Rights for Virginians with Disabilities

[Guest guest]

Friends:

News from VA TASH President s. For more information regarding

the Department of Rights for Virginians with Disabilities, and an updated

list of training events and workshops, visit the Coalition web site:

www.commcoal.org

Best wishes-

Pitonyak

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Subject: 1-23-02

Date: Wed, 23 Jan 2002 08:14:28 -0500

From: <lsd@...>

Recipient List Suppressed:;

1. Webcast 2. foxes at the henhouse 3. Tricare covers AAC ================= THE

KORNREICH TECHNOLOGY CENTER Announces the third in our series of FREE WEBCASTS 2

PM EST on January 24, 2002 AAC DECISION MAKING FOR PERSONS WITH ALS SPEAKER:

R. Beukelman, PhD is Barkley Professor of Communication Disorders at the

University of Nebraska, Lincoln; Director of Research and Education of the

Munroe-Meyer Institute for Genetics and Rehabilitation at the University of

Nebraska Medical Center, Omaha; and Senior Researcher at the Institute for

Rehabilitation Science and Engineering, Madonna Rehabilitation Institute,

Lincoln. He has published and presented extensively on augmentative

communication and related topics. Ball, PhD is Assistant Professor of

Rehabilitation Medicine at the Munroe-Meyer Institute for Genetic and

Rehabilitation, University of Nebraska Medical Center, Omaha; and Adjunct

Assistant Professor at the University of Nebraska, Lincoln. PROGRAM SCHEDULE:

Thursday, January 24, 2002 2:00-3:00 pm est: Interview 3:00- 3:30 pm est:

Question and Answer period (Questions will be posed through a live chat room and

answered in real time) HOW TO PARTICIPATE: Go to our web site: www.kornreich.org

.. Additional webcasts are planned for January and February. Check back

frequently with the Kornreich Technology Center page for the latest topics and

dates.

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-------- -------------------- Foxes at the henhouse ---------------------

Advocate for the disabled should be independent January 17 2002 One of the

issues candidate Mark Warner talked about was making the state's advocate for

the disabled more independent. On the first full day on his new job, Gov. Mark

Warner chose this as one of the first promises on which he would deliver. Every

state has an agency charged with protecting and advocating for the rights of the

disabled. In Virginia, that agency is the Department for Rights of Virginians

with Disabilities, or DRVD. If necessary, it's even supposed to take other state

agencies to court on behalf of the disabled. Critics argue that the DRVD has

failed, and they cite the agency's lack of independent status. The DRVD has the

same boss as the state agencies it is supposed to review and sometimes

challenge, and all good intentions aside, that boils down to having the fox

guard the henhouse. Gov. Jim Gilmore's solution was to move the department out

from under the secretary of Health and Human Services. That made sense, since

that secretary also oversees three of the agencies the DRVD most often goes up

against: the departments of Mental Health, Mental Retardation and Substance

Abuse Services; Rehabilitative Services; and Visually Handicapped. Now, DRVD

reports to the secretary of administration. Not enough, cry the hens' friends.

It just puts the fox's brother-in-law in charge of guarding the henhouse. What's

needed is a truly independent advocate and protector, like most other states

have. Last year the General Assembly passed legislation, introduced by Del.

Hamilton of Newport News, to create the Virginia Office for Protection

and Advocacy. Overseeing it would be an 11-member board with three members

appointed by the governor and eight by the General Assembly -- effectively

bringing the agency out from under the executive branch and putting it under the

legislative. Gilmore vetoed it. This year, with Warner's support, the outlook is

brighter for a run at the same plan. The approach is logically sound. But here's

a caution: If there are conditions, policies, staff or cultures in agencies and

institutions that create abusive or neglectful situations for the disabled, deny

them services or subvert the intention of programs, the General Assembly must

act aggressively to make these agencies and programs responsive and effective.

Changing the guard in front of the henhouse won't be enough. Copyright © 2002,

Daily Press ============ Tricare, formerly CHAMPUS, the health benefits program

for dependents of active duty military service members and military retirees,

will now cover and provide AAC devices to all program enrollees who require

them. Congress explicitly directed the expansion of Tricare AAC device coverage

in the FY 2002 military reauthorization bill, signed by the President on

December 28, 2001. Public Law 107-107, Section 702(2)(2001). Prior Law: The

Tricare statute states that both DME and prosthetic devices are covered

benefits. 10 U.S.C. Section 1077. However, the regulations defining these

benefits were filled with roadblocks to AAC device coverage. First, the

regulatory DME definition expressly excluded " communication devices, " 32 C.F.R.

