ATU219 – Steve Gleason Act and other AAC legislation with Lisa Satterfield of ASHA, First Look at Windows 10, RESNA AT Journal goes digital

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Your weekly dose of information that keeps you up to date on the latest developments in the field of technology designed to assist people with disabilities and special needs.

Show Notes:

Steve Gleason Act and other AAC legislation – Lisa Satterfield – ASHA – director of health care regulatory advocacy | www.asha.org

AT Journal – RESNA member benefit change | Rehabilitation Engineering & Assistive Technology Society of North America http://buff.ly/1IXmY4d

Microsoft Windows 10 Accessibility for People with Disabilities (Dan Hubbell and Brett Humphrey)| http://buff.ly/1D66x2T

App: Map My Fitness www.BridgingApps.org

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LISA SATTERFIELD: Hi, this is Lisa Satterfield. I’m the Director of Healthcare Regulatory Advocacy for the American Speech, Language, Hearing Association, and this is your Assistance Technology Update.

WADE WINGLER: Hi, this is Wade Wingler with the INDATA Project at Easter Seals Crossroads in Indiana with your Assistive Technology Update, a weekly dose of information that keeps you up-to-date on the latest developments in the field of technology designed to assist people with disabilities and special needs.

Welcome to episode number 219 of Assistive Technology Update. It’s scheduled to be released on August 7 of 2015.

I’m excited today to have Lisa Satterfield who is a Director of Healthcare Regulatory Advocacy over at ASHA to talk about the Steve Gleason Act and other augmentative and alternative communication related legislation.

Also interesting changes happening with RESNA and their now-digital journal; and I do a first look at Microsoft Windows 10, talk a little bit about accessibility and just some of the impressions I have of Windows 10 running on my Mac here in the studio.

We hope you’ll check out our website at www.eastersealstech.com, shoot us a note over on Twitter @INDATAproject, or call our listener line, give us some feedback. That number is 317-721-7124.

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Like this show? Also check out ATFAQ, our question and answer show. It’s over at ATFAQshow.com.

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It seems the way of the world these days. Print publications are becoming less frequent. I realized recently that RESNA, the Rehab Engineering Assistive Technology Society of North America, has changed how they’re going to be producing Assistive Technology Journal. These are the blue magazines that have been showing up in my mailbox for 20-plus years. Keeping up with the times, there are moving to an online version of that. You can still get the print version so never fear, but there’s going to be cost for that. If you want to continue to receive the paper version, it’s going to cost you $30 for an annual subscription. They also have option to buy individual print issues or articles out of the magazine. If you’re happy with the online version of RESNA members don’t need to do anything. It’s going to start coming to you electronically. But if you want the print version, you need to contact RESNA to tell them about that change. We are moving along with the times here and look forward to seeing the electronic version of the Assistive Technology Journal from RESNA. I’ll pop a link in the show notes. Check it out.

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Just last week, Microsoft announced their new version of Windows, Windows 10. Well They didn’t announce it. I guess they released it. It’s out. It’s in the wild and folks are using it. I have been looking around the web and there’s been some scuttlebutt around the office about what assistive technology is compatible, what assistive technology isn’t compatible, and it seems like there’s still some questions out there. I verified from Freedom Scientific that JAWS is working. I checked AI Squared’s website and don’t see anything conclusive there about compatibility. I know the folks over at Dolphin have been talking about the compatibility of their system with Windows 10 for a while. I looked at Dragon NaturallySpeaking, couldn’t find anything conclusive there. I’m thinking that it’s going to take another week or so for this to shake out and compatibility, the knowledge of compatibility, to kind of be there.

However, as I sit in my studio here with my MacBook, I have Windows 10 installed in a virtual machine on Parallels. I’ve been taking a look at it. It’s pretty interesting. I will say that the visual aspect of Windows 10 I’ve been impressed with. It’s got a pretty cool desktop with a smoky reflective window kind of image. I’m very happy to see the Start button back.

