Many of you have been following the big Medicare changes that have been happening over the last couple years regarding coverage of Augmentative and Alternative Communication (AAC) devices or Speech Generating Devices (SGDs). These changes, some of which were actually implemented on a short-term basis, threatened the ability of people with severe communication disabilities, such as ALS, to communicate. The following is a brief synopsis with links to more information if you are interested.
In the Beginning…
Prior to 2001, Medicare did not cover SGDs or AAC devices in any form. They referred to them as “convenience items and not primarily medical in nature”. On January 1, 2001, with the help of many advocates, Medicare began covering SGDs that fell under their definition of a communication device.
A Giant Leap Backwards
Medicare continued to cover SGDs until 2014 when the Centers for Medicare and Medicaid Services (CMS) decided to make some drastic changes. These changes included capped rentals and the elimination of the ability to unlock computerized features:
- Capped Rentals-SGDs that were previously purchased by Medicare were now subject to a 13 month rental period before the individual assumed ownership. If this person were to enter an inpatient facility before the rental period ended, their communication device would be subject to the Medicare rule that does not allow rental payments for Durable Medical Equipment. “If the SGD [was] not arranged and paid for by the hospital, skilled nursing facility (SNF), or hospice, the patient could be without the ability to communicate when that communication is most critical.”
- Elimination of the Ability to Unlock Computerized Features– “this prohibit[ed] “SGDs from having any non-speech capabilities (e.g., e-mail, internet, environmental control) or the ability to upgrade in the future at the patient’s own expense.” Previously, “computer-based and PDA-based AAC devices/speech generating devices [were] covered when they [had] been modified to run only AAC software“. They were considered dedicated devices, meaning the user was locked out of all of the computer functions such as Internet, email, and word processing. Once the device was delivered, the individual could then purchase an “unlock” key to have access to all of the computer features.
Now We’re Talkin’!
I am happy to say that after an overwhelming push from thousands of advocates, to include former NFL player, Steve Gleason, that Medicare coverage for SGDs has returned to its previous state!
The ability to “unlock” the device so other computer features can be used was made effective July 29, 2015 when CMS issued the 2015 National Coverage Determination (NCD). With the signing of the Steve Gleason Act into law on July 30, 2015, the capped rental policy will end effective October 1, 2015, which includes all Medicare recipients currently using an SGD under capped rental.
In addition based on comments from the public, the 2015 NCD changed the definition of speech by saying that an SGD can have the capability “to generate other forms of speech such as phone, email, and text messages”. This is quite a nice surprise in my opinion.
With any law/policy change there is usually a lot to learn and to be interpreted. This is certainly no different! Last night I listened to a webinar hosted by the International Society for Augmentative and Alternative Communication (ISAAC), “A New Day Dawns for Medicare SGD Coverage: What Do SLPs, Medicare Beneficiaries, and Families Need to Know?” with presenters, Lewis Golinker, Esq., AAC Advocate Facilitator; Amy Goldman, Speech-Language Pathologist; and Lisa Bardach, Speech-Language Pathologist.
I recommend to anyone that these changes effect to go to the ISAAC website and read the terrific PowerPoint slides and listen to the archived presentation when it becomes available. This information will be especially beneficial to speech-language pathologists as they continue to carry out their duties in the area of SGDs and to people currently obtaining an SGD through capped rental.