Section 199.2. Then, the prosthetic device definition stated these were

" artificial substitutes for missing body parts. " Id. In addition, there was a

Tricare program for people with disabilities. It had a long history of AAC

device coverage, but it was available only to the dependents of active duty

service members. Retiree dependents were not eligible. Potential to Change Prior

Law: During the past few years, I was contacted by military retirees, directly,

or through their SLPs, on behalf of family members who needed AAC devices. One,

whose wife had ALS, died without a device, having received nothing but denials

from Tricare. DME, prosthetic devices, and the PFPWD all were unavailing.

Another, with an 8 year old recommended for a Dynamyte, has a current appeal

pending with the program. The question for all of these families was how to

help? What strategy would work? The AAC device exclusion in the Tricare DME

definition was not like the Medicare " convenience item " national coverage

decision. The latter was not binding on all decision makers, so we have been

able to get consistent favorable decisions for those people who were able to buy

an AAC device with their own resources, and then pursue administrative appeals.

For Tricare, the regulatory exclusion of AAC devices would control all

administrative decisions. The only possibly " favorable " outcome in the

administrative process was a " recommended decision " by a hearing officer that

the Assistant Secretary of Defense for Health Affairs re-examine the regulation.

Alternately, the family would have to rely on a formal rulemaking request to the

Assistant Secretary to re-write the DME definition by dropping the AAC device

exclusion. Or, when all administrative remedies are exhausted, by filing a court

challenge the exclusion. In large measure, all these options are the same.

Regardless which course was followed, the same effort would be required. A

community-wide coalition would have to be re-established, Congressional and

disability community support would be needed to pressure the Assistant Secretary

of Defense to act, the Formal Request to Medicare would have to be re-printed

under a new cover and with revised references to Tricare, and we would have to

wait and hope the staff and administrators in the Department of Defense will be

as responsive as their counterparts at HCFA/CMS had been. Some readers of this

message received requests related to the first steps of that process. Late last

week, requests were sent asking whether anyone had worked with the person who

now holds the position of Assistant Secretary of Defense for Health Affairs; for

past Tricare funding decisions for AAC devices, and for information regarding

whether the private insurance programs in which the Assistant Secretary formerly

worked had funded AAC devices. New Law: None of those steps will now be

required, based on the FY 2002 military reauthorization. Public Law 107-107,

Section 702, amends the definition of " prosthetic devices " in the

TRICARE/CHAMPUS program. That provision states: (a) Only the following types of

health care may be provided ....: (15) Prosthetic devices, as determined by the

Secretary of Defense to be necessary because of significant conditions resulting

from trauma, congenital anomalies, or disease. 10 U.S.C. Section 1077(a)(15). As

noted above, the regulatory definition of prosthetic devices was very limited:

" an artificial substitute for a missing body part, " 32 C.F.R. Section 199.2. In

Section 702(2), however, Congress clarified the scope of the TRICARE/CHAMPUS

prosthetic device benefit, as follows: An augmentative communication device may

be provided as a voice prosthesis under subsection (a)(15). Impact of the New

Law: This change in the law will have immediate implications for SLPs working

with families presently or formerly associated with the military. Because of

this provision, dependents of both active duty service members and retirees will

be able to obtain necessary AAC devices. AAC devices will no longer be available

from Tricare only for the dependents of active duty military service members. It

is impossible to estimate how many people will now be able to get AAC devices,

but the active duty armed forces is comprised of between 1.5-2.0 million service

members. The number of retirees will increase this total significantly. If the

general demographic estimates we used for Medicare are applicable to Tricare

(1/1,000 of the general population), there will be thousands of individuals who

require AAC devices among the Tricare beneficiary population. In general, the

elimination of any AAC device coverage barrier is welcome news, and in addition

to the direct effects on those eligible for this program, it will serve as a

catalyst for positive outcomes for those eligible for other programs.

Mike Savory