When I click on the Start button, I get the tiles that were introduced in Windows 8 that have been controversial and designed for that tablet/smartphone interface. As I look there, on my default install, I see a tile for calendar and mail. I see the Internet Explorer icon has been updated and no longer called Internet Explorer. It’s called Microsoft Edge. I know that there’s some different personality there. I see a link for Cortana which I haven’t messed with yet. I hope to do that maybe even later today. And I also see some things for music and Xbox and a Solitaire collection and a place to get Office 365.

And then on the left right above the start button, I see some most used applications and then some stuff that really reminds me of Windows from years gone past. There’s a File Explorer, settings, and then a power button and a list of all apps. When I click on the list of all apps, I get these sort of flat stylized icons with stuff that you would kind of expect. The first thing I see is a 3-D builder and alarms, calculator, calendar. And then as I get down to bottom under the W, I see a whole bunch of Windows utility kind of stuff like Windows accessories and administrative access.

Ease of access is there by the way, and as I look under the ease of access list in the all apps list in the start button, I’m seeing the familiar things like magnifier, narrator, on screen keyboard and window speech recognition.

We had an episode not all that long ago where Dan Hubble came on our show and talked about the main differences with Windows 10. I’ll stick a link in the show notes that you can go back and listen to the episode again where Dan gives Microsoft’s perspective on it.

As we continue to get more experience with Windows 10 here and what that means for assistive technology and access by folks with disabilities, we’ll continue to do some updates here. But I’ve got it. I’ve got it installed. Ironically it’s on my Mac where I can have it on a virtual machine and keep an eye on it there. It’s out and about. It’s also, Microsoft says, the last version of Windows. It’s going to be free. You won’t have to pay for this version. It’s going to continue to be upgraded sort of in the background as you move along. Interesting stuff happening with Windows 10 and we hope to bring you more information in the future. I’ll pop a link in the show notes over to the interview with Dan Hubble and you can check out what Microsoft had to say.

Each week, one of our partners tells us happening in the ever-changing world of apps, so here’s an App Worth Mentioning.

AMY BARRY: This is Amy Barry with BridgingApps, and this is an App Worth Mentioning. This segment’s app is called Map My Fitness. Map My Fitness is a well-developed and established with functions with a GPS to track and document physical activities of its users; however, with many other excellent features,

Map My Fitness can be an interesting and unique tool to encourage physical activity and to decrease sedentary time for both children and adults with disabilities. The GPS map recording of an outdoor workout such as cycling, running, or walking, includes the app calculating distance traveled, pace, and duration. Map My Fitness also includes a log feature. If an activity is indoors or the GPS is not in use, a workout can be logged rather than recorded. This feature enables that mentation of activities like indoor walks, stationary bike rides, yoga, and gym workouts that are all part of their loved one’s home exercise program. Any workouts, either recorded or logged, can then be shared with others.

The family that trialed Map My Fitness view this feature as a virtual cheerleading section, providing an excellent way to connect with a close circle of friends and family, even those that live far away, with the ability to even create private group challenges. It is a fun way for everyone to encourage each other to get moving. Life tracking of GPS recorded activity is a premium account, called MVP, where others can follow an activity in real time while it is occurring. This has interesting potentials for families who may want to encourage indoor, independent activity while still keeping a watchful eye on where the family member is located. The live tracking feature is only viewable by those in one selected group of Map My Fitness friends and does disappear when the activity is completed.

Map My Fitness also has the capability to connect to other apps, devices, and wearables including the iPhone motion sensor. This allows for excellent flexibility for users to customize how they collect and log their physical activity data. The 24/7 centralizes all of the information and combines any workouts with regular movement to determine steps taken per day. BridgingApps finds Map My Fitness a very useful tool to encourage and engage people, especially those with disabilities, in physical activity. We love the capability for a virtual cheerleading section that connects people, creating a support system to help everyone maintain and improve their health. Map My Fitness is available at the iTunes Store and Google Play store for free, and is compatible with iOS and Android devices.

