2002 Conference Proceedings

Go to previous article 
Go to next article 
Return to 2002 Table of Contents


MEDICARE FUNDING AND AAC TECHNOLOGY

Carlene MacBride Yonemori
Molly Doyle
Las Floristas Center for Applied Rehabilitation Technology (CART)
Rancho Los Amigos National Rehabilitation Center
Downey CA
562-401-6800 (voice)
562-803-8892 (fax)
email: cmacbride@dhs.co.la.ca.us 
web: http://www.rancho.org/cart/

In January 2001 Medicare, under Part B, began funding augmentative and alternative communication (AAC) devices. A large number of individuals, specifically older adults with severe communication disorders, previously denied AAC, now have access due to new Medicare regulations. Medicare decided to refer to AAC devices as "speech generating devices" (SGDs) to clarify that only devices that generate speech are covered. Medicare classifies devices into "codes" based on features or characteristics within a device. All devices within a specific code are reimbursed at the same rate. See Table 1 for a listing of device codes. AAC device manufacturers and vendors decided to "accept assignment" for most devices. Accepting assignment means that the vendor accepts the Medicare reimbursement rate as payment in full. Medicare pays 80% of the vendor's total charge for the SGD and the patient is responsible for the remaining 20%. For example, a LightWRITER SL35, manufactured by ZYGO Industries, is coded K0543, and currently is reimbursed at approximately $3653. Medicare pays $2922 (80%) towards the device and the patient pays $730 (20%). Reimbursement rates do change. The AAC manufacturers keep current on rate changes.

Medicare policy states that only speech language pathologists (SLP) certified by ASHA may recommend SGD devices for Medicare patients. The SLP conducts a comprehensive evaluation and prepares a written report including several key elements. Some of these elements include a description of the client's current communication impairment, functional communication goals expected to be achieved with an SGD and other forms of treatment that have been considered and ruled out. A detailed list of all elements required in a written report may be found on www.aac-rerc.com - the Rehabilitation Engineering and Research Center on Communication Enhancement - a main resource of information on AAC and Medicare. Sample reports for patients with different medical diagnoses are also available on the website. The evaluation report must be reviewed and signed by the patient's primary physician. The physician then writes a prescription for the recommended equipment.

The recent changes in Medicare policy have resulted in many individuals with severe expressive communication impairments receiving AAC devices that previously were unobtainable. Educating speech pathologists, physicians and consumers on guidelines for securing Medicare funding will help more individuals receive the AAC equipment they need.

The objectives of this presentation include the following:
1. understand who is eligible for AAC services and devices through Medicare,
2. become familiar with evaluation and documentation requirements,
3. become familiar with the different categories of AAC devices,
4. identify resources for obtaining information on Medicare and AAC.

Case studies of clients will be presented. Evaluation results and rationale as to why specific SGDs were recommended will be shared.

Table 1: Medicare AAC Device Codes

K0541 devices that produce digitized speech, using prerecorded messages, less than or equal to 8 minutes recording time. Reimbursement rate: $541 (e.g. MessageMate, SpeakEasy)
K0542 devices that produce digitized speech, using prerecorded messages, greater than 8 minutes recording time. Reimbursement rate: $1446.05 (e.g. Dynamo, AlphaTalker)
K0543 devices that produce synthesized speech, requiring message formulation by spelling and access by physical contact with the device. Reimbursement rate: $3241.71 (e.g. Link, LightWRITER)
K0544 devices that produce synthesized speech, permitting multiple methods of message formulation and multiple methods of device access. Reimbursement rate: 6475.12 (e.g. Dynavox, Pathfinder)
K0545 SGD Software Program that produces synthesized speech, permitting multiple methods of message formulation and multiple methods of device access. Reimbursement rates vary (e.g. EZ Keys).

References

Doyle M and Blackstone S.: (2001). Medicare and AAC. Presentation to California Speech and Hearing Association, Los Angeles, CA.

Golinker L. (2001). Medicare Now Covers AAC Devices. Special Interest Division: Augmentative and Alternative Communication - American Speech and Hearing Association. Volume 10 Number 1.

Lasker J. et. al (2001). AAC Equipment Decisions for Medicare Enrollees: Selecting and Funding Devices. Short course to American Speech and Hearing Association (ASHA), New Orleans, LA.


Go to previous article 
Go to next article 
Return to 2002 Table of Contents 
Return to Table of Proceedings


Reprinted with author(s) permission. Author(s) retain copyright.