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INTRODUCTION TO ASSISTIVE TECHNOLOGY FOR ADVOCATES

PARTNERS IN POLICYMAKING CONFERENCEJanuary 9 & 10, 2004

Mendel A. Uychutin, OTR/L, ATP

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Who are you?Who are you?

Who Who are are

you?you?

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What is the single, most important What is the single, most important thing you wish to get at the end of thing you wish to get at the end of

this session?this session?

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COURSE OBJECTIVESCOURSE OBJECTIVESAt the end of the course, participants will be able to:At the end of the course, participants will be able to:

1. 1. Describe examples of current assistive technology (AT) applications in Describe examples of current assistive technology (AT) applications in various life situations, i.e. daily living, communication, work, recreation, various life situations, i.e. daily living, communication, work, recreation, education, travel, etc.education, travel, etc.

2. 2. Define "assistive technology devices" and "assistive technology Define "assistive technology devices" and "assistive technology services."services."

3. 3. Differentiate between "assistive technology device" versus "durable Differentiate between "assistive technology device" versus "durable medical equipment."medical equipment."

4. 4. Identify applicable legal basis and funding sources for AT services and Identify applicable legal basis and funding sources for AT services and devices given a specific case study.devices given a specific case study.

5. 5. Identify best practice features of an assistive technology service delivery Identify best practice features of an assistive technology service delivery model.model.

6.6. Articulate some effective advocacy strategies and leadership roles in Articulate some effective advocacy strategies and leadership roles in helping consumers access AT services and devices.helping consumers access AT services and devices.

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Assistive Technology ServiceAssistive Technology Service(from Assistive Technology Act of 1998-PL 105-394)(from Assistive Technology Act of 1998-PL 105-394)

"Any service that directly assists an individual with a disability in the selection, "Any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.“acquisition, or use of an assistive technology device.“

This may include:This may include: the evaluation of the needs of an individual with a disability, including a functional the evaluation of the needs of an individual with a disability, including a functional evaluation of the individual in his/her customary environment (evaluating their needs in evaluation of the individual in his/her customary environment (evaluating their needs in their usual surroundings)their usual surroundings) purchasing, leasing, or otherwise providing for the acquisition of assistive technology purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by individuals with disabilitiesdevices by individuals with disabilities purchasing, selecting, or borrowing AT devicespurchasing, selecting, or borrowing AT devices selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing of assistive technology devicesreplacing of assistive technology devices coordinating and using other therapies, interventions, or services with assistive technology coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programsdevices, such as those associated with existing education and rehabilitation plans and programs providing training or technical assistance for an individual with a disability, or where providing training or technical assistance for an individual with a disability, or where appropriate, the family of an individual with a disabilityappropriate, the family of an individual with a disability providing training or technical assistance for professionals (including individuals providing providing training or technical assistance for professionals (including individuals providing education and rehabilitation services), employers, or other individuals who provide services to, education and rehabilitation services), employers, or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of individuals with employ, or are otherwise substantially involved in the major life functions of individuals with disabilities.disabilities.

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Assistive Technology DeviceAssistive Technology Device(from Assistive Technology Act of 1998-PL 105-394)(from Assistive Technology Act of 1998-PL 105-394)

"Any item, piece of equipment, or product system, whether "Any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified or acquired commercially off the shelf, modified or

customized, that is used to increase, maintain, or improve customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities."functional capabilities of individuals with disabilities."

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Durable Medical EquipmentDurable Medical Equipment(as defined by Medicare)(as defined by Medicare)

Can withstand use; Can withstand use; Primarily and customarily used to serve a medical purpose;Primarily and customarily used to serve a medical purpose; Generally is not useful to a person in the absence of an illness or injury; Generally is not useful to a person in the absence of an illness or injury; Is appropriate for use in the home (42 C.F.R. '405.514a);Is appropriate for use in the home (42 C.F.R. '405.514a); Is necessary and reasonable for the treatment of an illness or injury or to Is necessary and reasonable for the treatment of an illness or injury or to

improve the functioning of a malformed body member (41 U.S.C. '1395a)improve the functioning of a malformed body member (41 U.S.C. '1395a)

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*All *All aboveabove elements must be satisfied before Medicare will purchase an item as a durable medical equipmentelements must be satisfied before Medicare will purchase an item as a durable medical equipment ..