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WADE WINGLER: Just a few weeks ago, I had the pleasure of being in Washington DC for a meeting of a lot of folks who were interested in assistive technology and augmentative medication and those kinds of things. I had the pleasure of being introduced to Lisa Satterfield who is the Director of Healthcare Revelatory Advocacy over at ASHA which is the American Speech Language and Hearing Association. She agreed to come on the show today and talk with us a little bit about something that’s come across my radar a lot lately: the Steve Gleason Act and some other subsequent things that are happening at the federal level that I think you guys are going to be interested in. Before we jump into the topic, first of all, Lisa, how are you today?

LISA SATTERFIELD: I’m good. Thanks for having me.

WADE WINGLER: Thank you much for coming on the show, especially when I know that things are so busy in Washington DC and you’ve got a lot going on there with ASHA. I thought it would be helpful, for folks in the audience who don’t know about ASHA, maybe spend a couple of seconds talk about what is ASHA, what does the organization do , and maybe a little bit of the background. And then I want to know about you and how you ended up there.

LISA SATTERFIELD: Great. So the American Speech Language Hearing Association, ASHA, is the association that credentials speech language pathologists and audiologists. It’s the professional association for the communication disorder fields. So we’re in Maryland and we advocate at the federal level for policies related to audiology and speech language pathology services. Of course like any other professional organizations, we put on conferences and support our numbers who were out in the field practicing and serving the patients with medication disorders.

I’ve actually been a member of ASHA before I was staffed with ASHA. I’ve been a member since 1995. I am an audiologist by training that became involved in California Medi-Cal program as a policy analyst and so have since transferred into the advocacy arena. I advocate specifically for healthcare related services related to Medicare for audiology and speech language pathology services.

WADE WINGLER: Excellent. When I was in a session in DC not too long ago, it was great for me to be able to hear some of the state of affairs in DC. But specifically, I want to start with the Steve Gleason act. Maybe you can tell a little bit about Steve Gleason, what does the act do and what’s the status of the act at this point.

LISA SATTERFIELD: Sure. Many people know Steve Gleason as a football player from the New Orleans Saints who blocked a kick that ended up in the New Orleans Saints winning the football game soon after the hurricane. That’s what he first became famous for. Later on, he was diagnosed with ALS. He has been extremely active in the ALS community advocating for rights and services for patients that are diagnosed with ALS. When Medicare made some decisions and a couple of years ago that significantly restricted access to speech generating devices, to Gleason, the ALS Association, and several others, ASHA, got involved in trying to figure out how we can get the speech generating devices, or SGD’s, into the hands of ALS and other patients who lose the ability to communicate through their voice. He was instrumental in the legislation that now has his name, the Steve Gleason Act of 2015, that lifted some of the restrictions for speech generating devices.

WADE WINGLER: So can we talk about some of the specifics of what the act did in terms of the lifting restrictions and some of the changes that it targeted?

LISA SATTERFIELD: Sure. If I can, I’ll go back a little bit to 2013 when Medicare made a couple of pretty significant changes to their own policy. There were three issues that occurred. One was that they decided to reclassify several durable medical equipment devices including speech generating devices into the capped rental category. What this means is that the devices have to be rented for a period of 13 months prior to the transfer of ownership to the Medicare patient. So that was one issue.

The other issue is that Medicare also restricted what the speech generating device could have on it in terms of technology. They decided that their policies said that speech generating device cannot have things like Internet and environmental controls and any of the technology items that have just naturally occurred over time. So that was another issue.

And then the third is that eye tracking devices were being denied because they were seen as nonmedical devices that could be used for other purposes. So that trifecta of issues really clamped down on the SGD’s and the ability to get them into the hands of patients. So what the Steve Gleason Act has done is it’s reclassified the speech generating device as a non-capped rental device, so it’s an item that is purchased and immediately transferred ownership to the patient. So that is a huge thing. And the other thing is that it recognizes eye tracking as a medical accessory for the speech generating device.

WADE WINGLER: And did it addressed the third issue talked about, about the kind of functionality the speech generating device could have in addition to generating speech?

