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Augmentative and Alternative Communication

An estimated 3.5 million Americans experience speech disability to the extent that they have significant difficulty being understood by others.

You may have seen someone write in a notebook to answer a question. Maybe you have seen people using sign language or other gestures. You may have seen someone push buttons on a computer that speaks for them. These are all forms of augmentative and alternative communication, or AAC.

AAC includes all of the ways we share our ideas and feelings without talking. We all use forms of AAC every day. You use AAC when you use facial expressions or gestures instead of talking. You use AAC when you write a note and pass it to a friend or coworker. We may not realize how often we communicate without talking.

People with severe speech or language problems may need AAC to help them communicate. Some may use it all of the time. Others may say some words but use AAC for longer sentences or with people they don’t know well. AAC can help in school, at work, and when talking with friends and family.

AAC Definitions and Types

Augmentative and Alternative Communication (AAC) includes all forms of communication other than speech.  AAC can range from no tech to high tech. The American Speech-Language-Hearing Association (ASHA) definitions are as follows:

  1. No-Tech AAC: facial expressions, body posture, head nods, reaching/pointing, gestures, and signs.
  2. Low-Tech AAC: pen and paper, pictures/symbols, communication boards, and communication books.  
  3. Mid -Tech AAC: battery operated or simple electronic devices.  
  4. High-Tech AAC: dynamic display devices which contain page sets with letters, words, phrases pictures, and/or symbols that the communicator navigates between to express messages.  

The first step for anyone looking at AAC for your child/student is to seek out a comprehensive AAC evaluation. Assume competence, that the communicator can communicate when the correct system and access system is identified.

Frequently Asked Questions:

How can I become a member, volunteer, or help the WI AAC Network?

Click on the Join the Network tab and enter your name and email address to join! You will receive our electronic quarterly newsletter and AAC updates. Volunteer as a communication partner and join us at our AAC Chat Club. You can help our organization by joining a committee or submitting an article for our newsletter.

How do I know if my child will benefit from using augmentative and alternative communication (AAC)?

Your child may benefit from using an appropriate AAC system if they are not able to speak or if they have insufficient speech to address daily needs and participate in daily situations.  Children may also benefit from AAC if they have a disability or diagnosis that likely will impact their ability to learn to speak.  Children may have a long term need for AAC or may only need AAC temporarily before they develop intelligible speech.  It is important for families to know that there are no prerequisite skills for using AAC.  Rather, the child must be matched to the appropriate AAC options through an evaluation process.  AAC should be introduced as early as possible if needed by the child to establish early communication and language skills.  Families should be reassured that concerns about AAC suppressing speech development are myths that are not supported by research.

The information provided above is a summary of information available from The National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC), available at the American Speech-Language-Hearing Association (ASHA) website: https://www.asha.org/NJC/.

Families can read additional information about AAC at the ASHA website: https://www.asha.org/Practice-Portal/Professional-Issues/Augmentative-and-Alternative-Communication/.

How do I know if my child will be eligible for obtaining an AAC device or speech generating device (SGD) through medical insurance, such as Wisconsin Medicaid?

Medical insurance, such as Wisconsin Medicaid, require that SGD meet the criteria for durable medical equipment (DME).  SGD that are DME support communication and do not offer other functions associated with regular computers or tablets such as web access or games.  At this time, Wisconsin Medicaid will not pay for off the shelf devices such as iPads.  Some SGD manufacturers and venders use iPads and other tablets in creating their SGD and they implement needed modifications so that their devices meet DME criteria.   They disable features not needed for communication, such as accessing games or the web.  Some manufacturers and venders may offer families an option to pay to unlock these features after the SGD is purchased through insurance.  It is important to note that Wisconsin Medicaid and Medicare cover SGD when their purchase criteria is met but private health plans including HMOs vary in terms of what they will cover related to SGD. Families should speak with a representative of their private insurance company or HMO to determine any coverage options they offer related to funding SGD.

Medical insurance that offers coverage for SGD will often have specific process and documentation requirements in order to approve a recommended SGD.  The current guidelines from Wisconsin Medicaid can be found at this link:  https://www.dhs.wisconsin.gov/publications/p1/p11065.pdf

Wisconsin Medicaid and most insurance companies require documentation from a speech-language pathologist (SLP) holding a Certificate of Clinical Competence (CCC) from ASHA.  The SLP’s report will include information about SGD considered and why the features of the recommended SGD are appropriate for the skills and needs of the child.  The report must provide information about the child’s medical need (medical necessity) for the SGD and document that the SGD supported enhanced communication and expressive language skills (functional use).  For most children, the evaluation will be a process rather than a single evaluation session.  The evaluation process may include a rental period using the SGD.  A rental period may be needed for some children to confirm that the recommended SGD is the appropriate option for them.  A rental period can provide the SLP, family and team with additional opportunities to teach the child new skills and to document changes in communication for the report.  The SLP’s documentation will be submitted to the SGD vender.  The vender submits the documentation and request for funding to Wisconsin Medicaid and/or other insurance companies.  The request for funding of the recommended SGD may be approved, returned for additional information, or denied.  If the funding request is denied, families have the option to appeal the denial decision.  It should be noted that most companies that sell SGD have a variety of resources for families and teams on their websites, including report templates and guidance about what documentation needs to be submitted to them.  Many SGD venders also have representatives that may be available for additional assistance during the evaluation and funding process.

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