USSAAC Advocacy Update

The USSAAC Advocacy Commitee, headedy by director Lewis Golinker, has been busy behind the scenes to ensure access to AAC systems.  Today's post highlights three recent actions that affect funding of speech generating  devices.


USSAAC Seeks Medicaid Policy Change Through Court Action

In 2016 USSAAC learned that New York Medicaid had denied several SGD funding requests based on a requirement that Medicaid recipients demonstrate they were "functional and proficient" in use of their devices as a condition of approval.  That phrase has no definition, so it was not clear what skills had to be shown to satisfy it.  Upon further review, this requirement could not be shown to be reasonably achievable, it was not consistent with why SLPs conduct SGD trials, and it was not consistent with the NY Medicaid definition of medical necessity. It also violates the federal Medicaid Act?s medical need standard applicable to all recipients younger than age 21.  Appeals were pursued for several children; all but one was successful in overturning the SGD denial.  The remaining denial was appealed to federal court.  

In November, 2017, the federal judge ordered Medicaid to provide the device sought by the one client whose appeal had been unsuccessful.  According to Medicaid, there may still be between 60 and 70 other recipients whose devices were denied based on this standard.  

In early February, the federal judge issued a second decision that will allow the challenge to Medicaid's policy to continue on the basis that it violates the Medicaid Act and the Americans with Disabilities Act.  

Anyone with knowledge of a Medicaid recipient who may have been adversely affected by this eligibility standard should contact USSAAC Advocacy Director Lewis Golinker  [607-277-7286 or].  For example, anyone whose SGD request was denied because NY Medicaid concluded the client did not demonstrate "proficiency," "competency," "advanced language skills," "independence" of device use, the ability to navigate pages independently, or to create novel messages, or did not use the device during a trial in all customary communication settings, should contact Lew Golinker.


USSAAC Persuades Insurer to Change Its SGD Coverage Policy 

In 2017, USSAAC participated along-side a child in a federal court appeal that challenged the SGD coverage policy used by the insurer Medical Mutual of Ohio.  The lawsuit challenged use of guidelines called "Inter Qual" that were written by a consulting firm called McKesson.  These guidelines stated that to qualify for a touch-screen SGD in the E 2510 code, clients had to have large vocabularies and also clients must require both multiple methods of access and multiple methods of message formation.  

The child in this case required an eye-gaze accessory.  Only E 2510 devices will support eye gaze control.  Thus, regardless of her vocabulary size, an E 2510 device is the only SGD she can operate. 

Also, the second requirement of the Inter Qual guideline had no factual basis: it mis-applied characteristics of the devices that fit within the E 2510 category with the characteristics of clients who need these devices; and it was not consistent with professional standards of practice.  Devices that fit the E 2510 code must permit multiple methods of message formulation and multiple methods of device access.  But there is no requirement that clients need for both of these capabilities.  This client in particular, who requires eye gaze, will only be able to access the device through this method.   

Although this child's device was denied in the administrative review process, Medical Mutual responded to the lawsuit by approving the child?s device and agreeing to not apply these provisions of the Inter Qual guidelines in the future.  This allowed the case to settle.

Congress approves the Steve Gleason Act February 9th. 

Thanks to all who joined in the effort to write their senators and representatives on such short notice.   

This legislation makes permanent the changes to the Medicare Act that were part of the 2015 Gleason Act.  That law had 2 provisions:  (1) it directed Medicare not to classify SGDs under a payment rule known as ?capped rental;? and (2) it added speech generating device eye gaze accessories as examples of covered DME in the Medicare Act?s DME definition.  The change related to ?capped rental? will protect all Medicaid recipients by ensuring that recipients will own their SGDs at the time they are first delivered.  As client property, the devices can then come and go with the recipients, including to hospitals, and to necessary residence in nursing facilities or during receipt of hospice care.  Under capped rental, which would have lasted for 13 months after device delivery, Medicare would not have paid for ongoing rental of the device if the client had an extended hospital stay, or began nursing facility or hospice care.  This would have created a risk of device loss at a time when the client would have a heightened need for the SGD.   The permanent extension of the Gleason Act ends this risk.  



Jill E Senner, PhD, CCC-SLP



Thank you for reading this blog post. The views expressed in this post are that of the author, and do not necessarily reflect the views and policies of USSAAC members and board members. No endorsement by USSAAC is implied regarding any device, manufacturer, resource or strategy mentioned. We would love to hear from you. Please connect with us through or or send an email to


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