funding of assistive technology resources in pennsylvania im4q annual statewide training conference...

Funding ofAssistive

Technology

Resources in Pennsylvania

IM4Q Annual Statewide Training Conference

Harrisburg, PAJuly 24, 2012

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YOUR PRESENTERS TODAY

Jamie A. PrioliRESNA ATP

Pennsylvania’s Initiative on Assistive Technology,

Institute on Disabilities

Susan TachauExecutive Director

Pennsylvania Assistive Technology Foundation

Phone: 1-800-204-7428Email: [email protected]

Phone: 1-888-744-1938Email: [email protected]

About PIATAt School At Work At Home In The

Community

Device DemonstrationsDevice LoansReused and Exchanged Equipment Partnership (REEP)Public Awareness ActivitiesTelecommunication Device Distribution Program (TDDP)Information and AssistanceAT Training and Technical Assistance

Website: disabilities.temple.eduPhone: 1-800-204-7428

About PATFNon-profit, statewide, organization that provides:

No-interest, mini-loans for the purchase of assistive technology

[$100 to $1,000] Low-interest loans for the purchase of assistive technology: traditional and

guaranteed (“backed” by PATF)

[$1,000 and above at 4% interest rate] Information & Assistance about assistive technology (AT) funding resources Financial education

Website: www.patf.us

Phone: 1-888-744-1938 (toll-free)

PATF Independence is priceless...we help make it affordable

GETTING ASSISTIVE TECHNOLOGY FUNDED

IN PENNSYLVANIA

ASSISTIVE TECHNOLOGY DEVICES, INCLUDING REPAIRS OF ASSISTIVE TECHNOLOGY,

MAY BE FUNDED BY THE FOLLOWING:

Getting Assistive Technology Funded in Pennsylvania

Medicaid Home and Community Based WaiversMedical Assistance (Medicaid)MedicareTricarePrivate health insuranceOffice of Vocational Rehabilitation

ASSISTIVE TECHNOLOGY DEVICES, INCLUDING REPAIRS OF ASSISTIVE TECHNOLOGY,

MAY BE FUNDED BY THE FOLLOWING:


Area Agency on AgingTelecommunication Device Distribution ProgramIndividuals with Disabilities Education Improvement Act (IDEA 2004)

MEDICAID HOME AND COMMUNITY BASED WAIVERS


Help persons with disabilities to live in the community rather than in institutions.

Aging (persons age 60 or older) COMMCARE (adult with traumatic brain injury) Consolidated (person with intellectual disability age 3 or older) Independence (adult with physical disability) OBRA Waiver (adult with developmental disability) Infants, Toddlers and Families (child birth to age 3) Person/Family Directed Support (person with intellectual disability age 3

or older)

Assistive Technology (AT) For People Who Have an Intellectual Disability

Home and Community-Based Waivers and Base Dollars (county):

Person/Family Directed Support WaiverConsolidated WaiverLimited County Dollars (FY 2012 – 2013 pilot

program with up to 20 counties)

What’s New in the Waiver World For AT?

The Person/Family Directed Support Waiver and the Consolidated Waiver were renewed with changes (including to service definitions & reimbursement rates), effective July 1, 2012.

AT devices and services are provided in 4 distinct areas: Assistive technology Home accessibility adaptations Vehicle accessibility adaptations Durable medical equipment

Participant Services Within the Waivers

Assistive Technology Service

Examples Limits

Assistive Technology switches, computer software, seat lift chair

$10,000 per lifetime*

Home Accessibility Adaptations

ramps, stair glides, roll-in showers, porch lifts

$20,000 per 10 years

Vehicle Accessibility Adaptations

ramp, lowered floor, tie-downs

$10,000 per 5 years

Durable Medical Equipment

grab bars, wheelchair, scooter, Hoyer lift

* with a possibility for an increase (the “exceptions policy”) Durable medical equipment—”An item or device listed in the Medical Assistance program fee schedule that can withstand repeated use; which are used primarily and customarily to serve a medical purpose; which are customarily not useful to a person in the absence of illness or injury and which are appropriate for home use.” 55 Pa code, chapter 1153

Services Are Allowable

Assistive technology “services” are an allowable expense in the waivers. “Services” include direct support to a participant in the selection, acquisition, or use of an assistive technology device (including repair, design, installation, training).

