If your clients are covered by Medicare
If you provide services to clients covered by Medicare, we want to be sure you are aware of upcoming changes to how speech generating devices (SGD) will be administered by Medicare.
Effective April 1 of this year, Medicare will reimburse a SGD under a ‘capped rental’ category. This includes all six of the E-codes related to speech devices. Capped rental is one of a number of reimbursement categories within Medicare and is typically used for products such as hospital beds.
In the capped rental category, a SGD is rented from the supplier (PRC, Saltillo, etc.) for a period of up to 13 months. After 13 consecutive months of the rental, ownership of the SGD will be transferred to the client. Prior to this change, speech devices were considered ‘routinely purchased’, the device immediately became the property of the client and the supplier was paid after the device was delivered. The capped rental category also allows for the re-use of speech devices that are rented, so it is very possible that future clients will not receive a new device under Medicare.
We are concerned that this change may cause problems for those clients who are admitted to a hospital, long term care facility, skilled nursing facility (SNF) or a hospice during the 13 month rental period, referred to as an “interruption in service”. Clients and their families are required to notify PRC and Saltillo about changes in their medical or residential status affecting eligibility thus resulting in an interruption of service. During an interruption in service, if a speech device is not arranged and paid for by the SNF, hospital or hospice, the client could be without any means of communication during these changes in settings because the equipment will need to be returned to the supplier. As you know, speech devices for these clients are often highly customized in terms of optimum access, vocabulary programs, client-specific content, etc. so even if ‘generic’ speech devices are available, they will not meet the needs of many clients.
If the interruption in service is long enough, the client may need a new evaluation in order to re-acquire a speech device.
We all appreciate your clinical services to these clients and want you to know that both PRC and Saltillo are committed to providing the best possible solutions within the Medicare regulations, now and following April 1. We believe the need to communicate is a constant, regardless of setting or location. Your skilled evaluations and therapy services are essential to enabling these clients to communicate to the full extent of their abilities.
We are working actively with other suppliers, patient advocacy groups, professional and trade associations and others to educate the decision-makers at the Center for Medicare and Medicaid Services about complications and the potential harm when this ruling goes into effect. We believe Medicare is unaware of the diverse population of clients, the complexity of the needs within this population and the extent to which these devices are customized to meet those needs. We will keep you informed on our progress in this education effort. We will also be ready to comply with these new regulations on April 1.
You can review the final regulation at: