LifeWorks

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LifeWorks
Pursuing better living for people with
disabilities and their families
Applied Clinical Solutions
INTRODUCTION TO ASSISTIVE TECHNOLOGY FOR
ADVOCATES PARTNERS IN POLICYMAKING
CONFERENCE January 9 10, 2004 Mendel A.
Uychutin, OTR/L, ATP
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Who are you?
Who are you?
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What is the single, most important thing you wish
to get at the end of this session?
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COURSE OBJECTIVESAt the end of the course,
participants will be able to

• 1. Describe examples of current assistive
  technology (AT) applications in various life
  situations, i.e. daily living, communication,
  work, recreation, education, travel, etc.
• 2. Define "assistive technology devices" and
  "assistive technology services."
• 3. Differentiate between "assistive technology
  device" versus "durable medical equipment."
• 4. Identify applicable legal basis and funding
  sources for AT services and devices given a
  specific case study.
• 5. Identify best practice features of an
  assistive technology service delivery model.
• 6. Articulate some effective advocacy strategies
  and leadership roles in helping consumers access
  AT services and devices.

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

• "Any service that directly assists an individual
  with a disability in the selection, acquisition,
  or use of an assistive technology device.
• This may include
• 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 their usual surroundings)
• purchasing, leasing, or otherwise providing
  for the acquisition of assistive technology
  devices by individuals with disabilities
• purchasing, selecting, or borrowing AT devices
• selecting, designing, fitting, customizing,
  adapting, applying, maintaining, repairing, or
  replacing of assistive technology devices
• coordinating and using other therapies,
  interventions, or services with assistive
  technology devices, 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
  appropriate, the family of an individual with a
  disability
• providing training or technical assistance for
  professionals (including individuals providing
  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 disabilities.

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

• "Any item, piece of equipment, or product system,
  whether acquired commercially off the shelf,
  modified or customized, that is used to increase,
  maintain, or improve functional capabilities of
  individuals with disabilities."

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Durable Medical Equipment(as defined by Medicare)

• Can withstand use
• Primarily and customarily used to serve a medical
  purpose
• 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 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)

All above elements must be satisfied before
Medicare will purchase an item as a durable
medical equipment.
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Rehabilitation Technology(from Rehabilitation
Act 29 U.S.C. '706(13)

• "The systematic application of technologies,
  engineering methodologies, or scientific
  principles to meet the needs of, and address the
  barriers confronted by individuals with
  disabilities in areas which include education,
  rehabilitation, employment, transportation,
  independent living and recreation. The term
  includes rehabilitation engineering, assistive
  technology devices and assistive technology
  services."

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What is Medicaid?

• It is
• a cooperative federal-state program authorized
  by Title XIX of the Social Security Act
• a health insurance program, designed to serve
  persons with limited income and resources
• typically the only or primary health insurance
  plan for persons with disabilities who have
  limited income
• can pay for a wide range of health-related
  costs for both children and adults with
  disabilities including assistive technology

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Quotes About the Medicaid Statutes

• ". . . almost unintelligible to the uninitiated."
  
• Friedman v. Berger, 547 F.2d 724, 727, n. (2nd.
  Cir. 1976)
• ". . . an aggravated assault on the English
  language, resistant to attempts to understand
  it."
• Friedman v. Berger, 409 F. Supp. 1226, 1226
  (S.D.N.Y., 1976)
• "This is a world populated by Pickle People,
  Pseudo-Pickle, DACs and QMBs (Quimbies)."
• Accessing Assistive Technology, 1st ed. 1995, CA
  Protection and Advocacy, Inc

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What is Medicare?

• It is
• a federal health insurance program authorized
  by Title XVIII of the Social Security Act
• for a majority of persons with disabilities, an
  inferior health insurance plan compared to
  Medicaid
• can pay for assistive technology under Part A
  or Part B if you are in an institution

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What is IDEA?

• It is
• Individuals with Disabilities Education Act,
  enacted by Congress in 1975 to provide free and
  appropriate public education (FAPE)
• authorizes provision of special education and
  related services
• authorizes assistive technology
  services/devices as part of related services

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

• Every childs IEP/IFSP must consider the
  following special factors
• in case of a child whose behavior impedes
  learning ... appropriate strategies,
  interventions, and supports
• in 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 Braille and
  the use of Braille unless the IEP Team determines
  that instruction in Braille is not appropriate
• 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, opportunities for direct
  communication with peers and personnel
• consider whether the child requires assistive
  technology devices and services.

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An Overview of Legislative, Funding and
Justification Matrix for Assistive Technology
Legal Basis Federal Program Funding 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 Assistive Technology
Legal Basis Federal Program Funding Agency Aliases for AT Key Justification Criteria
Social Security Act Impairment Related Work Expense (IRWE) Social Security Administration Medical devices, prosthesis, work-related equipment, Residential modifications, essential nonmedical equipment the expense must be impairment-related the individual must need the item or service to work
Social Security Act Plan to Achieve Self Support (PASS) Social Security Administration Equipment and supplies required to establish and carry on a trade or business increases a disabled person's income producing capability plan must show reasonable chance of achieving occupational goal and show connection between occupational goal and increased earning capacity
Social Security Act Blind Work Expense (BWE) Social Security Administration Any work expense incurred by a blind person in order to work, includes but not limited to braille printer, visual or sensory aids, scanners, "talkingcomputers, etc. necessary to allow a blind person to work
ADA and Rehabilitation Act (Sec. 501 and 504) Reasonable Accommodation in Employment Private employers, federal depts. agencies and other agencies who receives federal funds equipment modification, auxiliary aids services (for effective communication, e.g. closed caption decoders, assistive listening devices, large print materials, etc.) for reasonable accommodation individual must inform employer of his/her disability and the need for reasonable accommodation to provide that individual equal employment opportunities
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For many instances, the difference
between(assistive technology device and
durable medical equipment)
to-mah-to and to-mae-toe
flapjacks and pancakes
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Nada! Zip! None!

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

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Nada! Zip! None!
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Essential Features to Look For in
Choosing Your AT Service Provider

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

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IDEA Keypoints 1

• 1. Do your homework! Know the rules!
• 2. Be clear about the results you want for
  Johnny. Do not confuse getting an AT device with
  Johnnys improved ability to communicate as the
  pursued result. The AT device and service is
  only a means to an end.
• 3. Start your diary. Document events, dates,
  people, and transactions.
• 4. Despite the system, its a people to
  people transaction. Remember, in the long run,
  nice people always win.

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IDEA Key Points 2

• Know the appeal process and the timelines.
• Avoid making accusations and personal insults.
• Listen.
• If you reach an agreement, make sure it has the
  what, who, when and, it is put in writing.

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Does anyone have a question?
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Trends in Mobility

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