Medicaid of Delaware

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Accessing AAC Devices Through Medicaid
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Accessing AAC Devices Through Medicaid

AAC Device Purchase

The following chart outlines the process for obtaining AAC devices that are medically necessary under the Delaware Medical Assistance Program (Medicaid.) The steps progress in a sequence from the time an AT need is identified to when the equipment is provided. This is a process that involves many team members. Their roles and responsibilities are outlined following the chart.

Chart: Obtaining AAC Devices - Medicaid PDF | Text

Roles and Responsibilities of Team Members

Facilitator*

*The facilitator is the person who drives the process. The person could be the consumer, a family member, a case manager, etc.

Completes the Essential Information Form. Detailed instructions for completing this form are included.
- Essential Information Form | PDF | Large Print | Text
You will need:
- Consumer identification information
- Consumer support/contact information
- Insurance information
- Physician information
- A prescription.
Identifies the service provider options based on who is a Medicaid provider, who provides services to the MCO(s) and what providers deliver the type of service needed. The AT Provider section of this Website may assist you with this process.
Calls the service provider and schedules the evaluation, providing all of the information outlined on the Essential Information Form as well as the specific reason for the evaluation. The facilitator will need to know:
- Whether the individual had an AAC system at one time or currently uses an AAC device.
- If the consumer currently has an AAC system, who provided the device? With the manufacturer and the serial number (which is on the device), the manufacturer will be able to identify how and when the device was provided. It is important to take the device to the evaluation (even if the device is not working).
Once an appointment is scheduled, informs the appropriate parties (family members, care staff, etc.) of the appointment. The facilitator and a primary caregiver should attend and participate in the evaluation.
Arranges for transportation to the evaluation, if necessary.
Secures a copy of the LMN from the vendor, signifying that the claim submission process for the AT device has been completed. If a copy of the LMN is not received within 30 days of the evaluation, contact the vendor.
If there has been no action on the claim after 30 days of the submission of the LMN, contacts the appropriate Medicaid office:
DME Review Team
(302) 255-9500 or (800) 372-2022

First State Health Plan /Christiana Care
(302) 302 327-7600 (voice)
(302) 302-327-7699 (TDD)

Diamond State Partners
(800) 390-6093

Service Provider

Verifies insurance information provided on the Essential Information Form and schedules the appointment.
Reviews the intake information and obtains signatures on the assignment of benefits form on the day of the evaluation.
- Assignment of Benefit Examples | PDF | Large Print | Text
Requests a copy of the prescription (Rx) for the evaluation from the facilitator. Without an Rx, the service may not be provided.
Completes the evaluation with input from the facilitator, the consumer, and the caregiver(s).
Provides the facilitator and the caregiver/consumer with a summary of the recommendations. Recommendations should include information about:
- The specific type of equipment and component(s) needed
- Estimated date of delivery
- Training that is needed once the equipment is obtained.
Completes an evaluation report and sends a copy to the facilitator, the physician, the vendor, and the consumer/caregiver.
Sends information to the physician to support formulation of the LMN.
Contacts the consumer/facilitator to schedule an appointment when the equipment is ready to be delivered.
Sets up the new equipment per the specifications outlined in the assessment.
Provides information about the care and the operation of the equipment as well as warranties, repairs, and follow up upon delivery.

Vendor

The AAC vendor, in most cases, is the manufacturer and is not directly involved in the assessment process. The AAC manufacturers have funding specialists who will submit the documentation and claim to Medicare, Medicaid, or any other private insurance company. The vendor should:

Be enrolled as a medical equipment provider with Delaware's Medicaid Program. If the consumer is covered under an MCO, the vendor must be a participating provider with that MCO.
Submit the documentation related to the medical claim for the equipment to the insurance company.
Receive a copy of the Essential Information Form.
Call Medicaid/MCO for authorization once equipment is recommended.
Contact the physician to request the LMN if it has not been received.
Submit all paperwork to Medicaid/MCO.
Order the equipment.
Contact the facilitator, the service provider, the caregiver/consumer when the equipment is ready to be delivered.

Physician

Provides a prescription for the evaluation, equipment, and/or services needed.
Provides LMN to vendor based on results of the evaluation.
Completes the Medicaid CMN* at such times that repairs/modifications are needed.

