Funding for Services

ACTS is a fee for service agency. The hourly rate of reimbursement is based on standard and customary fee schedules for speech/language pathologists and assistive technologists. Contracts for services are obtained from local education agencies (school districts, counties, SELPA’s), Department of Rehabilitation, Regional Centers, private insurance, and private pay. The process for obtaining ACTS’ services for infants, toddlers, school-aged children and adults is provided in the referral documents you can download from the Referrals page. If you need additional assistance the ACTS office can help you determine the appropriate funding source for AAC/AT services.

Funding for Speech Generating Devices

For individuals who cannot speak, a Speech Generating Device (SGD) is first and foremost a medical necessity. ACTS conducts all evaluations for SGDs in accordance with Medicare Guidelines and follows the ACTS Funding Process to secure funding (click to download ACTS Funding Process Document). For the complete Medicare Assessment and Application protocol please refer to the AAC-RERC website www.aac-rerc.com Medicare Funding of AAC Technology. The AAC-RERC web site is supported in part by the National Institute on Disability and Rehabilitation Research (NIDRR).

For infants, toddlers, and school aged children ACTS submits for SGD funding through the child’s primary insurance carrier. If the primary insurance carrier denies coverage of the SGD, ACTS submits to Medicaid (MediCal in California) for device funding. If primary insurance and MediCal deny coverage, funding for infants and toddlers is provided through the Regional Center. For information regarding California Regional Centers and eligibility for service download this document (Regional Centers Document). For school-aged students 3-22 years school district funding is pursued when all other sources have been  ruled out. For further information regarding public schools’ responsibility in AT funding download this document (School’s Responsibility Document).

School-aged children with developmental disabilities can apply for MediCal through their Regional Center Case Managers. Children who are receiving at least two services through Regional Center are eligible to apply for MediCal through institutional deeming.  Eligibility is not based on the parent’s income. MediCal serves as the child’s secondary insurance carrier.  Some school aged children (CA residents) who require an SGD may also qualify for California Children’s Services (CCS) if they have a medically eligible diagnosis. The CCS occupational therapist serves as a case manager for students who will seek funding for an SGD through MediCal. For more information regarding SGD funding for school-aged children download the ACTS S Funding Q & A (ACTS Funding Q&A Document).

For adults with Medicare (Part B) and supplementary private insurance, Medicare serves as the primary insured. Medicare currently pays 80% of the Medicare Fee Schedule www.aac-rerc.com/pages/medicare/McFee.htm for the device code and description. The beneficiaries (patient/client) must pay the deductible (20%) if the fee is not waived.  For adults who have private insurance (but not Medicare) SGD funding is submitted through private insurance.