WATA Bulletin -- Spring 1999

Contents:

Funding for Assistive Technology: Case Studies from the Advocacy Team

Frances E. Pennell, J.D.
Policy & Funding Specialist

This is the first in a series of funding cases from the files of the Assistive Technology Resource Center. The names of all participants have been changed to protect their privacy. By sharing these experiences, we hope to provide readers with a better understanding of AT funding issues. Jeff’s story typifies the difficulties that many families face in dealing with health insurers and demonstrates that, in AT advocacy, persistence pays off. For more information about the ATRC’s advocacy work, please visit our website at http://wata.org and follow the link to Funding.

Jeffrey is a bright six year old with unintelligible speech attributable to a pre-natal stroke. The summer before first grade, Jeff was evaluated for an augmentative communication (AAC) device. In early August, Jeff’s parents requested pre-authorization for the device from their health insurance plan, a group policy provided through Dad’s employment, which included coverage for durable medical equipment, prosthetics and speech therapy.

The request for pre-authorization was twice denied on the grounds that the AAC device was not "medically necessary in the direct treatment of Jeff’s illness." Jeff’s parents contacted the ATRC. They appealed again – this time with our help. The appeal packet included additional letters of medical necessity from Jeffrey’s doctor and from his speech therapist. The therapist’s letter (a) documented the role of AAC in speech therapy; (b) described why and how the AAC device was selected; (c) detailed specific incidents in which Jeff’s health was put at risk because of his inability to communicate; and (d) noted the risk of developmental delay for children who are at a critical point in language development but cannot speak. The packet also included a brochure describing the AAC device; a statement from the vendor confirming that other insurers and Washington Medicaid routinely pay for AAC devices; and copies of relevant cases.

The third letter of denial arrived two months later. It stated that the device was "not an eligible durable medical equipment for the diagnosis submitted on the medical records." Baffled, we sought clarification and received a fourth letter explaining that while AAC devices were considered to be "medically necessary" for certain conditions (e.g., an artificial larynx for treatment of throat cancer) they were not covered for "kids with speech problems."

The company’s grievance procedure provided for two additional levels of appeal and mandatory mediation (with cost borne in part by the consumer). We dutifully appealed and filed a complaint with the Office of the Insurance Commissioner (OIC) using a form off their website (http://www.wa.gov/ins/). The OIC wrote immediately, asking the Insurer for an explanation. When it did not reply within 15 days, the OIC sent another letter pointing out the penalties for failing to do so.

The company called a few days later offering to pay for the device. We were elated but the company soon threatened to withdraw its offer when it found out that Jeff’s mom had already scraped together the money to buy the device. The company representative claimed that it need not reimburse the family because they did not obtain pre-approval. We told them that, if necessary, we would sue to enforce the terms of the insurance contract. We also pointed out that no judge was likely to agree that this family had waived coverage by buying the AAC device after having been denied pre-approval not once but three times. Ultimately, the company agreed and, after eight months of effort, Jeff’s family received a check for 80% of the cost of the device as provided for in their policy.

"[A]n augmentative communication device, . . . . is the single most appropriate and useful device to meet Jeff’s needs. Without this, Jeff will not be able to indicate his ongoing needs, his urgencies, his physical symptoms, his fears or any other aspect of interface with another individual. The most simple responses such as yes and no can be communicated but if Jeff had right lower quadrant pain due to appendicitis, . . . he would be able to communicate it specifically enough to allow expedient care. The medical risk to him from something as simple as appendicitis, a fracture or an increasing headache is predictable and needs to be addressed.

Legislative & Policy Update

Frances E. Pennell, J.D.
Policy & Funding Specialist

State Legislative WrapUp: The legislature has just recessed and the Governor has 20 days to review Bills on his desk. Although there are still some unknowns, here is a summary of some of the happenings—good & bad—this session.

CHIP Program: In the wee hours of the session, the Legislature finally approved the Governor’s proposal for a new State Children’s Health Insurance Program (CHIP). SSB5416 directs the Medical Assistance Administration to establish a Medicaid "lookalike" for an estimated 10,000 children in families between 200 and 250 percent of Federal Poverty Level – meaning that CHIP will cover durable medical equipment, prosthetics and orthotics and related services. Families will pay a small premium. Enrollment is expected to begin in January 2000.

Vehicle Modifications: HB1261 passed! It authorizes the Department of Labor & Industries to pay for modifications to vehicles owned by workers who have become amputees or paralyzed due to an industrial injury. The benefit is available to any "otherwise eligible worker" regardless of the date of injury.

Surplus Computers for Schools: SSB5175 authorizes state agencies to donate surplus computers and equipment to schools and educational service districts under guidelines established by OSPI and the General Services Administration. Priority must be given to meeting the computer-related needs of children with disabilities, including those necessitating the portability of laptop computers.

