Section He-W 575.07 - AAC Evaluation(a) An AAC evaluation shall be required for prior authorization of all AAC aids.(b) An AAC evaluation shall be completed by a SLP licensed as such by the state in which he or she practices, and who has one of the following credentials: (1) Has at least 3 years' experience in the provision of AAC aids; or(2) Has completed an accredited training in AAC.(c) The AAC evaluation shall include the following:(1) The recipient's identifying information including name and medicaid identification (MID) number;(2) A Form #288-F, "Augmentative and Alternative Communication (AAC) Aids Funding Information" (June 2014) that has been signed by the SLP who conducted the AAC evaluation;(3) The recipient's medical and communication diagnoses;(4) An explanation of the medical need of the recommended AAC aid, and how it will allow the recipient the ability to functionally communicate, including the recipient's communication prognosis both with and without the use of the AAC aid;(5) The recipient's past and current communication skills, including information about past AAC use;(6) A justification of need which indicates the need for modified equipment including information about any of the following areas: a. The recipient's environment;b. The recipient's behavior, cognitive skills, motor skills, perceptual skills, and sensory impairments;c. The recipient's ability to access and activate the AAC aid including activation through touch, eye gaze, or scanning; andd. The need for the AAC aid to be positioned and mounted;(7) A comparison of at least 3 different AAC aids from the same device code category using features match, simulation, or trial, and the results of the comparison including: a. Identification of the chosen aid and the rationale as to why it was chosen over the others;b. An explanation of how the chosen aid meets the recipient's communication needs including data demonstrating improvement over baseline using the selected equipment; andc. An explanation as to how the AAC aid represents the least costly, most clinically appropriate alternative given the recipient's demonstrated cognitive and linguistic abilities;(8) Except as allowed by (d) below, the results of a one-month long trial of the AAC aid identified in (7) a. above, which shall be provided on Form #288-T, "Augmentative and Alternative Communication (AAC) Aids Trial Summary" (June 2014), showing that the recipient's ability to communicate has been maintained or has improved over baseline, and signed by a SLP who completed the evaluation;(9) A detailed list of recommended AAC aids and accessories to be ordered as a result of the completed evaluation;(10) A plan of care for the recipient's use of the AAC aid, which shall include: a. Training of the recipient and the caregiver(s) in the use, maintenance, and care of the AAC aid;b. A safeguarding plan, which shall be provided on Form #288-SG, "Augmentative and Alternative Communication (AAC) Aids Safeguarding Plan" (June 2014), and signed by the SLP who completed the evaluation; andc. The frequency of direct treatment and/or consultation by the licensed SLP responsible for integration of the AAC aid or by the AAC consultant;(11) Documentation indicating that the use of the AAC aid will be supported in the home, school, and work settings as applicable;(12) Signature of the SLP who completed the evaluation who attests to his or her agreement with the findings of the evaluation and its recommendations; and(13) Signatures of any individuals who, as part of the plan of care, are responsible for ensuring that the plan is effectively implemented at home, at school, or at work, and their acknowledgement that they understand their role in the implementation of the plan.(d) When an AAC aid has 8 minutes of recording time or less and can be accessed by direct selection or scanning and light tech materials, a trial period shall not be required.(e) None of the individuals signing the evaluation in (c) above shall have any financial affiliation with the manufacturer or the supplier of the AAC aids.(f) The AAC evaluation shall be valid for 3 years from the date it was completed.N.H. Admin. Code § He-W 575.07