New Jersey lawyer focusing on special education law and employment law


iPhones, AAC, and Health Care Reform

There can be no question that software applications for the Apple iPhone and iPod Touch have become very sophisticated. Many of these apps have given people with disabilities a voice and the means to become more independent. Applications and systems that assist people with speech disorders are commonly referred to as “augmentative and alternative communication” (AAC). Augmentative communication applications help people who have little or unintelligible speech. Alternative communication applications help people who have no speech abilities.

Proloquo2go icons on an iPod Touch. Photo courtesy of Proloquo2go. Used by permission. © 2009 Tommy Reynolds & Jaime Alvarez of Fat Bird Studios.

A week ago, the New York Times published Insurers Fight Speech Impairment Remedy, a story about a mother with Lou Gehrig’s disease (Amyotrophic Lateral Sclerosis) who is speech impaired and requires an AAC device to communicate. Medicare, however, would rather cover the cost of an $8,000 “clunky” AAC computer than a $300 iPhone running a $200 AAC app (such as Proloquo2go) that would help the mother communicate. (For a follow-up story to the original New York Times article, see Text-to-Speech Technology Reaches an Inflection Point.) Bloggers like RangelMD, Prince McLean, and MobiHealthNews, and netizens who use Twitter, are engaging in a conversation about this story, correctly observing the relationship between emerging technologies, the need for health care reform, and the importance of monitoring fraud.

All things being equal, Medicare and insurance companies should not be faced with the “difficult” choice of picking a $200 AAC app on top of a multi-functional device (like the Apple iPod Touch) that costs approximately $200 over a uni-functional device that costs $8,000. From a taxpayer’s perspective, the choice is clear. Since Medicare (and some private health insurance companies) will only pay 80% of the cost of the device, the choice is also clear for the patient who must pay the remaining 20%.

But we’re assuming that an AAC app running on the iPod Touch can provide the same essential features and performance as an $8,000 device. This is the first issue that must be addressed. We know that the iPod Touch is portable and easier to carry than a bulky $8,000 box. But what else do we know? We–and especially the insurance companies–need more information about what features are available and what features are lacking in either device. There needs to be a comparison chart, illustrating what can and cannot be done on either system. Education is key.

Fraud is the second issue that politicians, insurance companies, and taxpayers are concerned with: If health insurance should only cover the costs of medical devices for medical purposes, then does it follow that iPhones and iPod Touch should not be covered?

The $8,000 system the New York Times refers to is a uni-functional computer that runs only the medical application required to assist the speech impaired person to communicate. All other programs, such as email, web, and word processing applications are permanently disabled (or “locked”) because these things are not medical applications.

Medicare’s uni-functional requirement is a way of ensuring that the device is used only for medical purposes. This helps prevent fraud. If Medicare agrees to cover multi-functional (non-medical) applications, might it be possible that more people with disabilities would take advantage of the Medicare system to obtain multi-functional computers at a reduced cost? Wouldn’t this constitute fraud?

Assuming that an iPod Touch installed with a particular AAC app is just as good (or better) than an $8,000 system, couldn’t Apple provide a uni-functional iPod Touch that runs just one AAC app to meet Medicare’s strict uni-functional requirement? I see no reason why they couldn’t. My guess is that Medicare has never asked Apple if this could be done. If Medicare insists on the uni-functional requirement, I imagine that Apple would be more than happy to disable all of the “multi-functional” features. After all, there’s more money in it for Apple.

A netizen proposed that Medicare/Medicaid/insurance companies should pay for the iPod Touch, and the patient should pay for the AAC app. But this wouldn’t ensure that the patient would actually use the iPod Touch for medical purposes, would it? The way the system is set up, you need the iPod Touch first in order to purchase an app.

Another netizen suggested that Medicare/Medicaid/insurance companies should pay for the AAC app, but the patient should be responsible for purchasing the iPod Touch. This sounds like a better solution than the first.

Would it be a viable option to have Medicare/Medicaid/insurance companies pay 80% of the cost of both the iPod Touch and AAC app? That’s another idea worthy of debate.

Health care reform is an important topic. Politicians, lobbyists, insurance companies, and the American people are encouraged to think creatively and with an open mind. We need to find ways to save taxpayer money and prevent fraud, but at the same time, we need to help those in need obtain the latest technology at the best possible prices so that they can communicate effectively and live independently.

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