Assistive Technology, PERS,

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Assistive Technology, PERS, Environmental
Modifications
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DURABLE MEDICAL EQUIPMENT (DME)

• State Plan Option Service
• Recipients in any Waiver may receive any
  medically necessary DME available to the general
  Medicaid population.
• Specific documentation requirements and coverage
  criteria are in the DME Manual, Chapter IV.

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ASSISTIVE TECHNOLOGY (AT)

• Assistive Technology is a waiver service
• Examples
• Sensory Integration Equipment
• Computers
• Specialized software to facilitate communication

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Assistive Technology Under the DD Waiver
Definition

• Specialized medical equipment and supplies,
  including those devices, controls, or appliances
  specified in the CSP but not available under
  regular DME criteria.

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Assistive Technology Under the DD Waiver
Definition

• Assistive Technology are devices which enable
  individuals to increase their abilities to
  perform activities of daily living
• or
• to perceive, control, or communicate with the
  environment in which they live or which are
  necessary to their proper functioning.

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Equipment and Activities Under AT in the DD Waiver

• The equipment and activities are
• Specialized medical equipment and ancillary
  equipment, necessary for life support not
  available under the State Plan for Medical
  Assistance
• Durable or non-durable medical equipment and
  supplies (DME) not available under the State Plan
  for Medical Assistance

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Equipment and Activities Under AT in the DD
Waiver Contd

• Adaptive devices, appliances, or controls, or
  all, not available under the State Plan for
  Medical Assistance which enable an individual to
  be more independent in areas of personal care and
  activities of daily living
• Equipment/devices not available under the State
  Plan which enable an individual to communicate
  more effectively.

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AT Criteria

• Service is available to individuals who are
  receiving at least one other DD Waiver service.
• Equipment or supplies already covered under
  regular DME criteria may not be purchased under
  the DD Waiver Assistive Technology.
• Equipment/supplies must be purchased from a DMAS
  approved Assistive Technology provider.

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Provider Requirements

• Assistive Technology and Environmental
  Modifications can be provided by companies with a
  Durable Medical Equipment(DME) provider agreement.

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Evaluation of Need for Assistive Technology

• Each individual must be evaluated to determine
  the need for Assistive Technology, and to
  recommend specific items to address the
  identified needs.

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Evaluation of Need for Assistive Technology

• An independent consultation must be obtained for
  each AT request prior to approval by DMAS.
• All assistive technology items must be prior
  authorized by DMAS.
• The Consultation needs to discuss the benefits of
  each item recommended for the individual

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Evaluation of Need for Assistive Technology

• Independent consultants include
• speech/language therapists
• physical therapists
• occupational therapists
• physicians
• behavioral therapists
• certified rehabilitation specialists, or
  rehabilitation engineers. 

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Pre-Authorization of AT Items

• Each item requested in the CSP must be
  specifically recommended by the appropriate
  professional
• Each item must be approved by DMAS on the CSP,
  and listed in the evaluation report or supporting
  documentation from the appropriate medical or
  rehabilitation professional.

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AT Criteria Contd.

• A Rehabilitation Engineer may be utilized if, for
  example
• The assistive-technology will be initiated in
  combination with environmental modifications
  involving systems which are not designed to go
  together or
• An existing device must be modified or a
  specialized device must be designed and
  fabricated.

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AT Service Units and Service Limitations

• Service must be prior authorized by DMAS
• Service unit is the total cost of the item
• And/or Supplies or hourly labor costs for
  Rehabilitation Engineering.

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Evaluation must match the pre-authorization
request

• Recommendations by the appropriate professional
  for items covered under assistive technology must
  include the specific items needed by that
  individual.
• The documentation must justify the need for each
  item listed on the invoice from the provider and
  be included with the pre-authorization request

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AT Service Units and Service Limitations Contd

• Maximum expenditure is 5000.00 per calendar year
  
• Costs for AT shall not be carried over from year
  to year

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AT Provider Documentation Requirements

• Supporting documentation that describes the need
  for the service (CSP), the process to obtain this
  service (contracts with potential
  vendors/contractors of service, etc.) and the
  time frame during which the service is to be
  provided
• DMAS 122 and CSP from Support Coordinator
• Separate notation of evaluation by an appropriate
  professional.

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AT Provider Documentation RequirementsCont.

• Documentation of the need for a Rehabilitative
  Engineer if one is needed (if disability
  expertise is required that a general contractor
  will not have)
• Documentation that the item is not covered by the
  State Plan for Medical Assistance under DME or is
  not available from a DME provider.

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Provider Documentation RequirementsCont.

• Documentation of the date services are rendered
  and the amount of service needed
• Any other relevant information about the device
  or modification, including family contacts, as
  appropriate

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Provider Documentation Requirements Cont.

• Documentation in the Support Coordination record
  of notification by the individual or individuals
  parent or legal guardian of satisfactory
  completion of the service.

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Example of DME

• Patient Lift HCPCS E0630
• 1.) Recipient-based outcome anticipated to
  stabilize the recipients medical condition by
  getting recipient up twice a day.
• 2.) Supportive Activities to Accomplish Outcome
  (must document all of the following)
• Part of care plan (use up to twice a day)

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Example of DME Contd

• Recipient/caregiver knows how to use the lift.
• Alternatives did not work (caregiver is unable to
  lift recipient out of bed twice a day).
• Recipient has no health condition that prohibits
  the use of the lift.
• Equipment reduces the need for other services
  (nurses aide).

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Example of AT Purchase

• A hand-held shower device is not covered under
  the State Plan for Medical Assistance (regular
  DME criteria). However, it could be needed to
  assist the individual in performing activities of
  daily living.

