Nonprofit Agencies Advocate for AAC

On February 26th 2020, Arizona Center for Law in the Public Interest (ACLPI) sent a follow up letter to AHCCCS to cite continued concerns over changes in policy and procedures in Arizona’s Department of Economic Security/ Department of Developmental Disabilities (DES/DDD) Augmentative Communication Unit. ACLPI’s most prominent concerns included failure to comply with federal and state laws, and excessive denial of speech generating devices, among other things. See ArSHA’s previous AAC DDD update for the original list of concerns.

Notice to Cure
In response, on March 4th 2020, Arizona Health Care Cost Containment System (AHCCCS) published a “Notice to Cure,” demanding the DDD Augmentative Communication Unit cease certain actions. In summary, grievances included:

  • “Failure to comply with federal and state coverage and authorization requirements specific to Augmentative and Alternative Communication (AAC) devices”
  • “Failure to comply with critical grievance and appeals system protections and requirements”
  • “For an extended time period DES/DDD has failed to issue timely and accurate Notices of Adverse Benefit Determinations to members who have requested such devices and/or related services and supports, providing members with no reasonable or reliable mechanism to challenge DES/DDD’s failure to act in accordance with state and federal requirements.”

The Notice to Cure provides background information into the history of the complex situation, which dates back to DDD/DES implementing a ‘hold’ process on all AAC related decisions as of August 1st 2019. Approximately 400 families were affected by these policy changes, including lack of “timely authorization determinations as well as DES/DDD’s failure to inform members of their appeal rights regarding the outcome of their AAC requests.”

AHCCCS Leadership Gets Involved
This issue was first brought to the attention of AHCCCS leadership in December 2019, when external parties notified the State of AAC related policies that appeared to violate DDD member rights, as well as state and federal guidelines. AHCCCS leadership met with Aug Comm Unit leaders several times and reiterated that DDD/DES must follow correct policy guidelines and a 14 calendar day timeline to respond to families. DES/DDD stated it began a comprehensive review of policies, would collaborate with AAC provider agencies, and would notify all affected families by the end of February. AHCCCS then began to receive additional concerns from families, advocates and external parties that devices were denied using “boilerplate” or rubberstamp reasons, rather than individual determinations, as well as limited chance to appeal, and that AAC related policies appeared unchanged since the joint AHCCCS/DDD/DES meeting in January.

Policy Changes
In response, AHCCCS issued the DES/DDD Aug Comm Unit the Notice to Cure on March 4th 2020, which includes an extensive request for data and information from the Aug Comm Unit. Most notably this includes: the total number of affected device requests and DDD/DES device determinations, as well as detailed documentation of all steps in the AAC request/evaluation process and any evidence based criterion used for decision-making.
In the Notice to Cure, AHCCCS cites requirements for immediate policy modifications for the DDD/DES Aug Comm Unit. AHCCS leadership will provide rigorous oversight of the corrective ’Cure’ process. The DDD/DES Augmentative Communication unit proactively agreed to produce a ‘comprehensive Action Plan’ with stringent timelines within the next several months for rollout of new procedures, policies, and retraining of staff. In addition, AHCCCS will then conduct a random audit to monitor DDD/DES compliance of Notice to Cure guidelines. To support DES/DDD through this transition process, AHCCCS is also hiring a national consultant with clinical expertise to evaluate DES/DDD policy, best practices, and make recommendations.

ArSHA strives to support its members with the professional knowledge and resources they need to service children and families with complex communication needs. Likewise, ArSHA supports AHCCCS and DES/DDD’s efforts to service individuals with disabilities. ArSHA will continue to work behind the scenes with all parties on behalf of children with complex communication needs, their families, and the SLPs who serve them.

Complete Notice to Cure and AHCCCS responses are available below.

DDD_AugComm_NTC_Final_March2020 (2) – signed

Response to ACLPI re DDD Augmentive Communication Devices 03062020