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Medicare SLP Sample Reports |
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This section contains examples of reports prepared by members of the Medicare Implementation Team. Their purpose is to assist SLPs in the development of reports that closely follow the Medicare protocol and address all the requirements set forth in the RMRP. For a copy of the protocol, click here. Additional examples will be posted from time to time and existing reports may be modified as we learn more about the process. Our intent is to provide a range of examples that represent different types of individuals with disabilities that benefit from AAC technology. Medicare suppliers are required to keep these reports for 7 years in case of an audit. The SLP report forms the basis of the decision to fund an AAC device. |
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II. CURRENT COMMUNICATION IMPAIRMENT A. General Statement Impairment Type & Severity (ICD-9 Diagnostic Code:
784.5, 784.69) Mr. ____(Patient) is functionally non-speaking. Patient's primary means of communication are inconsistent gestures, facial expressions, exaggerated changes in vocal intonation, and inconsistent yes/no head nods. Anticipated Course of Impairment : Aphasia and apraxia are judged to be stable and chronic in nature.
B. Comprehensive Assessment Hearing Vision Patient wears bifocals. Corrected visual acuity is within
normal limits. No other visual impairments are noted.
Discriminates 12-point font and 1/2 inch symbols on SGDs. Patient
possesses visual skills to use SGD functionally. Physical Patient can independently access SGD with left arm/hand and depress keys with left index finger. Demonstrates adequate movement and pressure to activate both a membrane keyboard and touch screen. Possesses physical ability to independently and effectively carry, maintain, and access SGD. Language Skills Overall Aphasia Quotient: 18.8/100 Informally, patient demonstrates functional understanding of basic adult conversation, presented at moderate rates. Comprehension improves when gestural and written cues are provided. Patient demonstrates ability to manage SGD displays with 30 items. Identifies printed words on a display of 30 with 50% accuracy. Rate of selection is slow, frequently taking > one minute. When printed words are enhanced with picture symbols on a display of 30, the patient demonstrates 90% accuracy with functional selection rates. Demonstrates ability to spell some functional words. Uses word prediction with 80% accuracy, but rate of selection is > 30 seconds (choice of 10 words). During a 2-hour evaluation, the patient masters independent use of up to 30 categories to access 30 screens of vocabulary/stored phrases (20-30 symbols/screen). Spontaneously uses vocabulary to answer questions or establish a topic, but does not formulate two or three- part messages. Cognitive Skills III. DAILY COMMUNICATION NEEDS A. Specific Communication Needs Primary communication situations involve 1:1 and small group conversations. Primary communication environments are home, telephone (emergency and exchange with grown children who live out of town), and community. Patient's primary communication partners include his wife, family, friends, and health professionals. Patient needs to communicate messages that provide identifying/biographical information, express physical status/needs, socialize, offer information about past and present experiences, and express feelings and opinions with familiar and unfamiliar communication partners across multiple environments. B. Ability to Meet Communication Needs With Non-SGD Treatment Approaches Patient has not shown speech improvement with traditional speech language therapy (Weekly 1 hour individual therapy 1998-2000). Given the time post onset and current severity of the patient's expressive aphasia and apraxia of speech, the patient is judged to have minimal to no potential to develop speech. Patient does not have adequate spelling skills to support writing as primary mode for expressive communication. Currently, patient is limited to communicating about objects/activities in the immediate environment (points to them), confirming or rejecting (fair reliability), answering some questions related to needs by pointing to written choices, and relying on family members' interpretations of vocalizations and facial expressions. Patient has attempted to use a word/picture communication book, but found that either vocabulary was too limiting or when additional vocabulary pages were added, one-handed page turning with the left/non-dominant hand was cumbersome/nonfunctional Patient lives at home with his wife. She reports difficulty understanding patient's requests for specific items. She notes patient is limited in his ability to communicate with other family members and friends. Patient's inability to communicate on the phone interferes with his potential to maintain contact with his two children who are away at college. As a result, Mr. ____daily functional communication needs
