Medicare costs for speech devices could change
Those who use speech generating devices may end up paying entirely for the technology if the Centers for Medicare & Medicaid Services do not stay a classification of the devices as medical equipment.
After inquiries from patient advocates, Congressman Tim Murphy (R-Upper St. Clair) and The Almanac, CMS is reconsidering its position to not pay for the devices if they incorporate other features other than face-to-face communication. Previously slated for a Dec. 1 change, patients now have until Dec. 6 to convince CMS to keep paying a portion of the devices, which typically cost between $7,000-14,000.
“These patients, with ALS, people who have suffered strokes, have cerebral palsy – sometimes literally the voiceless – are dependent on other communication features we take for granted like texting, email, Skype and the Internet. CMS has been saying if these are part of a device, we won’t pay for it. They had been advising patients to just get a tablet computer, but that shows that they don’t understand the needs of these people,” said Evelyn Meinert, a speech pathologist with the Augmentative and Alternative Communication Institute.
A family drove from Aurora, Colo., to the South Hills for an Oct. 25 ICAN Talk clinic with the AAC Institute only to find out they could be paying entirely out of pocket for a new eye-gaze system for their 20-year-old daughter, who has cerebral palsy.
“It caught us completely by surprise. Lauren uses email and texting much more than the face-to-face speech generator on the system because it’s easier for her. It takes a long time for her to use the audio device, so she feels more comfortable using that. We wanted to buy a new system with texting to help her with her independence, and now we’re looking at a cost of $16,000,” Vicky Opipari said.
“To take away this tool at a moment when these individuals are already suffering would be cruel and uncompassionate,” Murphy wrote in a Nov. 4 letter to CMS administrator Marilyn Tavenner. Murphy had been seeking justification and explanation for the proposed changes since September.
“I’ve never seen one instance of abuse of a device. These auxiliary components that incorporate with their speech devices often tap into their wheel chairs, the ability to turn on lights, control the TV – doctors and CMS look at communication as a last priority on a list of care when it really should be at the top,” said Margo Broehl, a patient advocacy attorney, “and this is a trivial cost savings for CMS. It’s .000008 percent of their budget.”
“Our devices do things like connect to the Internet and allow telephone use in addition to many other things … CMS would force us to remove these features,” said Bruce Baker, president of Semantic Compaction Systems, a language software developer in Castle Shannon.
Also of concern for patients if changes aren’t made, are requirements to rent devices from hospitals or hospice facilities if they enter their care.
“These are highly-specialized, personal devices. You cannot replace them with something ‘off-the-shelf’ as if they were a crutch or other medical device,” Meinert said.
“To take away a device as someone goes into hospice, it’s just unimaginable. You don’t get to repeat end of life. You don’t get to write that last letter to loved ones after death,” said Dr. Katya Hill, director of ICAN Talk, AAC, who started a change.org petition to review CMS policies.
CMS would also make patients in hospital or hospice care pay month to month to rent the device instead of purchasing it.
To make public comment or to find more information, go to www.cms.gov and enter “speech generation devices” in the search box.