Hi Alisa-

 

 A couple of thoughts-

 

1.       This seems like it would be a fairly easy case to appeal- since with ALS the predictor for speech loss is words per minute, not intelligibility.  With this particular case, was it mentioned that the person had fatigue?  Or mentioned that it was likely that within “x” months, the person would have no usable speech?

I think it’s important to educate Medicare about what “medical necessity” means for people with ALS.

 

2.       I personally don’t think an SLP should even put down intelligibility. It’s not required, and it doesn’t seem especially useful for many people with ALS.  (There are a number of issues other than intelligibility which need to be considered when looking at obtaining a SGD.)

3.       70% intelligibility is terrible.  It means that 1/3 of the time they aren’t being understood.  I think a tape recording of the person speaking should be sent to Medicare as part of the appeal.

4.       I think the key issue is not what the person’s  intelligibility is, but whether or not their speech is functional. For example, can they be understood on the telephone? Can they be understood at night?


Margaret Cotts

 

 

 

From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Alisa Brownlee
Sent: Tuesday, May 12, 2009 5:47 PM
To: AT National Listserv
Subject: [Assistive Technology] AAC funding info for the group

 

Hi everyone,

 

I am asking for feeback on the following information that I was given from a funding coordinator at Dynavox today.  I have her permission to ask the group for their reactions and to see if this is happening with some of your submissions for SGD funding. 

 

Problem is with Medicare and not funding a device based on a client's intelligibility.  Upon correspondence with this funding person, she informed me of a recent denial from Medicare that I have attached.  (SLP documented that the person with ALS had a 70% intelligibility)  The denial letter indicates that since this person can still make themselves verbally understood, they don't qualify for an SGD. 

 

Anyone have denials like this??? 

 

I am not sure what type of wording we need to use now because if CMS is considering the fact that someone can still make themselves verbally understood, regardless of fatigue or dysarthria, then when is someone to use an SGD?? When they have no vocalizations at all??

 

Feedback appreciated....

 

Thanks,

Alisa

 

 

 

Alisa Brownlee, ATP
Clinical Manager, Assistive Technology Services
ALS (Lou Gehrig's Disease) Association, Greater Philadelphia Chapter

 

Assistive Technology Consultant, ALS Association, National Office


Direct Phone Number: 215-631-1877