Least costly equally effective alternative, or LCEEA, is a valuable phrase to understand when putting together evaluation report.
LCEEA is defined as the least costly, equally effective SGD alternative that will achieve the treatment goal (see https://www.isaac-online.org/wordpress/wp-content/uploads/2018-02-08-USSAAC-Slides-golinker-website-upload.pdf). This is often the measure by which funding sources, including private insurance and state Medicaid programs, determine whether or not they will approve or deny funding of an SGD.
Many health plans will authorize funding of a requested SGD, "that is not more costly than an alternative that is at least as likely to produce equivalent therapeutic results for the treatment of the plan member's condition. Documentation must show that all least costly alternatives have been considered and ruled out before funding of an SGD will be authorized." (Fallon Health, Speech Generating Devices, Clinical Coverage Criteria). Knowing that most, if not all, SGD funding sources will be looking for a discussion of LCEEA can help to inform what an SLP must consider, evaluate, and include in an SGD evaluation report.
The following discussion will look at ways of thinking about LCEEA while evaluating and discussing various device options in an SGD report. When thinking about the concept of LCEEA, it is of utmost importance to keep in mind that "least costly" does not necessarily mean "cheapest."
With that idea held firmly in mind, how does an SLP narrow down the SGD options available and show that the chosen device is the least costly equally effective alternative to meet the client's needs, especially when the best choice for a client, may carry a price tag of many thousands of dollars?
According to Lewis Golinker, Esq., "SGD models are functionally and qualitatively distinct. SGD models do not merely copy each others' capabilities. Instead, different models seek their own niche: to address still-unmet needs among patients' enormous range of physical, cognitive, sensory and linguistic functioning. For this reason, SLPs make SGD recommendations on the basis of ‘feature-matching' between patients' abilities and needs and the distinct functional capabilities and limitations of various SGD models." (see link). There is not a single SGD that matches all of the features that every potential device user will need to achieve effective and efficient communication.
Therefore, SGD's are divided into three distinct categories which are coded separately. The key distinguishing features among the categories of SGDs are:
Each category of device offers features that can be matched by the SLP to the unique individual to find a reliable, effective and efficient communication alternative.
Digitized SGDs coded E2500, E2502 - E2506, are devices that contain words or phrases that have been recorded by someone other than the SGD user for playback by the SGD user. These types of devices provide the user with an entire phrase, sentence, or message that can be accessed by a single selection on an AAC device. They are typically used by individuals who do not have the linguistic skills yet to formulate messages independently. Examples of such devices are the GoTalk from Attainment Company, TechSpeak from AMDi, or BigMack Communicator from AbleNet.
Synthesized SGDs, coded E2508 or E2510, take the inputs of the user and translate them into computer generated speech. Users of synthesized SGDs are not limited to pre-recorded messages. They can independently generate utterances that are individualized and unique to themselves and their own thoughts.
E2510 devices, such as the Accent series or the NovaChat series of devices from PRC-Saltillo, differ from E2508 devices, such as a Lightwriter SL40 from TobiiDynavox, in that they offer the user multiple methods of message formulation (e.g. letters, words, pictures or symbols), and multiple methods of device access, coded E2599:
Many funding sources will require documentation show that all LCEEA have been considered and ruled out before will authorize funding of any SGD. Here are some tips for ruling out broad categories of devices and also how to mention specific device alternatives.
One final note on this topic: It is important to remember that cost is considered only after options are found that offer equal benefit or effectiveness for the client to meet their functional communication needs. After the options have been narrowed down and devices identified that will most effectively meet the client's needs, then cost is taken into account.
With a clear understanding of the meaning of the phrase least costly equally effective alternative, and what funding sources are looking for in establishing LCEEA, you are well on your way to navigating a successful path through the funding process, and securing funding for an SGD for your client.
– Beth Studdiford, M.S., CCC-SLP. Read additional articles by Beth.