Coverage changes for speech generating devices curbs access

WASHINGTON - A trifecta of moves by Medicare has left manufacturers, clinicians and beneficiaries confused about coverage and threatened access to speech generating devices (SGD).

A Sept. 1 coverage reminder from CMS, stating that the devices can be used only for face-to-face conversations, caught industry stakeholders off guard. The effective date for that reminder was pushed back to Dec. 1 after a conversation between Tobii Dynavox President Tara Rudnicki and CMS Administrator Marilyn Tavenner.

“To make such a drastic change in what (users) are able to do is devastating,” Rudnicki said.

The changes led members of Congress on Sept. 11 to send a Dear Colleague letter to Tavenner asking why the agency wants to restrict the capabilities of the devices, why it placed SGDs under the capped rental rule and why it's no longer paying for the eye-tracking technology that lets certain users access the devices.

To meet CMS requirements, manufacturers are “dumbing down” their sophisticated software to lock out other device capabilities, such as making phone calls or sending text or email messages.

“What do you expect patients to do all day?” said Stephan Floyd, marketing manager for Tobii Dynavox. “Right now, they're fairly independent on their own with our devices. They're completely pushing it back to the Stone Age.”

Even more frustrating: Technology with expanded capabilities costs the same as stripped-down versions.

“Medicare is not saving anything by restricting patient access to these machines,” said Chris Gibbons, director of SGD services for AbleNet.

CMS classified SGDs as capped rental items in the spring, but Monroe Wheelchair has continued to supply them, says CEO Doug Westerdahl.

“Medicare is a small portion of the business we do with speech generating devices, and, fortunately, the private insurers haven't taken on that whole capped-rental approach,” he said.

Still, stakeholders say access issues are compounded by Medicare's move last September to stop paying claims for the eye-tracking technology that lets users type, text, email or talk on the phone through SGDs by looking at text on a screen.

Part of that issue stems from coding, says Floyd.

“We've gone in to get a specific code for eye tracking to get everything buttoned up, but nobody is approving us, so we've been billing it as an accessory,” said Floyd. “They're saying it's an over-the-top accessory. This is, literally, the only access method these people have.”

People rely so heavily on these devices that they're making major healthcare decisions based on their availability.

“The least harm it has caused is to manufacturers who are in a state of confusion and not getting paid,” said Gibbons. “The worst part is for folks who are making big life decisions based on the technology they are unsure will be available to them. I've talked to people who say, 'If I don't have access to eye control, which is my only access to this device, what's the point of my breathing machine or taking nutrition?'