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MASSACHUSETTS ADVOCATES for CHILDREN
MassHealth: NEW Coverage
Augmentative and Alternative Communication (AAC)
for Children with Disabilities, including Autism Spectrum Disorder
September 15, 2015
Files: AACMassHealthFactSheet9-16-15Final PDF
Update from MAC’s Autism Center and Massachusetts Law Reform Institute
A new state law requires MassHealth to cover medically necessary treatments for low-income children with autism spectrum disorder.
Q. What is AAC – Augmentative and Alternative Communication?
Augmentative and Alternative Communication, also known as AAC, is a term used to describe various methods of communication that supplement or replace oral speech for people who are unable to use oral speech alone to communicate. Children with autism or any other type of disability that makes it difficult for them to communicate may benefit from AAC. Many different AAC methods are used by people of all ages with a range of disabilities.
MassHealth will cover electronic tablets that have been configured primarily for dedicated use as an AAC device, based on the recommendations of the speech pathologist and prescription. Use of the device to text and e-mail can be covered.
Q. What are the steps required to obtain an electronic tablet dedicated to AAC?
The following steps are required by current MassHealth regulations. They require the patient’s primary care clinician, a speech and language pathologist, and a durable medical equipment supplier to work together, utilizing the same MassHealth process already established for covering other kinds of AAC devices.
Q. What types of primary MassHealth insurance cover electronic tablets used for AAC?
Children under the age of 21 who are covered by MassHealth Standard and CommonHealth are entitled to medically necessary AAC devices, including electronic tablets dedicated to use for AAC.
Q. What is the process if I have MassHealth as secondary insurance?
If your private primary insurance provider covers electronic tablets used for AAC, you must first seek benefits under your primary plan. If you obtain a tablet through your primary insurance and have MassHealth as secondary insurance, MassHealth may cover the related co-pays and deductibles.
Q. What if my primary insurance does not cover electronic tablets used for AAC?
If a speech and language pathologist recommends an AAC device that your primary insurance does not cover and you have MassHealth as secondary insurance, you must meet MassHealth medical necessity, prior authorization, and other guidelines for MassHealth coverage of the device. See steps for MassHealth coverage above.
Q. Where can I get an electronic tablet approved by MassHealth?
Several of MassHealth’s current durable medical equipment providers can supply electronic tablets. Your speech and language pathologist will be able to connect you with a provider where you can obtain your device.
Q. Are speech applications (“apps”) or related software for electronic tablets covered?
Yes. MassHealth covers medically necessary AAC software, applications, and related equipment, as long as prior authorization is provided consistent with the steps for coverage outlined above.
Q. Who can I call for more information?
MassHealth Customer Service: (1-800-841-2900)
ADDITIONAL INFORMATION FOR PROVIDERS
Q. How is MassHealth going to determine “medical necessity” for coverage of electronic tablets used for AAC?
Recommendations for electronic tablets must meet the current medical necessity rules in the MassHealth regulations at 130 CMR § 409.428 and additional medical necessity guidelines specific to tablets, such as the requirement that the device be configured to limit the primary use to AAC.
Q. Are there new Prior Authorization procedures for providers?
No. The same procedures MassHealth now uses to authorize AAC devices will apply to electronic tablets configured as AAC devices. For members in the PCC plan or FFS (fee for service), the prescription, letter of medical necessity, and additional supporting clinical information will be submitted with the prior authorization request through the Provider Online Service Center (POSC) or by completing a MassHealth Prior Authorization Request form (PA-1) and attaching the documentation. Providers who work with MCEs will need to follow the MCE’s prior authorization process.
Q. Are there new codes for the DME providers of electronic tablets configured as AAC devices?
MassHealth codes for electronic tablets used for AAC are the same as current AAC codes, with modifiers.
Q. Who can I contact for more information?