LISA SATTERFIELD: Right. So, no, the act and adjust the third functionality , because in our research and in our discussions with the CMS officials, we discovered that we could simply update the regulation in order to address that problem. So actually that occurred and was just released Wednesday of this week where CMS has updated their national coverage determination which defines what they feel a speech generating device is. Now it does allow for Internet capabilities. They also expanded it to recognize communication by email, text, and telephone as necessary communication for the speech generating device to support.

WADE WINGLER: So we are recording this a little in advance of release, about a week or so, so this is just brand-new information as we’re recording, right?

LISA SATTERFIELD: National coverage determination was released this Wednesday, so the 29th [of July].

WADE WINGLER: And so we kind of talked in the preinterview just a little bit that the Steve Gleason Act made some of the changes at the legislative level, and then these new national coverage determinations is more of a regulation in terms of how these are applied. But the effect is those three problems are in the process of being alleviated? Do I have that right?

LISA SATTERFIELD: Yes. So the Internet and the regulations that were released by CMS actually go into effect immediately, but the Steve Gleason Act does not going to affect until October 1 of 2015.

WADE WINGLER: So just a little bit longer?

LISA SATTERFIELD: Right.

WADE WINGLER: Great. So I am not somebody who spends a lot of time actively involved in the legislative process. What is the current status of the act and the regulation? I think maybe you just answered the question about the regulation. So is it law? Has it been signed into law at this point?

LISA SATTERFIELD: That’s actually a really time the question because we just got word last night at 10 o’clock that the president of the United States did sign the Steve Gleason Act into law. It was signed into law officially yesterday, which means that the capped rental peace and that eye tracking will be recognized as of October 1, 2015.

WADE WINGLER: Great. And just because of the delay of the recording, that was on July 30 that the law assigned?

LISA SATTERFIELD: Yes.

WADE WINGLER: Great. So we’ve talked about kind of what the law and the changes in regulations will do. What’s the immediate and long-term impact going to be in the real world when we talk about people with disabilities using augmentative alternative communication? What’s the impact going to be? What’s it going to be like when the rubber hits the road?

LISA SATTERFIELD: Sure. When CMS made these decisions, it caused quite a bit of controversy and stir in the community for several reasons. One thing is that DME, or speech generating devices, are not able to move in and out of facility settings through the Medicare payment programs. So for example, when the patient was given ownership of the device immediately, while they were at home or in the clinic as an outpatient, they’re able to take their device to the hospital or skilled nursing facility with them. But when CMS made the decision to make it into a capped rental item, the payment for the rental would stop when the patient is an inpatient. So by relieving the capped rental requirements for speech generating devices, we now go back to the way it was before where patients immediately take ownership of their device and are able to take it in and out of the facilities as needed and is often needed for this community.

WADE WINGLER: So before that was changed, somebody’s device would be taken away from them? Or did the payment just get messed up?

LISA SATTERFIELD: Well, that’s the thing. To my knowledge, the devices were not actively taken away, but it did leave the manufacturers and the suppliers of the devices without payment for them for the time that the patient was in the inpatient setting.

WADE WINGLER: I see.

LISA SATTERFIELD: It would, in the long-term, effect payments. If this had gone on for much longer, I’m sure that policies would have had to of been arranged with the manufacturers and suppliers to figure out how to manage when a patient goes into the inpatient setting.

WADE WINGLER: That makes sense. From where I sit, again not being heavily involved, that was what I was hearing was from the manufacturers on how it was creating a business problem for them.

LISA SATTERFIELD: Definitely is a problem. While under the rental period, the supplier and the manufacturer is one hundred percent responsible for the device. The other part of this is that there was hesitation of the ability to customize the device for the patient. So for example, communication is a very personal, custom form of need, a form of function, so people would put personal pictures on their devices in order to communicate, because the speech generating device —

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WADE WINGLER: And we had a slight interruption from our Internet connection here. Standby.

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LISA SATTERFIELD: — Personal places, things like this, that would then generate the speech when they indicated that’s what they wanted to say. There was hesitation to allow that for rental devices because the rental device would eventually be turned back in and would need to be wiped out of all personal information like that. So just a lot of issues regarding the rental of the device that are now alleviated.