MEDICAL ASSISTANCE (MEDICAID)


Government-funded health insurance for eligible children and adults, including many persons with disabilities.

Many – but not all – forms of assistive technology are covered by MA

Apply for Medical Assistance at the local County Assistance Office



Depending on the level of eligibility or age, the types of assistive technology that may be covered include:

Medical suppliesDurable medical equipmentProsthesesOrthotics Surgical suppliesWheelchairsAugmentative communication devices



Depending on the level of eligibility or age, the types of assistive technology that may be covered include:

Eyeglasses Hearing aids Other medical supplies for children under age 21 through

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

If MA pays for the individual to be in a nursing facility or ICF, the facility MUST provide the necessary AT devices and services, including repairs



Always talk with the Primary Care Physician to discuss needs and to know what documentation is required to seek AT coverage through MA.

Devices and services must be medically necessary

Certain documentation must be provided to the health plan

The PCP should ask the individual’s health plan for any coverage rules regarding the specific AT device or service that is being prescribed



For information and assistance, contact the MA managed care health plan’s Special Needs Unit

NOT the same as Member Services!!!

Ensures that the individual has information about and access to physicians, specialists, and services they need

AAC AND MEDICAID


Medicaid pays for a range of speech generating devices (SGDs) as prosthetics and/or durable medical equipment

AAC services covered under speech therapy and/or rehabilitation

Getting AT and/or AAC through Medical Assistance (MA) - - - must be medically necessary and not “experimental”.

Payer of last resort

PRIOR APPROVAL REQUEST PROCESS FOR MA


Speech-language pathologist (SLP) and family assist provider (vendor) in gathering needed documentation.

Provider (vendor) submits prior approval request for device to MA (fee for service or MA MCO)

Documentation should demonstrate medical necessity (doctor’s prescription for specific devices, SLP report, letter of medical necessity, etc.)

MEDICARE


Government-funded health insurance for persons:Aged 65 or olderReceiving Social Security Disability payments (and

their dependent adults with DD)Receiving railroad retirement payments based on

a disabilityPersons with named diseases (end stage renal

disease; ALS)

AT may be funded through Medicare Part A and Part B

MEDICARE


Medicare Part A is generally provided at no cost

AT that may be funded under Part A includes medical appliances and equipment, or durable medical equipment

Medicare Part B is provided at a monthly cost, or premium

AT that may be funded under Part B includes durable medical equipment (power wheelchairs and augmentative communication devices), prosthetic devices, and orthotic devices

Services are usually funded under other categories

MEDICARE


Requires a doctor’s written prescription for the AT device or service

Item must be medically necessary

May be required to submit a Letter of Medical Necessity

For SGDs: SLP provider must have CCC (and license)

TRICARE


Health insurance for active and retired military personnel and their dependents

Benefits include durable medical equipment

Pays for prosthetics, including augmentative communication devices

For a list of covered devices and services, visit http://www.tricare.mil/

PRIVATE HEALTH INSURANCE


May pay for assistive devices and services

Check with the insurance to see if AT is covered and if prior authorization is required

Requires a prescription from the doctor ordering the AT device or services

Letter of Medical Necessity may be required

OFFICE OF VOCATIONAL REHABILITATION


Provides services to help individuals with disabilities prepare for, start, and maintain employment

OVR offices may arrange for a free evaluation of AT needs

Local OVR offices, including the Bureau of Blind and Visual Services, can help “customers” choose and get AT recommended by the evaluation

Based upon the individual’s financial resources, they may have to pay for part of the cost of AT devices and services

AREA AGENCY ON AGING


Local Agency may pay for home modifications and durable medical equipment, medical supplies, and assistive devices

Must be age 60 or older to qualify

All other resources must be exhausted before the Area Agency on Aging will pay for the AT

INDIVIDUALS WITH DISABILITIES EDUCATION IMPROVEMENT ACT (IDEA 2004)


Requires a school district to provide special education and related services to a child with a disability

States that the school district must provide services, including AT, to a child if necessary to provide a free appropriate public education (FAPE)

Child with a disability (3 or older) may receive AT devices and services as part of the IEP

Examples of How PATF and PIAT Can Help

• A young man (24 years old) wants an iPad to help access the Internet to look for jobs and keep in touch with friends, as well as to begin a journal (with pictures), play games and read books. He also needs voice-recognition and voice-output software.

iPad demonstration from PIAT Financial loan (Mini-Loan) for the iPad from PATF ($25/mo for 2

years) Waiver funds for the software applications

PATF and PIAT Can Help Put Together a Package

• A woman (36 years old) lives in SE PA and has an intellectual disability and cerebral palsy. She needs a telephone with large buttons, a ramp, a roll-in shower, a raised toilet seat and grab bars.

Investigate the Telecommunications Device Distribution Program (TDDP) for possible telephones. Before applying for a particular phone, it can be demonstrated or borrowed (from PIAT’s equipment Lending Library) to make sure it will work.

Use the case manager/supports coordinator to coordinate the home accessibility adaptations (ramp and roll-in shower). NOTE: If the cost of the shower and ramp exceeds $20,000, it may be possible to get a small grant from a disability-specific organization (i.e., UCP Philadelphia) to help cover the funding gap. If some of the expenses remain unpaid, a PATF loan may be able to pay for the balance!

Submit to Medical Assistance for payment for the raised toilet seat and the grab bars (Durable Medical Equipment).

OTHERRESOURCES

Assistive Technology Financial Loans

PATF provides no-interest or low-interest loans to people with disabilities for the purchase of assistive technology devices and services. PATF also provides Information and Assistance about other possible funding resources.

Who does PATF serve? Pennsylvanians of all income levels, disability diagnoses, ages

PATF Independence is priceless...we help make it affordable

Pennsylvania’s Initiative on Assistive Technology (PIAT)

Reused and Exchanged Equipment Partnership (REEP)Telecommunication Device Distribution Program (TDDP)Device DemonstrationsAssistive Technology Lending Library

ASSISTIVE TECHNOLOGY RESOURCES

•RESNA Catalyst Project • 56 statewide AT Act Programs

• 33 Alternative Financing Programs

• 57 Protection and Advocacy for AT Programs

• 19 Access to Telework programs

• http://www.resnaprojects.org/

•Note: AT Act Programs in every state as well as Puerto Rico, US Virgin Islands, Northern Mariana Islands, District of Columbia, American Samoa, & Guam.

PENNSYLVANIA TRAINING AND TECHNICAL ASSISTANCE NETWORK (PATTAN)

• Short Term Loan (STL) Program (www.pattan.net)

• Library of AT materials available to Local Educational Agencies (LEAs) for trial and evaluation

• STL kits contain devices for:• Augmentative communication• Computer access• Written communications• Environmental controls• Technology for sensory impairment (hearing and vision)

ASSISTIVE TECHNOLOGY AND LEGAL ASSISTANCE

• Disability Rights Network of Pennsylvania (DRN PA)

• Legal and “systems” issues around access to and acquisition of AT

• Offices in Harrisburg, Philadelphia and Pittsburgh

• Website: http://drnpa.org • Email: [email protected]

DISABILITY-RELATED ORGANIZATIONS

• National MS Society• Multiple Sclerosis Association of America (MSAA)• ALS Association• JEVS Human Services – Supports for

Independence• Disabled Children’s Relief Fund

QUESTIONS?

FEEL FREE TO CONTACT US

Jamie A. PrioliRESNA ATP

Pennsylvania’s Initiative on Assistive Technology,

Institute on Disabilities

Susan TachauExecutive Director

Pennsylvania Assistive Technology Foundation

Phone: 1-800-204-7428Email: [email protected]: disabilities.temple.edu

Phone: 1-888-744-1938Email: [email protected]: www.patf.us

funding of assistive technology resources in pennsylvania im4q annual statewide training conference...

Documents

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affordable slide

pennsylvania medicaid

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intellectual disability

communitybased waivers