cannot be met using natural communication methods or
low-tech/no-tech AAC techniques. Upon receipt of an SGD, treatment goals will target use of SGD in face-to-face interactions, on the telephone, and in daily communication situations to spontaneously:
V. RATIONALE FOR DEVICE SELECTION A. General Features of Recommended SGD and Accessories Based on the above noted comprehensive assessment, daily communication needs, and functional communication goals, the patient requires SGD with the following features: Input/Message Characteristic Features:
Output:
Other features:
Accessories
B. Recommended Medicare Device Category and
Accessory Codes The individual's ability to meet daily communication needs will benefit from acquisition and use of the SGD Category K0544 and accessories (carrying case and 2nd batter) from SGD Accessory Code K0547. C. Trial with SGDs The patient and his wife were introduced to a variety of SGDs which offer word/picture displays and voice output including: Patient's needs and abilities exceed the available vocabulary on the TechTalk8, Voice, and MessageMate. With >20 words/symbols on a Dynamo display, symbols are unclear and interfered with patient's symbol selection accuracy and rate. The exceeds size/weight criteria for the patient to carry it independently/safely. With the Communicator LT500 which weighs only 2.5 pounds, patient can use a personalized screen to provide 20 items regarding identifying/biographical information (name, address, phone, family members, education/work history, etc.). Navigates between 30 screens on verbal command with 70% accuracy. Answers object function wh-questions with 75% accuracy. Offers information for picture description activity with 70% accuracy. Expresses feelings/opinions with 60% accuracy. Uses Child User dictionary two times to find vocabulary not available on custom screens. Functionally types/uses word prediction for 12 words in conversation. In addition, he demonstrated an ability to use the carrying case to transport the device. D. SGD and Accessories Recommendation Based on SGD trials, it is recommended that the patient be fitted with:
Communicator LT500-to improve functional communication. These items are available from: Gus Communication Devices, Inc. E. Patient and Family Support of SGD The patient is highly motivated to use an SGD to improve his
communication. His wife supports the use of the Communicator LT500
and demonstrates good entry-level ability to program the device.
With additional time and support, the wife will be able to
independently program and maintain the equipment. A copy of this report has been forwarded to the patient's treating physician (DR. … #XXX) on ______ (date) for review and prescription. VI. TREATMENT PLAN Upon receipt of SGD, it is recommended that the patient receive 8 one-hour individual and 8 one-hour small group patient therapy sessions within 3 months. These sessions will address goals listed in Section IV of this report. An additional two hours of training are recommended to further train the patient's wife to program and maintain the device. VIII. SIGNATURES / SLP ASSURANCE OF FINANCIAL INDEPENDENCE The Speech-Language Pathologist performing this evaluation is
not an employee of and does not have a financial relationship with
the supplier of the SGD. |
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II. CURRENT COMMUNICATION IMPAIRMENT A. General Statement Impairment Type & Severity (ICD-9 Diagnostic Code:
784.3) Anticipated Course of Impairment: Aphasia is judged to be stable and chronic in nature.
B. Comprehensive Assessment Hearing Family denies hearing problems for patient or primary
communication partners. Patient responds at screening levels of
1000, 2000, and 4000 Hz bilaterally when tones are presented at a
cutoff level of 30dB in a quiet room. Patient attends and responds
to auditory information presented at conversational loudness
levels. Understands digitized speech and good quality synthetic
speech equally well as judged by appropriate responses and
reactions to message output (80 % accuracy). Possesses hearing
abilities to effectively use SGD to communicate functionally. Vision No visual acuity problems are noted. Patient demonstrates
severe visual field cut in lower right quadrant. Does not
compensate unless cued. Demonstrates best accuracy (85%)
identifying picture symbols when ten 2-3" color
symbols/display are presented in top-down array or left of
midline. Possesses visual skills to use SGD functionally. Physical Patient ambulates for short distances by cruising from furniture item to item. Spends 50% of day in manual wheelchair. Moves independently to a table (potential location of SGD) by ambulating or propelling his wheelchair. In community environments, the patient will have the SGD velcroed to a bean bag lap desk which he carries in his lap. Patient can independently access SGD with left arm/hand and
depress keys with left index finger. Demonstrates adequate
movement and pressure to activate both a membrane keyboard and
touch screen. Requires partner assist to change levels/overlays on