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Example of AT Purchase

• Documentation required to obtain the device
• Need for the shower device must be documented in
  the individual Service Plan (CSP) and supporting
  documentation.
• Itemized quotes are required when providing AT/EM
  quotes to DMAS, Drawings of the modification
  proposal may be used to clarify home
  modifications

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Example of AT Purchase

• The Invoice from the vendor should indicate the
  supply cost of item.
• documentation of the applied 30 mark up above
  supply cost (to the vendor) will equal cost on
  the CSP.
• Evaluation report from an Occupational Therapist
  or Rehab engineer suggesting a specific model of
  hand held shower to support the needs of the
  individual

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Documentation RequirementsCont.

• Documentation of the cost of the device and
  installation cost, if needed.
• Documentation in the record that this is a
  non-covered device under the State Plan.
• Date the device is provided to the individual.
• Documentation of the individuals satisfaction
  with the device.

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Documentation RequirementsCont.

• Instruction on warranties and service agreements
• Instruction on repairs and complaints

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Environmental Modifications
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Environmental Modifications

• Under the State Plan for Medical Assistance,
  home and environmental modifications are
  non-covered services
• Under the State Plan for Medical Assistance,
  items solely for safety and/or convenience of the
  individual are non-covered services

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Definition of Environmental Modifications

• Environmental modifications are physical
  adaptations to a house, place of residence,
  vehicle, or work site, when the modification
  exceeds reasonable accommodation requirements of
  the Americans with Disabilities Act, necessary to
  ensure individuals health and safety or to
  enable functioning with greater independence.

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Definition of Environmental Modifications..Cont.

• The adaptation is not to be used to bring
  substandard housing up to standard
• The adaptation is to be of direct medical or
  remedial benefit to the individual
• Environmental modifications are available to
  individuals receiving at least one other waiver
  service

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Definition of Environmental Modifications Cont.

• The need for the adaptation must be documented in
  the individual Service Plan (CSP)
• The adaptation must be necessary to ensure the
  health, welfare, and safety of the individual or
  enable the individual to function with greater
  independence in the home, and without which, the
  individual would require institutionalization.

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Environmental ModificationExclusions

• Adaptations or improvements to the home that are
  of general utility and not of direct medical or
  remedial benefit, such as carpeting, roof repair,
  central air conditioning, etc.

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Modifications and Activities

• All adaptations must be provided in accordance
  with applicable state or local building codes.
• Modifications and activities are
• Physical adaptations to a house or place of
  residence necessary to ensure an individuals
  health or safety (installation of specialized
  electric and plumbing systems to accommodate
  medical equipment).

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Modifications and Activities Contd

• Physical adaptations to a house or place of
  residence that enable an individual to live in a
  non-institutional setting and to function with
  greater independence (ramps, grab bars, widening
  of doorways, modifications to bathroom
  facilities, etc)
• Environmental adaptations to the work site.

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Modifications and Activities Contd

• Modifications to the primary vehicle used by the
  individual (car or van)

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Criteria to Receive Environmental Modifications

• Demonstrated need for the modification as a
  medical or remedial benefit in the individuals
  home, vehicle, community activity setting, or day
  program.
• The modification cannot be covered under the
  State Plan for Medical Assistance, or another
  program, such as DRS, or the Consumer Service
  Fund.

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CriteriaContd

• A Rehabilitation Engineer may be used to evaluate
  the individuals needs and act as project
  manager.
• A Rehabilitative Engineer may design and complete
  the modification.

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CriteriaContd

• A Rehabilitation Engineer may be required if (for
  example)
• The environmental modification involves
  combinations of systems which are not designed to
  go together or
• The structural modification requires a project
  manager to assure that design and functionality
  meet ADA accessibility guidelines.

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Service Units and Service Limitations

• Must be prior authorized by DMAS
• Cap of 5000.00 per CSP year.
• Costs for EM can not be carried over from year to
  year.

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Provider Documentation Requirements

• Supporting documentation that outlines the need
  for the service (CSP), the process to obtain this
  service (contracts with potential
  vendors/contractors of service, etc.) and the
  time frame during which the service is to be
  provided.
• DMAS 122 and CSP from support coordinator

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Provider Documentation Required..Contd

• Separate notation of costs for evaluation/design,
  labor, and supplies/materials.
• Documentation in the CSP of the reason a
  Rehabilitation Engineer is needed, if involved.

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Provider Documentation RequiredContd

• Documentation of the dates of service and amount
  of service.
• Documentation of any other relevant information.
• Documentation of notification by the individual
  or individuals parent or legal guardian of
  satisfactory completion of the service.

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Provider Documentation RequiredContd

• Instructions regarding any warranty and servicing
  that may be needed.
• Instructions regarding complaints and repairs.

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Example of Environmental Modification

• Wheelchair ramp
• Non-covered service under the State Plan for
  Medical Assistance (DME criteria).
• Covered service under the DD Waiver
• Documentation requirements
• Included in CSP as needed service
• If Rehabilitation Engineer is needed, document
  need in CSP.

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Example of E-ModContd

• Documentation regarding the timeline for
  completion of the individual components of the
  service
• Documentation of date of service and cost of
  installation and supplies for the ramp.
• Itemized quotes are required when providing AT/EM
  quotes to DMAS, Drawings of the modification
  proposal may be used to clarify home
  modifications

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Example of E-Mod Contd

• Documentation of notification by the individual
  or individuals parent or legal guardian of
  satisfactory completion of the service.
• Instructions regarding any warranty and servicing
  that may be needed.
• Instruction on complaints and repairs.