Speech Generating Devices: Beneficiary Voices Silenced Once Again by CMS

Medicare coverage of speech generating devices (SGDs) has historically fallen victim to unintended consequences for beneficiaries who need an SGD to communicate. Most recently, it literally took two Acts of Congress to remove barriers to SGD coverage borne of discriminatory administrative policies.[1] What could be more deserving of coverage than to provide a voice for a person who cannot otherwise be heard? But, once again, the Centers for Medicare and Medicaid Services (CMS) has created coverage obstacles for SGDs in the midst of COVID, this wretched disease we are all having to endure while isolating and social distancing. At least most of us are able to find ways to communicate. Some people unable to get SGDs, however, have been left more isolated than ever.

In the advent of COVID and the declaration of a public health emergency (PHE), CMS adopted an extensive array of policies intended to make it easier for beneficiaries to meet their health care needs while staying relatively safe. CMS greatly expanded telehealth coverage, but neglected to include evaluation for prescription of SGDs and therapeutic services for use of SGDs, creating yet another new discriminatory barrier for people who are forced to choose between risking their lives to get an SGD or to go voiceless.

Testimonials from speech-language pathologists, and other experts, about the complete ability to accurately and effectively evaluate SGD needs via telehealth have been rejected.[2] CMS refuses to include SGD-related coverage codes in telehealth and CMS does not provide any reasons for that decision[3]. CMS covers other speech and hearing services via telehealth.[4] These include: speech/hearing therapy, evaluation of speech fluency, evaluation of speech production, speech sound language comprehension, and behavioral quality analysis of the voice.[5] CMS also covers telehealth services for assistive technology assessments by physical therapists and occupational therapists for beneficiaries who have lost use of their limbs and who can benefit from new technological advances.[6] If those services can be provided by telehealth, it defies reason why SGDs are excluded from telehealth coverage.

SGD manufacturers report a one-third decrease in Medicare-covered SGD orders since the start of the PHE[7]. Given the lack of telehealth coverage for SGDs, this statistic is not surprising. Many people who need SGDs are also the most vulnerable to falling victim to COVID.

Forcing individuals who require SGDs to attend a face-to-face appointment with a clinician during a pandemic when there is a safe and efficacious alternative creates an impossible choice for such individuals to make – to speak or to live, but maybe not both.

The Centers for Medicare & Medicaid Services’ disturbing history of disrespecting beneficiaries who need SGDs is repeating itself during COVID. Despite concerns the Center for Medicare Advocacy has about the expansion of telehealth and potential impacts on quality of care from providers who might abuse telehealth practice, we strongly support the use of telehealth with Medicare-covered SGD codes. SGD coverage should be equivalent to other telehealth-covered services and be retroactively effective to March 1, 2020.

___________________

[1] Steve Gleason Act of 2015 https://www.govtrack.us/congress/bills/114/s984; Steve Gleason Enduring Voices Act of 2017 https://www.congress.gov/bill/115th-congress/house-bill/2465/text?format=txt.
[2] Assistive Technology Law Center: https://medicareadvocacy.org/wp-content/uploads/2021/01/SGD-Ftn-2-1-2020-08-21-Cover-Letter.pdf; https://medicareadvocacy.org/wp-content/uploads/2021/01/SGD-ftn-2-2-2020-08-23-Complete-Request-File-1-pages-1-to-64.pdf; https://medicareadvocacy.org/wp-content/uploads/2021/01/SGD-ftn-2-3-2020-08-23-Complete-Request-File-2-pages-65-to-84-end.pdf.
[3] CMS 1-20-2021 Letter: https://medicareadvocacy.org/wp-content/uploads/2021/01/SGD-ALert-Ftn-3-Golinker-1.pdf.
[4] COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing (cms.gov), pages 65, 71, 114, 154-157. MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET | CMS, pages 5-7. Microsoft Word - COVID-PhysiciansandotherClinic11-04.docx (cms.gov).
[5] CMS maintains a list of services that may be furnished via Medicare telehealth. This list is available here: https://www.cms.gov/Medicare/Medicare-GeneralInformation/Telehealth/Telehealth-Codes.
[6] Id. (Code 97755).
[7] Information provided by manufacturers Tobii-Dynavox and PRC-Saltillo to the United States Chapter of the International Society for Augmentative and Alternative Communication.