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Q.

What is an augmentative communication device?

A.

An augmentative communication device is durable medical equipment that is used to assist a member who has difficulty speaking. 

Q.

What augmentative communication devices, accessories, and services are covered by Wisconsin Medicaid and BadgerCare Plus?

A.

The following augmentative communication devices, accessories, and services are covered by Wisconsin Medicaid:

• The rental and purchase of medically necessary speech-generating devices.
• Speech-generating software programs.
• Mounting systems.
• Carrying cases.
• Repair of member-owned speech-generating devices.

Q.

What makes an augmentative communication device medically necessary?

A.

All services funded by Wisconsin Medicaid and BadgerCare Plus must be medically necessary. The member must have a condition that severely limits his or her ability to talk. It must be demonstrated that the device chosen for rental or purchase will significantly improve the member’s ability to communicate and help to make his or her thoughts and needs known. The member must be able to use the device effectively. 

Q.

What products, accessories, and services are not covered by Wisconsin Medicaid and BadgerCare Plus?

A.

The following products, accessories, and services are not covered by Wisconsin Medicaid and BadgerCare Plus:

• Extended warranties.
• Fax machines.
• Laptop computers.
• Non-speech-generating software programs.
• Printers.
• Repair of rented speech-generating devices.
• Sales tax.
• Shipping and handling.
• Video games.

Q.

What is needed to request augmentative communication devices and accessories through Wisconsin Medicaid and BadgerCare Plus?

A.

• Verify the member is Medicaid or BadgerCare Plus eligible.
• Complete an augmentative communication assessment (see 
  description on pages 5 and 6) documenting the medical necessity for 
  the augmentative communication device and accessories. 
• Obtain a physician’s prescription for the rental or purchase of the 
  specific augmentative communication device and accessories 
  chosen. 
• Contact a Medicaid and BadgerCare Plus-certified provider who will 
  submit the prior authorization and receive payment for the equipment. 
  
  Find a Medicaid and BadgerCare Plus certified provider by contacting the 
  manufacturer of the chosen augmentative communication device and ask for 
  their Medicaid and BadgerCare Plus certified provider in Wisconsin or by 
  contacting a local medical equipment and supplies dealer. 

• Rent the chosen augmentative communication device and accessories to try, 
  if necessary. Prior authorization is not required for the first 60 days of rental 
  for most augmentative communication devices.
• Submit a prior authorization request to Wisconsin Medicaid and BadgerCare 
  Plus for the purchase of an augmentative communication device and 
  accessories. The Medicaid and BadgerCare Plus certified provider is 
  responsible for submitting all documentation included in a prior authorization 
  request. 
  

Q.

What is prior authorization?

A.

Some services require approval from Wisconsin Medicaid and BadgerCare Plus before they are provided. This is called “prior authorization.”

A Medicaid and BadgerCare Plus certified provider requests prior authorization from Wisconsin Medicaid and BadgerCare Plus. Wisconsin Medicaid and BadgerCare Plus must approve the service before the individual receives the service.

Members and / or their caregivers have the right, and are encouraged, to review the prior authorization request before it is sent to Wisconsin Medicaid and BadgerCare Plus. 

A Medicaid and BadgerCare Plus consultant will review the request to make sure it meets Wisconsin Medicaid and BadgerCare Plus requirements. After all of the required information is sent in, the Medicaid and BadgerCare Plus consultant either approves, modifies, or denies the request. 

Q.

What is included in the augmentative communication assessment?

A.

This assessment is completed by a speech-language pathologist.  The assessment includes the member’s medical diagnosis and communication diagnosis, provides a description of how the member currently communicates, and indicates how an augmentative communication device will improve communication.  The report also includes the current baseline of the member’s:

• Receptive language skills.

• Expressive language skills

• Cognitive abilities.

• Ability to initiate communication.

• Ability to remember signs or pictures, attach meaning to them, and use them to communicate.

• Attention to task.

• Speed and accuracy of processing information.

• Description of the rental period, if applicable.

The assessment should include a discussion regarding which equipment was considered and why, and why the equipment being requested was chosen over other available options.  Justification that the recommended equipment represents the least costly option that meets the member’s functional communication needs should be provided.

The report also needs to include a statement of where the device will be used and the personal who will be responsible for programming the device.

An occupational therapist or physical therapist may provide recommendations for positioning, mounting, and access of the equipment.

Q.

Can a letter of support be submitted with the prior authorization request?

A.

Yes. Additional documentation supporting the member’s need for the augmentative device would be beneficial to a prior authorization request, but is not required. Sometimes letters from parents, family members, teachers, or caregivers may be helpful in documenting how the device has aided the member. 

Any supporting documentation must be submitted with the prior authorization request and should not be mailed separately.

Q.

What can a member do if Wisconsin Medicaid or BadgerCare Plus modifies or denies a prior authorization request?

A.

If the prior authorization request is denied or modified, the member will receive a letter from Wisconsin Medicaid and BadgerCare Plus. The letter will provide information about how the member can appeal the decision and request a fair hearing before an administrative law judge. 

The speech-language pathologist and member may want to discuss the decision to make sure that all of the required information was sent. If more information is needed, the durable medical equipment provider may contact Wisconsin Medicaid and BadgerCare Plus to determine if additional information should be submitted.

Q.

Is a trial period to rent and try out the augmentative communication device required by Wisconsin Medicaid and BadgerCare Plus?

A.

No, a trial period is not required, but it is strongly recommended. A trial period allows a recipient and his or her caregivers to use the device for several weeks and see if it will meet the recipient’s daily needs. Prior authorization is not required for the first 60 days of rental for most augmentative communication devices.

Q.

How often will Wisconsin Medicaid and BadgerCare Plus approve the purchase of a new augmentative communication device for a recipient?

A.

Wisconsin Medicaid and BadgerCare Plus considers each member’s situation separately. There is no established time period that an augmentative communication device is expected to last. Wisconsin Medicaid and BadgerCare Plus monitors the purchase of augmentative communication devices as a part of the prior authorization process.

Q.

What if a Member has other insurance?

A.

The durable medical equipment provider will bill the member’s other health insurance before billing Wisconsin Medicaid and BadgerCare Plus.

Q.

What if a member is enrolled in a Medicaid HMO or BadgerCare Plus?

A.

Contact your Medicaid/BadgerCare Plus HMO directly for more information on how to receive an augmentative communication device through a Medicaid/BadgerCare Plus HMO.

Q.

What should a member do if the device is no longer needed?

A.

Medical equipment that is purchased for members by Wisconsin Medicaid  and BadgerCare Plus becomes the property of the member. When the member no longer needs the equipment and does not anticipate any future need for the medical equipment, he or she may choose to donate the used equipment. 

Wisconsin Medicaid and BadgerCare Plus has established a convenient listing of the locations that accept used medical equipment. This information can be found on the Medicaid Web site at https://www.forwardhealth.wi.gov/WIPortal/Tab/42/icscontent/Member/donation_site/used_dme.htm.spage    Select a state wide program or county for listings that accept used medical equipment. This information is also available to members by calling Member Services at 1-800-362-3002 and to providers by calling Provider Services at 1-800-947-9627.