Rehabilitation TechnologyRehabilitation Technology(from Rehabilitation Act 29 U.S.C. '706(13)(from Rehabilitation Act 29 U.S.C. '706(13)

"The systematic application of technologies, "The systematic application of technologies, engineering methodologies, or scientific principles engineering methodologies, or scientific principles

to meet the needs of, and address the barriers to meet the needs of, and address the barriers confronted by individuals with disabilities in areas confronted by individuals with disabilities in areas

which include education, rehabilitation, which include education, rehabilitation, employment, transportation, independent living employment, transportation, independent living and recreation. The term includes rehabilitation and recreation. The term includes rehabilitation engineering, assistive technology devices and engineering, assistive technology devices and

assistive technology services."assistive technology services."

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What is Medicaid?What is Medicaid?

It is:It is:

a cooperative federal-state program authorized by Title XIX of the Social a cooperative federal-state program authorized by Title XIX of the Social Security Act;Security Act;

a health insurance program, designed to serve persons with limited income a health insurance program, designed to serve persons with limited income and resourcesand resources

typically the only or primary health insurance plan for persons with typically the only or primary health insurance plan for persons with disabilities who have limited income;disabilities who have limited income;

can pay for a wide range of health-related costs for both children and adults can pay for a wide range of health-related costs for both children and adults with disabilities including assistive technologywith disabilities including assistive technology

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Quotes About the Medicaid StatutesQuotes About the Medicaid Statutes

". . . almost unintelligible to the ". . . almost unintelligible to the uninitiated."uninitiated."

Friedman v. Berger, 547 F.2d 724, 727, n. (2nd. Cir. 1976)Friedman v. Berger, 547 F.2d 724, 727, n. (2nd. Cir. 1976)

". . . an aggravated assault on the English ". . . an aggravated assault on the English language, resistant to attempts to language, resistant to attempts to understand it."understand it."

Friedman v. BergerFriedman v. Berger, 409 F. Supp. 1226, 1226 (S.D.N.Y., 1976), 409 F. Supp. 1226, 1226 (S.D.N.Y., 1976)

"This is a world populated by Pickle People, "This is a world populated by Pickle People, Pseudo-Pickle, DACs and QMBs (Quimbies)."Pseudo-Pickle, DACs and QMBs (Quimbies)."

Accessing Assistive Technology, 1st ed. 1995, CA Protection Accessing Assistive Technology, 1st ed. 1995, CA Protection and Advocacy, Incand Advocacy, Inc

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What is Medicare?What is Medicare?

It is:It is:

a federal health insurance program authorized by Title XVIII of a federal health insurance program authorized by Title XVIII of the Social Security Act;the Social Security Act;

for a majority of persons with disabilities, an inferior health for a majority of persons with disabilities, an inferior health insurance plan compared to Medicaid;insurance plan compared to Medicaid;

can pay for assistive technology under Part A or Part B if you can pay for assistive technology under Part A or Part B if you are in an institution ;are in an institution ;

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What is IDEA?What is IDEA?

