When to Begin Services

Admission and Discharge Criteria in Speech-Language Pathology

Speech-language pathology services may be appropriate when a person has—or may at some point have—a communication, cognitive, social interaction, or feeding and swallowing problem. The problem is one that affects independence, safety, or participation in meaningful activities or daily routines. Services may be provided to

• help prevent the start of a disorder;
• improve a person’s functioning and disability related to communication, cognition, social interaction, or feeding and/or swallowing skills;
• maintain a person’s safety or quality of life;
• reduce the effects of a new or ongoing condition
• slow or prevent a decline;
• support the person’s recovery during temporary changes in function (e.g., delirium)

Speech-language pathologists (SLPs) make decisions to begin services with the person receiving services and, when appropriate, their family or representative. Clinical judgment, the person’s goals, and the context of service delivery guide these decisions.  

The following factors support the decision to start services:

• a referral from any source (e.g., physician, care partner, teacher, nurse, self-referral)
• a standardized screening tool showing the need for more assessment
• a communication, cognitive, or feeding and/or swallowing disorder confirmed by an SLP
• skills and abilities that differ from those of other individuals who are of a similar age, gender, culture, or language background—as shown through appropriate tests or data
• functional limitations—across environments or with different partners—that affect a person’s school, work, social interaction, health, safety, or well-being
• feeding and/or swallowing concerns that affect a person’s nutrition, hydration, respiratory health, or quality of life
• a person’s expressed desire to improve function or participate in services

SLPs are advised to confirm insurance or funding requirements at the start of care and then continue checking throughout the course of care to avoid gaps in coverage or unexpected denials.

Preventative and Maintenance Services

In addition to treating existing disorders, speech-language pathology services may also be provided proactively. These services can take two forms:

• pre-habilitation: Services that help prevent a problem before it begins—for example, preparing for surgery, a medical treatment, or a major life change that could affect communication, cognition, or swallowing
• maintenance: Services that help prevent an existing or already diagnosed disorder from (a) declining, (b) contributing to further loss of function, or (c) causing complications (rather than achieving new improvement)

Both types of services support health, independence, and participation across the lifespan, and both require clear clinical justification and documentation of their impact.

Speech-language pathology services are appropriate to help the person achieve the following outcomes:

• Maintain function for people at risk of losing skills that support independence, safety, or participation in daily activities—such as work, education, and community life.
• Prevent decline in people with chronic or progressive conditions.
• Prevent complications from communication, cognitive, or feeding and/or swallowing challenges—for example, aspiration pneumonia, social isolation, loss of employment, or care partner stress.
• Support skill development or adaptation when life circumstances change—such as aging with a developmental disability, moving to independent living, or adapting to new work or social expectations.

These services should be clinically justified, time limited, and supported by documentation showing their impact or the likely consequences of not providing them. Coverage for preventative or maintenance services varies by payer, so SLPs should understand the applicable policies for each person’s payer when planning or advocating for care.

Understanding External Requirements

In addition to clinical need, other factors can influence the decision about when services can begin: One such factor is the rules set by early intervention programs, schools, employers, laws and regulations (e.g., Individuals with Disabilities Education Act [IDEA],  and Early Hearing Detection and Identification programs [EHDI]), or health care payers (e.g., Medicare, Medicaid, or private insurance). These regulations may include eligibility criteria, documentation requirements, timelines, or limits on how services are delivered.

The sections below describe how these requirements apply within key service settings:

• Early intervention programs: Each state has its own eligibility rules. These rules often include the stipulation that there must be a documented developmental delay, a diagnosed condition likely to cause such a delay, or evidence from informed clinical opinion when test scores do not fully show the child’s needs. These services are planned by implementing an individualized family service plan (IFSP) with the family or care partner and follow state and federal rules.
• Health care and private practice: Some insurance companies require prior authorization before therapy can start. Employers and payers often require documentation of , which usually means showing evidence of a functional limitation and a reasonable expectation that skilled services will make a meaningful difference. For preventative or maintenance services, documentation should show the impact on daily functioning, safety, or health outcomes. SLPs are encouraged to verify each person’s benefits and coverage before services start and ensure that coverage continues throughout the course of care.
• Schools: A student must have a communication disorder or a feeding and/or swallowing disorder that adversely affects their ability to learn. Eligibility is determined by the individualized education program (IEP) team—which consists of the student, their family or care partner, the school SLP, and school teachers and staff—in line with federal, state, and local regulations.