Disability Rights Ohio committed to helping people with communication disabilities get speech-generating devices
December 28, 2012 / speech-generating devices
Speech-generating devices (SGDs) can be life-changing to individuals with communication disabilities. Thanks to this kind of assistive technology, SGD users can create sentences or select from pre-set messages to talk with others. The device then “speaks” for the person, giving them a voice to communicate their wants, needs, and other thoughts. SGDs range from relatively low-tech devices with a few pre-programmed messages, to high-tech devices that allow users to create their own, novel messages.
Disability Rights Ohio has been involved in making SGDs available to individuals with disabilities for many years, including working on the original rule that set criteria for Medicaid funding of SGDs. Over the past few years, Disability Rights Ohio has assisted dozens of individuals whose requests for prior authorization for SGDs had been denied by Ohio Medicaid or a managed care plan. In some cases, Disability Rights Ohio worked with the individual’s speech therapist and device vendor to ensure that they were submitting the necessary information. In cases where the necessary information had been submitted but Medicaid continued to deny the prior authorization request, Disability Rights Ohio has represented individuals in the Medicaid state hearing and administrative appeal process. In many of those cases, the denial has been overturned, and the individual has received the SGD.
Earlier this year, Disability Rights Ohio submitted comments to the Ohio Department of Job and Family Services (ODJFS) during the agency’s process of overhauling the SGD funding rule. Since the rule was revised, Disability Rights Ohio has seen a decrease in the overall number of requests for assistance related to SGD denials, but a significant increase in denials by managed care organizations. Many of these denials are attempts to restrict individuals to low-tech devices that cannot be used to create novel messages; in most cases, the managed care organization relies on reports by “independent reviewers,” who recommend lower-cost devices or iPads, which are generally not funded by Medicaid as SGDs.
In recent months, Disability Rights Ohio has represented four individuals whose managed care organizations denied prior authorization for SGDs. In each case, the managed care organization’s “independent reviewer” recommended alternative low-tech devices despite substantial information from the individual’s speech therapist that the individual needed a higher-tech device to fully communicate with his or her family and peers. All four appeals were sustained, which means that the hearing officer found that the managed care organization’s denial was not correct.
SGDs are critical pieces of equipment that allow individuals to communicate with their family and friends at home, school, work and in the community, but Medicaid and other insurers try to restrict their availability because of their cost. Disability Rights Ohio is committed to helping individuals with disabilities get the assistive technology they need. If you have been denied coverage for a SGD or other assistive technology, contact Disability Rights Ohio for assistance at 614-466-7264 or 800-282-9181 or (TTY) 614-728-2553 or 800-858-3542.