11. Medicare versus Medicaid No premium for any recipients (as of March 2006) Premiums generally required Needs-based eligibility (income or disability) Eligibility based on work record of self or family member Enacted by Congress in 1965, Title XIX Enacted by Congress in 1965, Title XVIII Medicaid Medicare

12. Medicare versus Medicaid (continued) Administered by state; subject to federal requirements Administered federally (through subcontractors) “ Payer of Last Resort” except with respect to schools Will pay before Medicaid Medicaid Medicare

13. Medicare versus Medicaid (continued) Qualified SLP must be licensed Qualified service provider must be licensed and CCC Prior approval before SGD delivered and claim paid For original Medicare, reimbursement after delivery Medicaid Medicare

36. SGD criteria comparison Assessment of hearing, vision, physical status Documentation of visual, motor, and auditory comprehension Comprehensive assessment; language skills, cognitive skills Speech evaluation Diagnosis; impairment type and severity; anticipated course of impairment Diagnosis Demographics – date of birth; age of onset Demographics – age Medicare (www.aac-rerc.org) AmeriChoice (one MA MCO)

37. SGD criteria comparison (continued) Rationale for device selection, including general features of recommended SGD+; equipment used in assessment Results of trial of other AT devices Daily communication needs; ability to meet with non-SGD approaches Medicare (www.aac-rerc.org) AmeriChoice (one MA MCO)

38. SGD criteria comparison Evidence of ability to use; participation of patient/family in choice; commitment to support equipment for daily communication Documentation of ability to use device independently Functional communication goals; treatment plan using the SGD, including type of treatment, follow-up Treatment plan Medicare (www.aac-rerc.org) AmeriChoice (one MA MCO)

39. SGD criteria comparison Description of physician involvement (e.g., review of SLP report prior to Rx) Letter of medical necessity from physician; prescription Estimated pricing Medicare device and accessory codes for recommended device Vendor name, provider number Medicare (www.aac-rerc.org) AmeriChoice (one MA MCO)