The Latest on Medicare Coverage of SGDs Recent changes in speech-generating device policies leave SLPs wondering: What, exactly, is covered? Bottom Line
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Bottom Line  |   July 01, 2015
The Latest on Medicare Coverage of SGDs
Author Notes
  • Lisa Satterfield, MS, CCC-A, is director of ASHA health care regulatory advocacy. lsatterfield@asha.org
    Lisa Satterfield, MS, CCC-A, is director of ASHA health care regulatory advocacy. lsatterfield@asha.org×
Article Information
Augmentative & Alternative Communication / Practice Management / Telepractice & Computer-Based Approaches / Bottom Line
Bottom Line   |   July 01, 2015
The Latest on Medicare Coverage of SGDs
The ASHA Leader, July 2015, Vol. 20, 28-29. doi:10.1044/leader.BML.20072015.28
The ASHA Leader, July 2015, Vol. 20, 28-29. doi:10.1044/leader.BML.20072015.28
“Upheaval” describes coverage of speech-generating devices (SGDs) for Medicare patients in recent years. In 2014, strict enforcement of the Medicare policy requiring a device to be “dedicated” only to speech-generation forced manufacturers to remove Internet, email and other non-speech features.
Medicare’s rent-to-own policies keep patients waiting 13 months to assume ownership of their devices. Medicare’s denials of eye-tracking features limited manufacturers’ ability to provide these medically necessary accessories for patients with severe physical limitations.
After concerted advocacy efforts, policies are shifting back in favor of patients. Here’s where we are today.
Does Medicare now cover all augmentative and alternative communication devices?
No, it does not. Medicare will cover only equipment and devices that meet the definition of “durable medical equipment.” The only communication devices that meet this definition are SGDs and voice amplifiers.
Does Medicare cover tablets?
No, Medicare does not cover tablets or computers. SGDs are defined as durable medical equipment used solely by the patient with a severe speech impairment. Personal computers are defined as “non-medical equipment.” Speech-generating software that patients download onto personal computers or devices, however, is a covered benefit.

Medicare does not cover tablets or computers. Speech-generating software that patients download onto personal computers or devices, however, is a covered benefit.

Can a patient “unlock” the Internet features on a device?
Yes, Internet accessibility is expected to be covered under regulations scheduled to take effect this month. The final National Coverage Determination (NCD) that defines SGDs would allow manufacturers to “unlock” these features on current devices. SGDs distributed after the start date of the NCD may have Internet and email, and additional non-covered features (such as video-conferencing and environment control) will not need to be locked. Manufacturers may distribute devices with these additional features, but the Medicare beneficiary is financially responsible for anything outside the speech-generation, email or Internet capability benefit.

Internet accessibility is expected to be covered under regulations scheduled to take effect this month.

Does this mean Medicare will cover Internet services?
No, “allowed” is not the same as “covered.” The regulation explicitly states that Internet and phone services, or modifications to a patient’s home to use the SGD, are not a Medicare benefit.
Will Medicare cover eye-tracking accessories?
Yes, eye-tracking will be covered. Although the rule was not explicit, Medicare officials have assured ASHA that medically necessary accessories are a covered benefit. Regional Medicare policies state that accessories are covered when reasonable and necessary.
Can my currently hospitalized patient get an SGD?
The hospital/inpatient facility is responsible for ensuring that patients have the medical equipment they need. However, an SGD for home use cannot be ordered while the patient is under the inpatient (Part A) benefit. Medicare covers SGDs for home use as an outpatient (Part B) benefit.
When does my patient own the device?
For devices distributed from April 1, 2014, through Sept. 30, 2015, Medicare pays the device manufacturer for the SGD over a period of 13 months, after which the patient owns the device. Pending legislation that has passed the Senate and the committee of jurisdiction in the House would lift this capped rental policy for devices distributed on or after Oct. 1, 2015, and the beneficiary would have immediate ownership. House passage is expected before Congress adjourns for the August recess.
How do I help my patient obtain an SGD?
The process for getting a device has not changed. The speech-language pathologist performs a comprehensive evaluation and sends the report to the patient’s physician. The physician attaches this report to the order for the SGD. The manufacturer provides the device and submits the claim to Medicare for reimbursement. The SLP should work with the manufacturer to ensure that the evaluation meets the coverage guidelines.
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July 2015
Volume 20, Issue 7