Medicare Green-lights Web Access for SGDs In a major departure from current rules, a proposed Medicare policy will allow speech-generating devices (SGDs) to connect to the Internet to generate email, text or phone messages. The proposal from the Centers for Medicare and Medicaid Services (CMS), which is scheduled to take effect July 28, expands the type ... News in Brief
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News in Brief  |   June 01, 2015
Medicare Green-lights Web Access for SGDs
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Augmentative & Alternative Communication / Practice Management / Regulatory, Legislative & Advocacy / News in Brief
News in Brief   |   June 01, 2015
Medicare Green-lights Web Access for SGDs
The ASHA Leader, June 2015, Vol. 20, 10. doi:10.1044/leader.NIB6.20062015.10
The ASHA Leader, June 2015, Vol. 20, 10. doi:10.1044/leader.NIB6.20062015.10
The proposal from the Centers for Medicare and Medicaid Services (CMS), which is scheduled to take effect July 28, expands the type of communication and features of SGDs that will be covered for Medicare beneficiaries.
The proposal specifically changes two rules that SGD users have found to be most problematic: the requirement that SGDs be “dedicated” and that they not be connected to the Internet.
Dedicated use
Under previous rules, Medicare covered an SGD only if the device was “dedicated”—that is, used only to generate speech. According to the proposal, if the SGD is used only by someone with a severe speech impairment and primarily to generate speech, it will be covered.
“We do not believe it is necessary for a speech-generating device to be dedicated only to speech generation” to be covered, the CMS proposal memo states.
Internet capability
By CMS definition, SGDs include devices that produce digitized or synthesized speech, as well as software that allows a computer to function as an SGD. Under previous rules, the devices could not have Internet capability, causing two distinct problems:
  • The user could not download updates to the software or device.

  • The user could not communicate remotely.

In extending coverage to devices that generate speech and can also generate written or phone messages, CMS acknowledges that written or phone messages serve the same communication purpose as speech generation.
“An individual with severe speech impairment always needs to communicate, regardless of where they are and the person to whom they are communicating is,” the memo states.

In extending coverage to devices that generate speech and can also generate written or phone messages, CMS acknowledges that written or phone messages serve the same communication purpose as speech generation.

Exclusions
Although Medicare will pay for a necessary device that can connect to the Internet, it will not pay for the Internet service required to send messages, one of several exclusions in the draft policy. Medicare will not cover:
  • A device that is useful to someone without severe speech impairment.

  • Internet or phone services or any modification to the user’s home to allow use of the SGD.

  • Personal computers, tablets or mobile device that may be programmed to perform the same function as an SGD.

  • Specific features of an SGD that are not used by the person with a severe speech impairment to meet his or her functional speaking needs (for example, hardware or software used to create documents and spreadsheets or to play games or music).

  • Video communications or conferencing software.

Advocacy
This revision is the result of collaborative advocacy efforts by ASHA and ASHA members, the Amyotrophic Lateral Sclerosis Association, the Independence Through Enhancement of Medicare and Medicaid Coalition, and SGD manufacturers. These stakeholders worked with CMS and Congress to revise the policy, which had been significantly tightened in February 2014.
Opposition to the change surfaced immediately after the February announcement, including a letter to CMS questioning the rules that was signed by more than 200 members of Congress. In response, Medicare postponed the effective date of the tightened restrictions—originally set for Sept. 1—for three months. In early November, however, Medicare rescinded the policy, opened up a 30-day comment period to the coverage rules, and advised that new rules would be issued in July 2015.
CMS received 2,290 comments in the 30-day period, all of which supported expanding coverage to include SGDs that allow other types of communication.
For more information, contact Lisa Satterfield, director of ASHA health care regulatory advocacy, at lsatterfield@asha.org.
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June 2015
Volume 20, Issue 6