SERVICE POLICY GUIDELINES
COMMUNICATION THERAPY SERVICES
Tri-Counties Regional Center enhances the quality of life for persons with developmental disabilities by working with individuals and their families to secure assessment and treatment supports and services that maximize their opportunities and choices for living, learning, working, and pursuing recreational activities in their community.
Tri-Counties Regional Center will coordinate, support, and advocate for individuals to obtain appropriate therapy services in their community. Tri-Counties Regional Center works with and advocates within communities it serves to develop and identify appropriate speech, language, and communication therapy services provided by professionals experienced with and sensitive to the needs of individuals with developmental disabilities. Such services maximize the potential for persons served to develop and/or prevent deterioration in areas of their development.
Speech, language, and communication therapies are services that assess and teach communication skills in all its modalities, including receptive and expressive language. These modalities include oral language (speech), sign language, gesture, written communication, and/or the use of appropriate augmentative communication systems. Tri-Counties Regional Center may fund speech or communication therapy services when prescribed by a physician and significant deficits exist in communication skills as compared to other areas of development. The planning team must determine that there is a reasonable expectation, based on medical, psychological, audiological, and speech and language assessments, that the proposed intervention is clinically indicated and will result in significant improved communication skills for the individual. Also, the Planning Team must establish measurable objectives and time lines for progress that result from the therapy. For individuals in early intervention programs, of school age, and in adult services, speech and communication services are expected to be provided as part of the individual’s program, rather than as a separately funded service.
Tri-Counties Regional Center will counsel and work with individuals to choose the communication modality that offers the most effective means to interact at home, work, or in the community. Tri-Counties Regional Center may assist individuals or significant persons in the individual’s life with assessments and training in the use of augmentative systems such as electronic communication devices.
Tri-Counties Regional Center service coordinators will refer individuals to the IPP planning team for consideration of speech and language services when any of the following conditions are noted:
Tri-Counties Regional Center may authorize funding for specialized speech and communication therapy services when the need is directly related to, or is the direct result of, a developmental disability and all generic and private resources, including private medical insurance, deny necessary therapy services. Tri- Counties Regional Center service coordinators will actively advocate with early intervention service providers, California Children’s Services, local education agencies, health care facility providers, and health care agencies to ensure the delivery of required and mandated speech and communication therapies. For children under the age of three (3) years, Tri-Counties Regional Center will request the use of private insurance as a generic service in accordance with Section 95004 of the Government Code for Early Start services.
Tri-Counties Regional Center understands that there are recognized therapies not covered by this policy. Tri- Counties Regional Center will consider authorization of funding for therapy services on the list of recognized therapies developed and maintained by Medi-Cal and California Children’s Services. Therapies on these lists have been reviewed by panels comprised of experts in the specified therapy who have determined that the listed therapies are effective for specific clinical indications. Such therapies are prescriptive in nature and will be considered upon review of a Tri-Counties Regional Center physician or psychologist within the planning team process. Tri-Counties Regional Center will not authorize funding of any therapy service that is considered experimental, optional, or elective in nature.
It is the financial responsibility of individuals or their families to pay premiums and, for any non-IPP/IFSP services, meet any required deductible amount, co-insurance, or co-payment liabilities as determined by generic resources and/or private insurance carriers. Tri-Counties Regional Center may pay co-insurance, co-payments, or deductibles when the family’s annual gross income does not exceed 400% of the Federal Poverty Level or the family meets criteria for an exception permitted in the Lanterman Act, section 4659.1, when their income exceeds 400% of the Federal Poverty Level. Except as legally prohibited by the terms of a Special Needs Trust, trust funds established for the care or benefit of a person served are considered a private resource and, therefore, it is expected that this source of funds be used prior to regional center funds. If a generic or private resource initially denies a required therapy service that Tri-Counties Regional Center has determined to be their responsibility, that denial will be appealed. Tri-Counties Regional Center may authorize funding for a therapy service while an individual or family member appeals a denial of service by a generic or private resource when a prolonged wait for the service will have an irreversible impact on the individual’s health and safety.
Exception Policy:
Tri-Counties Regional Center recognizes that some individual needs are so unique that they may not be addressed in this Service Policy and may require an exception. Such requests for an exception to a Service Policy will be made through the IPP planning team process.
Approvals:
