Funding Closed Circuit Televisions

Funding Closed Circuit Televisions

Funding Closed Circuit Televisions

(CCTVs)

Through Medical Insurance

by Greg Trapp
Editor's Note: Greg Trapp has been a staff

attorney with the Protection and Advocacy System of New Mexico since 1992. In 1993 he

taught disability law as an adjunct professor at the University of New Mexico School of

Law. Mr. Trapp submitted the following article simutaneously to the Braille Monitor, the

monthly publication of the NFB, and to Future Reflections. Subsequently, it was published

in the November, 1997, issue of the Monitor. The article has some helpful information

about financing Closed Circuit Television Systems (CCTVs), equipment which some blind

students and adults find useful. This is what Greg says:

In this era of decreasing state and federal

budgets, it is increasingly necessary for blind people to explore alternative ways to fund

assistive technology. An assistive technology device is defined as any item, piece of

equipment, or product system that is used to increase, maintain, or improve the functional

capability of a person with a disability. If the device serves a medical purpose, it may

also meet the definition of "durable medical equipment" (DME). A closed circuit

television can be included within the definitions of assistive technology and durable

medical equipment.

A closed circuit television (CCTV) may enable

some people who are legally blind or who have low vision to read printed materials. It

uses a camera and television screen to create an enlarged image of printed text. It can

also enhance contrast by placing white letters over a black background. If you could

benefit from having a CCTV at home, you might be able to obtain one through your private

medical insurance, Medicaid, or Medicare. These funding sources should be considered along

with more traditional funding methods such as vocational rehabilitation or through an

employer as a reasonable accommodation. Since a CCTV can cost over $3,000, medical

insurance may be the only practical way for many people to obtain a home CCTV.

For some people a properly used CCTV can be a

valuable tool which can enhance productivity and independence. However, it is necessary to

understand the limitations of a CCTV. Keep in mind that a CCTV magnifies only a small

portion of text at a time and that usually the reader must physically move the item being

read beneath the camera. Prolonged reading with a CCTV may also cause eyestrain and

headaches. For these reasons reading with a CCTV can be slow and inefficient. Accordingly,

a CCTV is often more appropriate for elderly persons who have lost vision later in life

and who have not developed more efficient alternative techniques.

Despite its limitations a CCTV can be an

effective supplement to other reading methods such as using Braille, tapes, scanners,

electronic text, and sighted readers. A CCTV can be especially useful for reading and

filling out forms, reading small amounts of text, and writing checks. A CCTV can also be

an effective alternative to the use of large print or hand-held magnifiers.

Some school-aged children may be able to benefit

from a CCTV. However, children who improperly use a CCTV could actually have their

educational development impaired. For instance, there is often a strong tendency to

encourage blind children to read using partial vision instead of using more efficient

methods such as Braille. Unfortunately some parents find it painful to recognize that

their visually impaired child is actually legally blind and in need of Braille. In

addition, some school districts are often reluctant to pay for teachers who have the

expertise needed to teach Braille, arguing that a CCTV (or other adaptive equipment) makes

teaching Braille unnecessary. A tragically common situation is a child with a degenerative

eye condition whose teacher ignores Braille in favor of having the child use her remaining

vision even though the vision is likely ultimately to be lost entirely. In such a case,

improper reliance on a CCTV when Braille should be taught could limit the child's ultimate

Braille proficiency.

Regardless of the age of the person seeking to

obtain a CCTV, the individual should be evaluated by a qualified low-vision professional

to determine if a CCTV would be appropriate. The evaluation should include consideration

of factors such as whether the visual condition is degenerative, whether the condition is

stable from day to day, whether eyestrain will be incurred as a result of using the

equipment, and whether the person can use the CCTV efficiently. Most important, the

evaluator must appreciate the benefits of Braille and speech devices in order to insure

that the evaluation will be balanced.

In order to obtain medical insurance coverage for

a CCTV, you must have a physician prescribe a CCTV to treat the visual condition. The

first step in the process is to determine whether your medical insurance could classify a

CCTV as a medical device within the scope of covered services. This process is similar for

private health insurance, Medicaid, and Medicare. Accordingly, because the processes are

similar and since Medicare operates much like a private insurance program, this article

will focus on the process under Medicare.

Medicare is divided into two parts. Part A pays

for hospital stays and home health care. The latter coverage can include payment for

durable medical equipment (DME). Part B coverage can also include payment for DME, as well

as coverage of prosthetic devices.

The Medicare description of DME includes devices

such as iron lungs, hospital beds, and wheelchairs. In order for a device to be classified

as DME, it must be able to withstand repeated use, be primarily and customarily used to

serve a medical purpose, be generally not useful to an individual in the absence of an

illness or injury, be appropriate for use in the home, and be necessary and reasonable for

the treatment of an illness or injury or to improve the functioning of a malformed body

member. A CCTV can meet all of these criteria. A physician must prescribe the CCTV,

include it in a treatment plan, and supervise its use. If these requirements are met,

Medicare can pay for a CCTV as an item of durable medical equipment.

Medicare may also cover a CCTV as a

"prosthetic device." Medicare defines prosthetic devices as devices which

replace all or part of the function of a permanently inoperative or malfunctioning

external body member or internal body organ. For instance, Medicare covers pacemakers as

prosthetic devices, even though a pacemaker does not replace the heart. Likewise a contact

lens prescribed after cataract surgery is also covered as a prosthetic device since the

contact replaces the function of the natural lens. Accordingly a CCTV may be covered as a

prosthetic device since it replaces the functioning of the damaged portion of the eye.

Once you determine that a CCTV may fall within

the scope of a covered service, you must next obtain a prescription from a physician. In

order to obtain a prescription, the CCTV must be reasonable and necessary. A CCTV is

already recognized as a treatment for certain types of visual impairments. For example,

the American Academy of Ophthalmology recognizes the CCTV as a prosthetic device. In

addition, the CCTV is not a comfort item. A comfort item is an item such as a tape

recorder which does not contribute to the treatment of the visual condition. By contrast a

CCTV is a treatment for the damaged portion of the eye. It does not matter if you will use

the CCTV for recreational reading.

Medicare also functions like most private health

insurance providers in the way claims are processed. You must normally first purchase the

CCTV from an approved Medicare supplier, then file a claim for reimbursement. However,

some Medicare suppliers will order medical equipment while awaiting payment from Medicare.

Medicaid differs from this process in that you must first obtain prior approval before you

can purchase a CCTV. Medicare will send the CCTV reimbursement claim (along with

supporting documentation) to a Durable Medical Equipment Regional Carrier (DMERC). The

DMERC will determine if the CCTV is covered and is reasonable and necessary. Reasonable

means that it is the lowest priced item that will meet your medical need. Necessary refers

to the medical need established by your physician. The DMERC will then determine the

reasonable cost of the CCTV.

Unlike Medicaid, which pays in full, Medicare

subjects you to a deductible of $100 and a 20 percent co-payment. From the cost determined

by the DMERC, Medicare will pay you an 80 percent reimbursement after the $100 deductible.

If the supplier has agreed to "accept assignment," the supplier will only charge

the amount determined by the DMERC. However, suppliers who have not accepted assignment

are allowed to charge above the amount determined by the DMERC, and you will be

responsible for the additional charge. Suppliers who have agreed to accept assignment are

listed in the Medicare Participating Physicians/Suppliers Directory (MEDPARD), which you

can request from the DMERC. In some circumstances Medicare may allow or require rental of

a CCTV.

Requests for CCTV's are often denied. However,

you have the right to appeal, and Medicare appeals are often successful when pursued

beyond the initial appeal levels. For instance, as long ago as 1980 a Medicare beneficiary

successfully appealed the denial of a CCTV. (Medicare Fair Hearing Decision, HIC No.

062-44-0658-A, 1980.) If you receive a denial, the letter of denial will explain the

appeal process, and you should carefully meet all deadlines and follow all procedures. The

appeal procedure is different depending on whether the claim is under Part A or Part B.

The first level of appeal under Part B is to request a review. The next level is to a

hearing officer. Since a CCTV costs more than $500, claimants under Part B have the right

to continue to appeal by requesting a hearing before a federal administrative law judge

(ALJ). The ALJ level affords you the greatest chance of success. If the ALJ appeal is not

successful, you may request a review by the Appeals Council. The final appeal level is to

federal court. The appeal process under Part A is somewhat similar but begins with a

request for reconsideration. If the denial of the CCTV is under Medicaid, you also have

the right to appeal. In addition, most private insurers also have appeal procedures.

Regardless of the funding source and appeal procedure, you should be persistent and not

take "no" for an answer.

The CCTV can be a valuable tool and has a place

in the arsenal of alternative techniques. By being persistent, you may be able to obtain

medical insurance funding for a CCTV. The immediate goal is to expand the choices you

have. The ultimate goal is to enhance your productivity and maximize your potential.