2002 Conference Proceedings

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MEDICARE FUNDING FOR AAC DEVICES: UPDATE/REFRESHER

Lewis Golinker, Esq., Director
Assistive Technology Law Center
202 East State Street, Suite 507
Ithaca, New York 14850
v: 607-277-7286
fax: 607-277-5239
e-mail: lgolinker@aol.com 

Medicare, the nation's largest health benefits program, began to cover AAC devices in January 2001. Medicare has 40 million beneficiaries, of which it is estimated approximately 50,000 currently are in need of AAC devices. However, for more than a decade, Medicare refused to address these beneficiaries' needs, asserting that AAC devices were "convenience items."

As of January 1, 2001, Medicare's perception of AAC devices changed. In late 2000, Medicare adopted 2 sets of guidance for AAC devices. One address the scope of devices that are covered. The other identifies the data required to establish that AAC devices are "reasonable and necessary," the Medicare "medical need" standard. Medicare also created four "codes" for AAC devices, and three more for AAC software, mounts and accessories. Finally, Medicare adopted "fee schedules" for the four AAC device codes, which govern Medicare reimbursement levels.

A session at CSUN 2001 introduced speech-language pathologists and others interested in AAC device funding to the new Medicare coverage standards. This session also explained how the new standards were developed. However, because the guidance had only been in effect for little more than 3 months, little was known about the actual interpretation of the guidance when claims for AAC devices were submitted. Many questions were posed, the solutions for which would have to await further developments.

Now, almost a full year has passed since the Medicare AAC device coverage guidance went into effect. Many of the initial uncertainties have been addressed, and far more is known about the Medicare program's potential to be a significant funding source for adults with severe communication disabilities. Among the issues that have been addressed in the past year have been claims filing procedures; coverage for computer based devices; coverage for individuals with dual Medicaid and Medicare eligibility; accepting Medicare assignment; and the populations most likely to benefit from Medicare coverage. There also have been increases in the fee schedules for AAC devices, and the implications of those changes are now known. Finally, significant written resources have been developed and are available to assist SLPs as they pursue Medicare funding. All of these topics will be addressed.

This session will offer an introduction to those who will be considering Medicare as an AAC device funding source for the first time. The session will identify who Medicare currently covers, and for which populations Medicare is, and is not likely to be a meaningful funding source in the future. It will review the Medicare principles of coding, reimbursement, and fee schedules, and explain the claims process.

This session also will be an update or refresher course for those who seek the latest information and developments regarding the operation of the Medicare program.

Lastly, this session is intended to offer both SLPs and others interested in AAC device funding an opportunity to raise individual questions about the scope of Medicare funding based on their own experiences.

This session is designed as a lecture but is more aptly described as a question and answer format. The presenter was involved in the advocacy effort to persuade Medicare to cover AAC devices and has worked throughout 2001 to resolve many of the initial coverage barriers, questions and problems. Because many of the other individuals who worked on Medicare coverage reform are likely to attend CSUN as well, such as David Beukelman, Sarah Blackstone, Molly Doyle, and Pat Ourand, to name a few, it is possible some will attend the session and participate in the discussions.

This session is intended to run in tandem with one proposed by Molly Doyle, from Rancho Los Amigos Rehabilitation Hospital, which addresses AAC device assessment. If possible, these sessions should run back to back.


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