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July 1998
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July 1998
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Assistive Technology Funding and Systems Change Project (ATFSCP) To Coordinate Advocacy Effort to Reform Medicare AAC Device Funding Policy
By Lewis Golinker, Esq.
Medicare, the nation's largest health services program, has significant barriers to coverage and funding for Alternative Augmentative Communication (AAC) devices. These barriers were created more than a decade ago and they remain in place today, despite the continuing erosion of MC device funding barriers imposed by other funding sources, most notably those in the Medicaid program.
Research sponsored by ATFSCP in 1997 illustrated that Medicare barriers can be challenged. The size of the Medicare program and the importance of expressive communication to adults and senior citizens with disabilities creates an urgency to do so.
In response, ATFSCP is coordinating the development of a multi-pronged nationwide advocacy strategy to reform Medicare MC device coverage and funding policy. Its partners in this initiative will include some state assistive technology projects, state Protection & Advocacy offices (P&A), AAC services providers and other disability organizations. Three major focus areas are information dissemination, development of information for specific advocacy efforts, and provision of technical assistance information.
Information Dissemination
A shortage of information exists -both practical and advocacy related -about how the Medicare program operates. Neighborhood Legal Services (the project's subcontractor that provides legal technical assistance to state Protection and Advocacy assistive technology attorneys) and ATFSCP are developing an informational brochure about Medicare funding of AAC devices. This brochure will be useful for state P&A program staff and others to Medicare recipients, family members and services providers. It will contain, among other information, a specific outline of the Medicare claims and appeals processes (including names and addresses of decision makers); time frames for decisions and appeals; and options and issues to be considered regarding exhaustion of administrative remedies. It also will provide an evaluation form that can be completed by speech-language pathologists when assessing a Medicare recipient for an AAC device.
For advocates, ATFSCP is preparing an advocacy "looseleaf" about Medicare funding for AAC devices. This "looseleaf" will be created electronically and in hard copy. It will include all the materials produced regarding the Medicare AAC policy reform initiative, including:
copies of articles and descriptive materials about Medicare funding for AAC devices and of the strategy to overcome funding barriers that can be inserted into locally produced newsletters; the informational brochure, including evaluation forms;
- legal strategy memoranda;
- copies of Medicare AAC device decisions;
- copies of relevant Medicare guidelines; and
- other similar information.
ATFSCP will provide ongoing information and support to Medicare recipients, family members, services providers and advocates regarding the scope of Medicare funding; the status of Medicare funding barriers and the status of the systems change initiative.
ATFSCP also is also engaged in ongoing contact and networking activities with other organizations with common interests regarding Medicare AAC device policy reform. These organizations include the state assistive technology projects, United States Society for Augmentative and Alternative Communication, the United States ALS Society and its state chapters, CINI, American Speech and Hearing Association and Muscular Dystrophy of America.
NLS will hold every-other-month conference calls with Protection & Advocacy program staff devoted to Medicare AAC device funding reform. ATFSCP staff also will develop materials for and deliver a presentation about Medicare funding for AAC devices and the strategy to overcome related funding barriers.
Development of Advocacy Tools
A second focus of this initiative is to develop advocacy tools that can be used by Medicare recipients in individual Medicare funding requests and appeals; by state Medicaid programs in Medicare funding requests in and appeals for its recipients with dual eligibility; and by advocates pursuing direct Medicare policy reform.
To achieve these goals, ATFSCP is developing an outline of the Speech and Language Pathologist evaluation and report that must be submitted in support of Medicare funding for an AAC device. The factors to be considered and reported are intended to be included in the Medicare AAC device funding informational brochure.
In addition, ATFSCP is developing an outline of the expert witnesses' testimony. The testimony is needed to support Medicare funding for AAC devices before three Medicare decision-makers. These decision-makers include: (i) a Medicare administrative law judge in support of an individual appeal; (ii) a Medicare administrator in support of negotiated policy reform of a systemic nature; and (iii) a judge in support of judicially ordered policy reform.
The ATFSCP outline will include the topics to be addressed by one or more expert witnesses. Also included will be: videotape evidence and/or videotaped testimony of AAC users; AAC intervention literature reviews; supportive affidavits by nationally respected AAC experts; a script of the questions and answers generated as part of direct testimony of an expert; and the topics to be addressed in cross examination of an opposing expert.
For individuals or advocates who pursue Medicare funding for AAC devices, ATFSCP will develop model legal memoranda and/or pleadings, and will be available to help identify expert witnesses who can help with funding appeals and/or policy reform activities. Technical Assistance
The third and final prong of this strategy is to provide ongoing advocacy technical assistance. This will be directed to ATFSCP staff and state Assistive Technology Projects who have begun to recruit their state Medicaid programs as sources of individual Medicare AAC device appeals for persons with dual Medicare and Medicaid eligibility, and advocates, including state Medicaid program representatives, who are pursuing individual Medicare appeals. ATFSCP will develop and maintain a database of Medicare AAC device appeals being pursued.
Lewis Golinker, Esq., will be coordinating this initiative for ATFSCP. For more information about the initiative, or if you have questions, please contact him at:
607-277-7286(v);
607-277-5239(fax); or via
e-mail lgolinker@aol.com address.ATFSCP will be providing updates in subsequent issues of the Tech Express.
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