It is:It is:

Individuals with Disabilities Education Act, enacted by Individuals with Disabilities Education Act, enacted by Congress in 1975 to provide free and appropriate public Congress in 1975 to provide free and appropriate public education (FAPE);education (FAPE);

authorizes provision of special education and related services;authorizes provision of special education and related services;

authorizes assistive technology services/devices as part of authorizes assistive technology services/devices as part of related servicesrelated services

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What Changed in the Re-Authorization of IDEA?What Changed in the Re-Authorization of IDEA?(20 U.S. C, 1401, Section 614 (3) (B)) (emphasis added)(20 U.S. C, 1401, Section 614 (3) (B)) (emphasis added)

Every child’s IEP/IFSP must Every child’s IEP/IFSP must considerconsider the following special factors: the following special factors:

in case of a child whose behavior impedes learning ... appropriate strategies, in case of a child whose behavior impedes learning ... appropriate strategies, interventions, and supports;interventions, and supports;

in the case of a child with limited English proficiency… language needsin the case of a child with limited English proficiency… language needs

in the case of a child who is blind or visually impaired, provide for instruction in in the case of a child who is blind or visually impaired, provide for instruction in Braille and the use of BrailleBraille and the use of Braille unless the IEP Team determines that instruction in Braille unless the IEP Team determines that instruction in Braille is not appropriate;is not appropriate;

consider the communication needs of the child, and in the case of a child who is deaf consider the communication needs of the child, and in the case of a child who is deaf or hard of hearing, consider the child's language and communication needs, or hard of hearing, consider the child's language and communication needs, opportunities for direct communication with peers and personnelopportunities for direct communication with peers and personnel……;;

consider whether the child requires assistive technology devices and services.consider whether the child requires assistive technology devices and services.

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An Overview of Legislative, Funding and Justification Matrix for An Overview of Legislative, Funding and Justification Matrix for Assistive TechnologyAssistive Technology

Legal Basis Federal ProgramFunding Agency Aliases for AT Key Justification Criteria

Medicaid Act (Refers to Medi-Cal in California)

Medicaid Varies Durable Medical Equipment, prosthesis, orthotics, medical supplies, and Allied Health Services e.g. OT, PT, SLH

"to protect life, to prevent a significant illness or disability, or to ammeliorate severe pain"

Medicaid Act (Refers to Medi-Cal in California)

EPSDT (children up to age 21 yrs.)

Varies Durable Medical Equipment, prosthesis, orthotics, medical supplies, and Allied Health Services e.g. OT, PT, SLH

"to correct or ameliorate defects and physical and mental illnesses and conditions…"

IDEA Special Education and Related Services

Schools Assistive Technology Device and Services

to benefit from special education and/or related services in the least restrictive environment

Medicare Act Medicare Part B Private insurance companies, e.g. HMOs, PPOs, etc.

Durable Medical Equipment, prosthesis, orthotics, medical supplies, and Allied Health Services e.g. OT, PT, SLH

establish medically necessity, that item is part of beneficiary's course of treatment, the potential functional outcome and, that no less expensive appropriate equipment is available.

Rehabilitation Act Vocational Rehabilitation Service, Supported Employment, Independent Living Services

Dept of Voc. Rehab.

Assistive Technology Device and Services, Rehabilitation Technology Services

necessary to "increase, maintain or improve functional capabilities…", secure and maintain employment; improves an individual's work performance to achieve competitive employment, enhance the ability of an individual with severe disabilities to live independently in the community, etc.

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An Overview of Legislative, Funding and Justification Matrix for An Overview of Legislative, Funding and Justification Matrix for Assistive TechnologyAssistive Technology

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Legal Basis Federal Program FundingAgency

Aliases for AT Key Justification Criteria

Social Security Act ImpairmentRelated WorkExpense (IRWE)

Social SecurityAdministration

Medical devices, prosthesis,work-related equipment,Residential modifications,essential nonmedicalequipment

the expense must be impairment-related;the individual must need the item orservice to work

Social Security Act Plan to AchieveSelf Support(PASS)

Social SecurityAdministration

Equipment and supplies Equipment and supplies required to establish and required to establish and carry on a trade or businesscarry on a trade or business

increases a disabled person's income producingincreases a disabled person's income producingcapability; plan must show reasonable chance of capability; plan must show reasonable chance of achieving occupational goal and showachieving occupational goal and showconnection between occupational goal and connection between occupational goal and increased earning capacityincreased earning capacity

Social Security Act Blind WorkBlind WorkExpense (BWE)Expense (BWE)

