How can communication services, including AAC devices, be documented as "medically necessary"?

For each case, the starting point is a review of the insurer's definition of medical necessity. These definitions can vary considerably from one insurer to the next. Typically, medical necessity is tied to an identified condition or diagnosis that limits the person's functioning in some way.

In the case of communication, treatment would be medically necessary when the diagnosed condition (for example, cerebral palsy, brain injury, apraxia, ALS) impairs the individual's ability to communicate effectively. Services/devices address the medical necessity by attempting to restore lost function, forestall further functional decline, or provide an alternative means of performing the function. It is actually difficult to imagine a situation in which communication services, including AAC supports, are not medically necessary, as most instances of significant communication limitations are associated with diagnosed conditions.

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Devices and services are deemed educationally necessary when they allow the child to benefit from a free, appropriate public education in the least restrictive environment. The Individuals with Disabilities Education Act specifies that special education services should enable students to access, participate in, and demonstrate progress with respect to the general education curriculum. It is hard to imagine a case in which a student would have equal access to the curriculum and the ability to participate and progress without benefit of an adequate means of spoken and/or written communication!

Communication services can be represented on the IEP as special education, related services, or supplementary aids and services. Because assistive technology is one of the "special factors" that IEP teams must consider for all children, IEP teams are obliged to discuss communication devices and services when a child's communication limitations are so significant that they impact the child's ... more.

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