WADE WINGLER: So we have the Steve Gleason Act and then this national coverage determination that’s fixing some of these problems. Are there any drawbacks with the way the legislation and the relations have been implemented?

LISA SATTERFIELD: There are. So in the process of developing the legislation, we worked really closely with several stakeholders and with Representative Kathy McMorris Rodgers from Washington and with Sandra Vitter from Louisiana. In the process of the legislation moving through and trying to get it moved through quickly to alleviate the problems as soon as we could, a date was inserted in the text of the language for the bill that end dates the capped rental exemption. So the capped rental program as of today is only good from October 1, 2015 to September 30, 2018. As of October 1, 2018, capped rental would then start to apply again to the speech generating devices. So we still have some work to do to get a long-term fix in there.

WADE WINGLER: I see where that would be a problem. So what other kind of legislation is current and relevant right now to augmentative communication and assistive technology from your perspective? What else is happening?

LISA SATTERFIELD: That’s an interesting question. Right now we don’t have any specific legislation out there related to augmentative communication devices. I do follow the Complex Rehabilitation Technology bill that is sponsored by United Spinal and several others. What that’s doing is it’s creating a new benefit category in the Medicare program that allows for technology and complex devices to be exempt from some of these rules like capped rental and the competitive bidding and things like this. So right now, I’m not sure where that legislation is, but it is something that we are following very closely. I personally think that speech generating devices may have a place in that law, and I think it’s a good law. Again, it’s not expending a benefit that’s not already there. The complex devices are being covered by Medicare. They are just subject to so many rules that were not conducive to the type of technology they offer. We’ll be watching that one.

WADE WINGLER: For sure. Are there other big topics that are kind of on the horizon that maybe aren’t teed up for legislation action but you think need to be addressed? What’s on the radar?

LISA SATTERFIELD: Definitely we’re going to need to figure out how to fix this deadline of twenty ten. So that’s one thing. I think in general the Medicare program needs to be encouraged for recognizing technologies. So for example, in the regulations that did come out that we are actually pretty pleased with from CMS, there’s one phrase in there that I think is going to come under scrutiny in the future. What it is, is they will not recognize the video conferencing as a method of communication. I believe that’s a little bit shortsighted in the fact that, as you know, videoconferencing, all of it, is just occurring so much in everyday life. The idea that that would be limited so early on is a little bit concerning. Also it does kind of put a limit to the technology that occurs in the future, and it has the potential to limit the ability to perform telemedicine. So telemedicine is another area that we are really focused on here at ASHA. Right now telemedicine is performed by only certain specialties and recognized by certain specialties in the Medicare program, but it’s not recognized for speech language pathologists and audiologists, when actually it is something that SLP’s and audiologists could do quite easily with the technology available. So I would say that we need to talk more about telemedicine in terms of the complex rehab technology and other methods of really reaching people who need our services the most.

WADE WINGLER: Excellent. Lisa, we’re just about out of time for the interview today. If people wanted to learn more for they wanted to connect to ASHA, what would you recommend for a good place to get started?

LISA SATTERFIELD: You can contact me through the reimbursement@ASHA.org. We also have a Take Action site that’s open to the public. It is geared towards the issues for audiology and speech language pathologists but our Take Action site helps members connect with their congressmen on the issues that ASHA feels important. I would be happy to help anybody get to those sites and talk to anybody who has any questions.

WADE WINGLER: Lisa Satterfield is the Director of Healthcare Regulatory Advocacy and has helped us today sort out a little bit about what’s happening with the Steve Gleason Act and some related litigation. Lisa, thank you so much for being on our show.

LISA SATTERFIELD: Thank you. I appreciate it.

WADE WINGLER: Do you have a question about assistive technology? Do you have a suggestion for someone we should interview on Assistive Technology Update? Call our listener line at 317-721-7124. Looking for show notes from today’s show? Head on over to EasterSealstech.com. Shoot us a note on Twitter @INDATAProject, or check us out on Facebook. That was your Assistance Technology Update. I’m Wade Wingler with the INDATA Project at Easter Seals Crossroads in Indiana.