Try AZTAP Lending Library
● Devices can be borrowed by persons with disabilities, family members, service providers, etc. for two weeks at a time.
● Devices may be picked up from the AzTAP office or can be shipped/returned at no cost to the borrower.
● School districts and charter schools can use ADE/AT Short term library
● Assistive Technology Loan Libraries - AzTAP
During Referral Process: Follow up and communicate.
● Client’s support coordinator
● SC supervisors
● MCO’s customer care liaison
● Keep in contact with the AAC evaluator/agency the family chooses
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