*Taken from the Supplies and Durable Medical Equipment Program Provider Manual on the Delaware Medical Assistance Program Website: http://www.dmap.state.de.us/downloads/manuals/DME.Provider.Specific.pdf.

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AAC Device Repair

You do not need a therapist to handle the repairs of a communication system. The manufacturer is your best resource when a device is not working. The manufacturer's "tech support" system is set up for your use and is user friendly. Prepare to call the manufacturer by having the device at hand. Identify the make, model, and serial number (look on the underside of the device for this information). Complete the following steps to gain assistance from the manufacturer:

Call the Technical support department or customer service to get information about getting the device repaired. Many companies prefer to do some troubleshooting on the phone before recommending that the device be returned to the manufacturer.
Refer to the AAC Companies Guide for telephone numbers, web site information and hours of operation.
- AAC Companies Guide | PDF | Large Print | Text
Follow the manufacturers’ directions for troubleshooting and identifying the problem with the device.
- Does the device need to be returned to the manufacturer?
- Do you have a return authorization number?
- Does the manufacturer have specific instructions for returning the device to them?
Complete the Request for Repair form.
- Request for Repair Form | PDF | Large Print | Text
The facilitator determines the source of funds for the costs of the repair.
If the communication device user has Delaware Medicaid, the costs of most repairs are covered by Medicaid as long as the following criteria are met:
- CMN is completed and signed by the physician.
- The manufacturer is enrolled as a Delaware Medicaid Provider.
- A licensed SLP has verified that the device being repaired continues to be an appropriate device for the user.
If the cost of the repair is under $300, the manufacturer will proceed with repair upon receipt of a CMN.
If cost of the repair is more than $300, Delaware's Medicaid fee-for-service will require:
- Authorization
- A CMN signed by the physician
- A letter from the SLP indicating that the device is in need of repair and that it is appropriate to repair the device since the user continues to use the system as a primary means of communication.
If the repair is not covered by Medicaid, a source of funds to cover the costs of the repair must be procured.
If the manufacturer is not an enrolled provider with Delaware Medicaid, the repair may be facilitated through a DME provider who is enrolled. Refer to the AAC Companies Guide to assist with this.

Chart: Repairing AAC Devices - Medicaid PDF | Text

Information About Specific Manufacturers

Before Dynavox will repair a device, the company must receive the LMN as well as the prescription. If the repair costs are over $300, Dynavox requires the CMN as well. The company must then submit the request to Medicaid before the repaired device is returned to the consumer. If the repair costs are less than $300, the LMN and prescription are still required, however, Dynavox is able to proceed with the repair without prior authorization. Without prior approval, Dynavox will not proceed with a repair to a First State Health Plan member’s device no matter what the cost of the repair.

Prentke Romich Company will proceed with the repair if the costs are under $300, if Medicaid purchased the device, and if there is no Medicare or private insurance present. If the repair costs more than $300, this manufacturer requires:

A CMN signed and dated by physician.
Prescription from the physician
Letter of recommendation from the SLP.

Once funding is identified and obtained for the repairs, the device is repaired and returned to the user.

If the manufacturer or manufacturer's designee for the repair concludes that the device is not able to be repaired, written notice will be provided to the user or the person acting on the user's behalf that a replacement device is needed, which requires prior authorization.

Repair/Replacement of AAC Device Batteries

When the manufacturer identifies the device battery as the malfunctioning or nonfunctioning part, the following procedure will be followed:

Repair or replacement of the AAC device battery will be performed, and the device returned to the user or to the person acting on the user's behalf, as soon as possible.
Repair of the battery will occur independent of the $300 approval and the replacement of the battery will occur without the need for prior approval.
To have the battery replaced, follow the steps outlined in the AAC Device Repair section.
Rental of AAC Device during Assessment, Repair and/or Replacement Period

The manufacturer is authorized to provide the user, on a rental basis, an AAC device during the assessment, repair and/or replacement period. The rental period is authorized to continue without regard to the need for prior approval for the repair and/or replacement of the user's device. Rental of the AAC device is not limited to devices for which Medicaid was the original payment source.

Rental of AAC Device During Assessment, Repair and/or Replacement Period

Note: Equipment will not be purchased or rented for use in nursing homes or health care facilities such as, but not limited to, SNF, sub-acute and acute rehabilitation, hospitals, inpatient or outpatient treatment facilities.

Exceptions may be made for specialized DME equipment on a case by case basis.

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