Medical Necessity of Speech Generating Devices for Severe Communication Impairments

Permanent Severe Expressive Speech Disability

The patient has permanent severe dysarthria and aphonia resulting from a large pontine hemorrhage, which represents a permanent neurological condition causing severe expressive speech disability 1, 2
The impairment is documented as permanent with reduced speech intelligibility expected to be chronic, meeting the requirement for a medical condition resulting in permanent severe expressive speech disability 3, 4

A comprehensive SLP evaluation has been completed documenting all required elements including functional communication goals, treatment plan with training schedule, assessment of natural communication modes, and demonstration of cognitive and physical abilities to use the device 1, 2
The evaluation documents that the patient can read, comprehend, and physically operate the SGD using mouse system despite bilateral lower extremity paresis and left hemiparesis 2

Natural communication methods have been systematically ruled out: the patient cannot rely on speech due to severe dysarthria and aphonia, cannot perform sign language due to dexterity limitations, and cannot use communication boards due to dexterity limitations 1, 2
Alternative low-tech and mid-tech options have been appropriately trialed and failed, meeting the requirement that other forms of treatment have been considered and ruled out 3, 5

The patient has already demonstrated ability to use the SGD effectively with mouse system access, can read and comprehend, and has the cognitive capacity to operate the device 2

Stroke patients with severe communication impairments should be considered for assistive technology and communication aids by appropriately trained clinicians 1
Alternative means of communication including augmentative and alternative communication devices are appropriate when natural speech is inadequate 1, 2

The mouse system represents a medically necessary alternative input device given the patient's inability to use standard input methods due to bilateral lower extremity paresis, left hemiparesis, and limited right hand function 3, 5
A variety of access devices including head control mouse and pointers are medically necessary to enable persons with neurologic conditions to use an SGD 3

Medicare regulations authorize medically necessary SGDs for all beneficiaries with functional communication needs and permanent severe expressive speech disabilities 4
The American Academy of Pediatrics recognizes SGDs as critical assistive technology for communication impairments when natural communication methods are inadequate 3, 5
Stroke guidelines from the Australian Stroke Foundation and UK guidelines specifically recommend consideration of assistive technology and communication aids for stroke patients with communication problems 1

Diagnosis of permanent neurological condition (pontine hemorrhage with resulting dysarthria and aphonia) 3, 4
Formal SLP evaluation with all required components including functional goals, treatment plan, assessment of natural communication modes, and device selection rationale 3, 2
Documentation of failed conservative treatments (inability to use sign language, communication boards) 3, 5
Demonstration of ability to use the device (able to use mouse system, read, comprehend) 2
Medical necessity for specific access method (mouse system due to motor limitations) 3, 5

The SLP performing the evaluation must not be an employee or have a financial relationship with the SGD supplier to meet medical necessity requirements 3
Only one SGD at a time is considered medically necessary per patient; multiple devices would require exceptional documentation 3
Follow-up training and reassessment are critical for successful SGD implementation, though funding for these services may require separate authorization 4, 5
The device should include capability to generate email, text, or phone messages to allow remote communication, which is a medically necessary feature 3