all devices. Possesses physical ability to effectively use SGD. Language Skills The patient demonstrates severe aphasia and concomitant severe apraxia of speech as formally measured on the Western Aphasia Battery: Overall Aphasia Quotient: 11/100 Because of the patient's limited ability to communicate through text or speech, a symbol assessment was conducted using an informal clinician-made task according to criteria from Beukelman and Mirenda (1998) as well as the Multimodal Communication Assessment Task for Aphasia (Garrett, 1998). Results include:
In conversation, patient demonstrated ability to follow basic
commands and follow basic conversation when gestural and written
cues were provided. Cognitive Skills The patient sustains attention for up to one hour if
communication partners facilitate his understanding with use of
gestural and written communication cues. Recalls symbol locations
on a display from session to session. Attempts to initiate
communication and independently reaches for the SGD. Turns SGD
On-Off independently. Possesses linguistic and cognitive abilities
to use basic SGD to communicate functionally. A. Specific Daily Communication Needs Primary communication situations involve 1:1 and small group conversations. Primary communication environments are home, telephone (emergency and exchange with grown children who live out of state), and to a lesser extent, community. Patient's primary communication partners include his wife, caregivers, family, and visitors. Patient needs to communicate messages that convey needs/physical problems/ pain, greetings and basic social exchange, leisure activity choices, and information about recent/past events to the primary communication partners across communication environments. B. Ability to Meet Communication Needs with
Non-SGD Treatment Patient has not shown speech improvement with traditional
speech- language therapy(1 hour individual therapy, weekly/1993-4,
1 hour group therapy, weekly/1998 to present). Given the time post
onset and current severity of the patient's oral apraxia, apraxia
of speech, and severe aphasia, the patient is judged to have
minimal to no potential to develop speech. In addition, due to
profound agraphia, the patient did not write functional words
except for his signature. Upon receipt of SGD, treatment goals will target use of multiple displays on SGD (6-8 symbols per display) in real-life situations to*:
*The communication partner will consistently be responsible for
setting up the correct message level. V. RATIONALE FOR DEVICE SELECTION A. General Features of Recommended SGD and
Accessories Based on the above noted comprehensive assessment, daily communication needs, and functional communication goals, the patient requires SGD with the following features: Input/Message Characteristic Features:
Output:
Other features:
B. Recommended Medicare Device Category and
Accessory Codes The individual's ability to meet daily communication needs will benefit from acquisition and use of the SGD Category K0544. C. Trials with SGDs The patient was seen for 3 individual and 2 group therapy sessions using a variety of SGDs. The patient activates all keyboards successfully. Becomes confused by displays with more symbols (e.g. Tech/Speak and MessageMate 40). On 6-8 large symbol displays, the patient increases the frequency of his purposeful communication attempts, increases his attention to peer speaker or clinician facilitator (from 40%-90%), and demonstrates success in locating messages stored on an SGD to answer conversational questions and make requests. Patient requires cues to scan display to compensate for his right visual field cut. Does not use categories to benefit from dynamic display. Does not formulate two-part messages/sentences. D. Recommended SGD and Accessories Based on SGD trials, it is recommended that the patient be
fitted with the:
*Available from: E. Patient and Family Support of SGD The patient is highly motivated to use an SGD to improve his communication. His wife supports the use of the Communicator 3500 and demonstrates good entry level ability to prepare overlays and program the device. With additional training and support, the wife will be able to independently program and maintain the equipment. F. Physician Involvement Statement A copy of this report has been forwarded to the patient's treating physician (DR. … #XXX) on ______ (date) for review and prescription. VI. TREATMENT PLAN Upon receipt of SGD, it is recommend that the patient receive
45 minutes of individual therapy and one hour of group therapy
weekly for 8 weeks (total 16 sessions). These sessions will
address goals listed in Section IV of this report. An additional
two hours of training are recommended to train caregivers to
program the device. VIII. SIGNATURES / SLP ASSURANCE OF FINANCIAL INDEPENDENCE The Speech-Language Pathologist performing this evaluation is
not an employee of and does not have a financial relationship with
the supplier of the SGD. |
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