ALS software, Lou Gehrig, stroke, aphasia, speech disorders

1. Has AAC assessment been completed pursuant to the DMERC RMRP outline?	Yes No
2. Have appropriate device or AAC software to meet the individual's daily functional communication needs been identified and specified?	Yes No
3. Have necessary AAC device accessories been identified and specified?	Yes No
4. Is recommended device and accessories are covered by Medicare?	Yes No
5. Does manufacturer/supplier of the recommended device and accessories accept Medicare assignment?	Yes No
6. Has clinician discussed equipment costs with client and/or family? (Particularly important if the device is not covered, or no assignment will be taken.)	Yes No
7. Has an alternative device been identified if the recommended device is not affordable?	Yes No
8. Has the written report been completed pursuant to the DMERC RMRP outline that it: a) supports recommendation of the AAC device, AAC software, and each AAC accessory; b) identifies the SLP who will provide setup and training services (if different from SLP conducting assessment); and c) describes treatment plan for training and services needed to achieve listed functional goals:	Yes No
9. Has the written report been forwarded to individual's treating doctor for review so physician can prescribe all recommended items?	Yes No
10. Has the beneficiary and family been informed how to contact manufacturer/supplier of AAC device to obtain the device and process the Medicare claim?	Yes No
11. Has the beneficiary and family been informed to contact SLP who will provide set up and training services after delivery of AAC device, AAC software and/or accessories?	Yes No

Medicare Checklist

Speech-Language Pathologist Role

Updated 5/25/01