FACT SHEET

Overview: The Health Care Financing Administration has taken a first step toward Medicare coverage of augmentative and alternative communication devices for beneficiaries unable to communicate by speaking. Prior national policy had precluded these devices from the Medicare benefit. A decision, posted today on the HCFA web site, http://www.hcfa.gov/quality/qlty-1.htm, now enables the private insurance companies, known as carriers, that process Medicare claims to decide locally whether to cover the devices, either on a case-by-case basis or through local policy. The decision to allow coverage reflects HCFA's commitment to help Medicare beneficiaries gain access to the latest effective technology. HCFA also is seeking additional information that could lead to a decision for national coverage.

Better Quality of Life. Augmentative and Alternative Communication devices can greatly improve the quality of life of people who either cannot speak or whose speech is unintelligible to most listeners. For such people, the ability to convey information to others is severely limited. Interaction with family members, friends, caregivers and members of the community is restricted. But technology can help people cope with or overcome these difficulties. Augmentative communication involves aids or techniques that supplement severely limited vocal or verbal communication skills. Examples of augmentative and alternative communication are speech synthesizers and other mechanical and electronic devices. Thus, this technology gives severely speech-impaired people ways to communicate their thoughts with others.

Implementation. Within 60 days of today's decision memorandum, HCFA will publish criteria on coverage of these devices including a planned implementation date.

Coverage Decisions. HCFA's decision allows local carriers to make coverage decisions for claims for the communication devices on either a case-by-case basis or through a local policy, although they are not required to cover them. Most Medicare coverage and policy decisions are made locally by HCFA contractors, the private companies that by law process and pay Medicare claims. HCFA also makes coverage policies that apply nationwide and are binding on all HCFA contractors and administrative law judges. In the absence of national decisions for particular services, contractors have the discretion to issue local coverage policies. The former national policy held that the devices were "personal convenience" items that by law could not be covered as a Medicare benefit. Today's decision says such devices are durable medical equipment and are a Medicare benefit.

The requesters included a coalition of advocates and health care professionals. HCFA expects to be able to make a national coverage policy after reviewing the additional information it is requesting to define the population for whom such devices would be "reasonable and necessary" to cover. Until a new national coverage policy is developed, local discretion prevails.

Medicare is committed to having an open, understandable and predictable coverage process for benefits provided by the program. HCFA relies on medical and scientific evidence to make coverage decisions, including medical literature and data, discussions with medical experts and technology assessments. The agency is committed to striking the appropriate balance between providing timely access to medical advances and ensuring that new technologies and treatments are effective and "reasonable and necessary." By law a service must be "reasonable and necessary" to be covered by Medicare.

A listing of all current and pending national Medicare coverage decisions is available on HCFA's website at http://www.hcfa.gov/quality/qlty-1.htm.

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Last Updated April 26, 2000