Social SecurityAdministration

Any work expense incurred Any work expense incurred by a blind person in order to work,by a blind person in order to work,includes but not limited to: brailleincludes but not limited to: brailleprinter, visual or sensory aids,printer, visual or sensory aids,scanners, "talking“computers, etc.scanners, "talking“computers, etc.

necessary to allow a blind person to work

ADA and ADA and Rehabilitation Act Rehabilitation Act (Sec. 501 and 504)(Sec. 501 and 504)

Reasonable Reasonable AccommodationAccommodationin Employmentin Employment

Private Private employers, employers, federal depts.&federal depts.&agencies andagencies andother agenciesother agencieswho receives who receives federal fundsfederal funds

equipment modification,equipment modification,auxiliary aids & services (forauxiliary aids & services (foreffective communication, e.g.effective communication, e.g.closed caption decoders, assistiveclosed caption decoders, assistivelistening devices, large print listening devices, large print materials, etc.) for reasonablematerials, etc.) for reasonableaccommodationaccommodation

individual must inform employer of individual must inform employer of his/her disability and the need for his/her disability and the need for reasonable accommodation to providereasonable accommodation to providethat individual equal employment that individual equal employment opportunitiesopportunities

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For many instances, the difference For many instances, the difference between:between:

(“assistive technology device and durable medical equipment”)(“assistive technology device and durable medical equipment”)

““to-mah-to” and “to-mae-toe”…to-mah-to” and “to-mae-toe”…

““flapjacks” and “pancakes” …flapjacks” and “pancakes” …

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Nada! Zip! None!Nada! Zip! None!

Except…Except…

You better use the right word and right You better use the right word and right way of asking for it, otherwise you get …way of asking for it, otherwise you get …

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Nada! Zip! None!Nada! Zip! None!

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Essential Features to Look For in Choosing Essential Features to Look For in Choosing Your AT Service ProviderYour AT Service Provider

Availability of multidisciplinary team (OT, PT, SLH, Rehab Engr., Availability of multidisciplinary team (OT, PT, SLH, Rehab Engr., AT Specialist, etc.) experienced in various aspects of ATAT Specialist, etc.) experienced in various aspects of AT Team approach and consumer drivenTeam approach and consumer driven Outcomes-Based ServiceOutcomes-Based Service Availability or access to a wide selection of AT devices and Availability or access to a wide selection of AT devices and equipment for diagnostic or loan purposesequipment for diagnostic or loan purposes Competitive Response Time and RatesCompetitive Response Time and Rates Track Record of Successful AcquisitionTrack Record of Successful Acquisition Effective Case Management and Follow-upEffective Case Management and Follow-up

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IDEA Keypoints 1IDEA Keypoints 1

1. 1. Do your homework! Know the rules!Do your homework! Know the rules!

2.2. Be clear about the results you want for Johnny. Do not confuse getting Be clear about the results you want for Johnny. Do not confuse getting an AT device with Johnny’s improved ability to communicate as the an AT device with Johnny’s improved ability to communicate as the pursued result. The AT device and service is only a means to an end.pursued result. The AT device and service is only a means to an end.

3.3. Start your “diary”. Document events, dates, people, and transactions.Start your “diary”. Document events, dates, people, and transactions.

4.4. Despite the “system”, it’s a “people to people” transaction. Remember, Despite the “system”, it’s a “people to people” transaction. Remember, in the long run, nice people always win.in the long run, nice people always win.

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IDEA Key Points 2IDEA Key Points 2

Know the appeal process and Know the appeal process and the timelines.the timelines.

Avoid making accusations and Avoid making accusations and personal insults.personal insults.

Listen.Listen. If you reach an agreement, If you reach an agreement,

make sure it has the “what, make sure it has the “what, who, when” and, it is put in who, when” and, it is put in writing.writing.

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Does anyone have a question?Does anyone have a question?

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Trends in MobilityTrends in Mobility

The I botThe I bot