Regional Carrier Covers AAC Devices Advocacy Results in Reversal of Exclusionary Policy ASHA News
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ASHA News  |   April 01, 2008
Regional Carrier Covers AAC Devices
Author Notes
  • Angela Foehl, director of private health plans advocacy, can be reached at afoehl@asha.org.
    Angela Foehl, director of private health plans advocacy, can be reached at afoehl@asha.org.×
Article Information
Augmentative & Alternative Communication / Regulatory, Legislative & Advocacy / ASHA News
ASHA News   |   April 01, 2008
Regional Carrier Covers AAC Devices
The ASHA Leader, April 2008, Vol. 13, 1-8. doi:10.1044/leader.AN.13052008.1
The ASHA Leader, April 2008, Vol. 13, 1-8. doi:10.1044/leader.AN.13052008.1
Recent advocacy by ASHA brought reversal of a policy that had excluded coverage of speech-generating devices (SGD) and other augmentative and alternative communication (AAC) devices for autism-spectrum speech-language disorders.
The longstanding coverage exclusion by Premera Blue Cross—with more than 1.6 million subscribers in Washington, Alaska, Oregon, and Arizona—was based on the insurer’s position that SGDs and AAC devices were “investigational” in the treatment of autism-related speech-language disorders, a term that precludes coverage on the basis of medical necessity. Under the revised policy, effective Mar. 11, 2008, the autism-related devices are no longer considered “investigational.”
The Premera family of companies includes Premera Blue Cross of Washington, Premera Blue Cross Blue Shield of Alaska, and other non-Blues subsidiary plans. The coverage change could affect 320 to 960 of Premera’s members.
Unfounded and Inequitable
Premera’s former policy covered SGDs and AAC devices only if they met the definition for “durable medical equipment (DME);” were used to treat speech-language impairments not “primarily” due to autism or other pervasive developmental disorders; and met Premera’s “medically necessary” criteria. ASHA protested the exclusion for autism-related disorders as unfounded and inequitable, disagreeing with Premera’s characterization of the devices as “investigational” and advocating that autism-related disorders receive the same treatment as other etiologies in coverage determinations for SGDs and AAC devices.
ASHA provided the insurer with documentation that use of SGDs and AAC devices for autism-related speech-language impairments conforms to the national practice standard for speech-language pathologists. ASHA also documented research results, such as the 2006 meta-analysis by Diane C. Millar and Janice C. Light (Journal of Speech, Language, and Hearing Research, 49, 248–64) that demonstrate communication improvements in clients with autism through the use of AAC devices.
Although Premera had reviewed this and other literature, the insurer discounted the findings as unpersuasive, and omitted ASHA’s policy document, Guidelines for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders Across the Life Span (ASHA, 2006). This document supports SGDs and AAC devices for autism-related communication impairments and pre-dates Premera’s October 2007 exclusionary policy update.
Under the revised policy, SGD and AAC devices still must meet the DME and medical necessity criteria. Devices that are not dedicated SGDs, such as computers and personal digital assistants that perform other functions, will not meet the DME definition. AAC/SGD-enabling software will be covered, but not the costs for installation and technical support.
Scope
The policy provides guidance to individual plans under the Premara umbrella, but coverage is subject to each plan’s specific contractual terms. Premera Blue Cross of Washington and Premera Blue Cross Blue Shield of Alaska defer to the corporate policies of Premera Blue Cross, according to their Web site information. Premera’s corporate medical policy is not mandatory for affiliated plans, but does influence their approach and that of other companies that follow Premera’s lead.
ASHA has subsequently contacted the BlueCross BlueShield Association, which licenses the Blues plans, to advocate for the elimination of autism-related coverage exclusion policies for all Blues plans. ASHA has also alerted insurance departments in all states affected by the change.
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April 2008
Volume 13, Issue 5