Information Technology Portfolios: SB 5194 requires state agencies to develop IT portfolios and directs the Department of Information Services to develop technology standards governing such portfolios. The law requires agencies to identify implementation strategies which incorporate "consideration of a variety of electronic technologies, including those that help transcend geographic locations, standard business hours, economic conditions of users, and disabilities. . . "

The Bad News: Although three separate bills were introduced, the Legislature did not even hold a hearing on proposals to eliminate sales and use taxes on medical equipment and motor vehicle modifications or a bill to add rehabilitation therapies to the Basic Health Plan. These measures died in committee. The legislature heard, but did not pass, in spite of strong support from the Insurance Commissioner, several bills that would have provided greater consumer protections in dealing with health insurers. The Secretary of State’s proposed Task Force to study Internet voting (including its role in improving access to independent polling by individuals with disabilities) also died.

The Other Washington: The U.S. Department of Education’s final IDEA regulations were issued in March and can be found at http://www.ed.gov/offices/OSERS/. The Health Care Financing Authority is developing new procedures for National Coverage Decisions. NCD’s are often critical in determining coverage of AT under Medicare. The new procedures will outline how the public can request NCD’s and how such decisions will be made. More information is available from HCFA at: http://www.hcfa.gov/quality/8b.htm.

For more detailed updates on both state and federal policy issues, please check WATA’s website at http://wata.org and follow the link called Policy.

Did You Know?

Update from the CSUN Technology for Persons with Disabilities Conference in Los Angeles, March 16 – March 20.

WATA was well represented at the recent CSUN conference in LA. Kurt Johnson and Dagmar Amtmann gave a presentation on the use of the Internet in the career counseling and job placement process. Debbie Cook and Dagmar Amtmann gave a presentation on our projects with the public libraries to provide accessible computers for patrons. More information about the topics can be found in the conference proceedings on line at http://www.csun.edu/cod/ or on WATA’s webpage at http://wata.org/

While there were numerous examples of technology at CSUN, let me highlight a couple of exciting developments. We observed that robotic arms which can be attached to wheelchairs and operated using a joy stick, mouth switch, or other input device have dropped in price to only $25,000! Obviously this is still out of reach for most folks, but two years ago the cost was $50,000 so perhaps the drop in price will continue!

We also discovered that both Kurzweil and Dragon Systems have discontinued their discrete speech recognition programs that gave users hands-free operation of the computer through voice commands. On the up side, there are numerous continuous speech recognition programs that allow users to dictate text in their regular speaking voice and these programs are improving.

Finally, we saw an example of creative thinking applied to an every day problem: access to a computer for people who use one hand. One company is marketing "one handed" keyboard software that uses a standard keyboard. Every time the single handed keyboard user needs to use "the other hand," the user either hits a foot switch (or any other kind of switch) or the space bar and the keyboard "remaps" to the other side. For people who were experienced keyboarders, this requires much less "new learning" and is likely an efficient solution.

Calendar of Events

Introduction to Assistive Technology: Summer Institute - June 21-25, 1999, Seattle, WA

The summer institute will provide participants with a comprehensive introduction to the field of assistive technology (AT): augmentative and alternative communication (AAC), seating and mobility, computer access, technology for individuals with learning disabilities, electronic resources in AT (Internet and WWW), psychosocial and legal issues related to AT, and funding for AT. Hands-on labs in computer access, AAC, technology for people with learning disabilities, and technology for access to the web and the Internet will be available during the institute. Contact Jovine Umali at (206) 685-4181 V, (800) 841-8345 V/TTY, email: watap@u.washington.edu or on the Web at http://wata.org/si99.

Assistive Technology Industry Association (ATIA) World Conference ‘99 – October 6-9, 1999, Orlando, FL

Manufacturers, sellers, service providers, and professionals in Assistive Technology industry will showcase, train and educate on the newest technology and applications available in Assistive Technology. Contact ATIA, 526 Davis Street, Suite 217, Evanston, IL 60201, (847) 869-1282, email: ATIA@northshore.net or on the Web at http://www.ATIA.org.

Closing the Gap, Computer Technology in Special Education and Rehabilitation – October 21-23, 1999, Minneapolis, MN

The 17^th Annual Conference will cover a broad spectrum of technology as it is being applied to all disabilities and age groups in education, rehabilitation, vocation, and independent living. Contact Closing The Gap, P.O. Box 68, 526 Main St., Henderson, MN 56044, (504) 248-3294, email: info@closingthegap.com, or on the Web at http://www.closingthegap.com.

Please send comments, mailing list additions or changes, and requests for this newsletter in different formats to: WATA Bulletin, Box 357920 Seattle WA 98195-7920 800-841-8345 (V/TTY) 206-616-1396 (TTY) 206-543-4779 (fax) e-mail: watap@u.washington.edu

WATA Bulletin is supported by grant H224A3006 from the National Institute on Disability and Rehabilitation Research, U.S. Department of Education, to the Division of Vocational Rehabilitation, Olympia, WA.