Assistive Technology Act Projects
2001 State Legislative and Policy Report
The Assistive Technology Act of 1998 (AT Act—P.L. 105-394) provides discretionary grants to assist states in the development and implementation of comprehensive programs of technology-related assistance for adults and children with disabilities. All 50 states, the District of Columbia, Puerto Rico, American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands are operating consumer-responsive assistive technology projects (AT Act Projects). The AT Act requires these Projects to examine the barriers that are preventing individuals with disabilities from accessing and obtaining assistive technology (AT), and to reduce or eliminate those barriers. Oftentimes legislation, regulations, policies, practices, and organizational structures impede individuals from accessing AT devices and services. Therefore, there is a need for capacity building and advocacy in these areas.
The National Institute on Disability and Rehabilitation Research (NIDRR), Office of Special Education and Rehabilitative Services of the U.S. Department of Education, administers the AT Act program. A listing of AT Act Projects can be accessed at www. resna.org/taproject, the Web site for the RESNA Technical Assistance Project.
During the 12 years that the AT Act Projects have been in existence, the Projects have concentrated on developing, implementing, and monitoring legislation, policies, practices, and organizational structures to overcome barriers and to make information technology (IT) and AT devices (see note) and services more accessible for individuals with disabilities at home, at school, at work, and in the community. This report focuses on the many AT legislative initiatives, policies, and regulations that State AT Act Projects worked on during 2001, in collaboration and coordination with other agencies and organizations. Although the legislative work of State AT Projects includes the development and support of new legislation, much of the states' activities are focused on monitoring the implementation of existing laws and policies to ensure that AT services are provided to individuals with disabilities, and to guard against any erosion of current AT services. Thus, while many State AT Projects may need to develop or support new legislation concerning AT in a given year, new AT legislation would not be needed in every state each year.
This report describes the legislative and policy achievements of State AT Projects in a number of areas including Health Care, Telecommunications, Employment, Funding, Community Living, and Education. This report is not an exhaustive listing of all AT legislative and policy work for every State AT Project but rather a representative record of these activities. The work of individual State AT Projects highlighted in this report will serve to illustrate similar work accomplished by many other states in meeting the AT and IT needs of individuals with disabilities. (In this report, the term "State AT Act Projects" refers to the AT Projects in all states, the District of Columbia, and outlying areas).
In 2001, State AT Act Projects have secured specific legislative and policy changes in the following areas:
- Included assistive technology coverage in Medicaid waivers.
- Increased reimbursement rates for Medicaid providers of AT services.
- Broadened hearing aid and durable medical equipment (DME) coverage in private insurance.
- Worked to insure access for people with disabilities to state information technology (IT) services and provided valuable assistance to state information technology officers in complying with Section 508 of the Rehabilitation Act.
- Developed state electronic and information technology standards or adopted Section 508 IT access standards as state policy.
- Expanded a state telecommunications equipment distribution program for persons with disabilities.
- Ensured the accessibility of One Stop Career Centers for persons with disabilities.
- Established state Medicaid Buy-In programs implementing the federal Ticket to Work and Work Incentives Improvement Act (TWWIIA). Medicaid Buy-In options extend Medicaid coverage to certain workers with disabilities who qualify for this program.
- Expanded individual development accounts to include savings for assistive technology.
- Helped to secure increased funding for alternative financing programs and low-interest loan programs that allow consumers alternative private means to finance assistive technology and home modifications.
- Increased funding for state AT programs to continue strong state assistive technology networks.
- Helped press for sales tax exemptions for durable medical equipment and assistive technology.
- Encouraged the development of home and community based Medicaid services that include access to assistive technology devices and services and worked to encourage compliance with the U.S. Supreme Court’s Olmstead decision.
- Encouraged the inclusion of universal design features in new home construction and in-home modifications.
- Worked to allow for the portability of AT devices; this ensures that AT equipment purchased in one school district will go with a student when the student moves to another school district.
ASSISTIVE TECHNOLOGY ACT PROJECTS'
2001 STATE LEGISLATIVE AND POLICY REPORT
The AT Act Grantees have promoted access to assistive technology (AT) devices and services by encouraging state legislative activities and regulatory changes. Below are highlights of states' 2001 legislative and policy accomplishments.
Although in many instances, AT Act Projects, in collaboration with other state agencies, community-based groups, and consumers, were able to secure the passage of legislation, policies, or regulations to improve AT services for individuals with disabilities in 2001, sometimes the states' efforts did not result in immediate changes. Efforts by State AT Projects to introduce new AT proposals are notable, however, whether or not they are successful. These initiatives are important because they introduce state and legislative officials to new ideas or ways to increase or enhance access to AT devices and services for individuals with disabilities. Often, a policy or regulation that does not pass immediately will gain approval in a subsequent year or legislative session. Additionally, each state's efforts, whether successful or not, are watched by other states and often are successfully emulated in other states.
As mentioned in the Executive Summary, the initiatives in this report provide a "snapshot" of just one aspect of State AT Projects' work under the AT Act of 1998. Information about other aspects of State AT Projects is available in the publication, Accomplishments of State Assistive Technology Projects, 1999-2001: Providing Assistive Technology for Employment, Community Living, Telecommunications, Education, and Health Care, published by the RESNA Technical Assistance Project, Arlington, Virginia, 2001.
Medicare and Medicaid
Medicare is one of the largest, if not the largest single payer for durable medical equipment, and sets the standards for health insurance coverage of assistive technology both in private health insurance and in the Medicare program. Medicaid impacts millions of children and adults with disabilities in all states and currently provides authority for coverage for a full range of AT. These programs are administered by the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration).
Arkansas. Changes in the Arkansas state Medicaid program have enhanced the ability of Arkansans to obtain AT. The types of AT covered under the Aging and Adult Waiver for people with physical disabilities has been expanded to include "independence" items that could be used outside the home, such as vehicle modifications and van lifts, that were previously not covered by Medicaid. Arkansas Increasing Capabilities Access Network (ICAN), the State AT Act Project, also worked with Medicaid to change procedures accessing these funds. Clients now may access up to five years of technology funding in advance. This permits persons to combine funding over a range of years to purchase more expensive items. This expands the options and choices that beneficiaries have available to them.
Georgia. Georgia Tools for Life, the State AT Project, supported the "Unlock the Waiting Lists" Campaign that was successful in obtaining additional home and community based services under Medicaid waivers. Increases in services have been obtained under independent care/traumatic brain injury waivers, community care services program, and mental retardation waivers. Georgia's tobacco settlement was used to fund these waivers.
Indiana. Assistive Technology Through Awareness in Indiana (ATTAIN) collaborated with the Arc of Indiana and other organizations to increase the number of autism waivers funding for the next biennium by 200 slots. Access to AT is included in the autism waiver.
ATTAIN was successful in ensuring AT as a covered service for each of the state's Medicaid Waiver programs: Children's Medically Fragile, Autism, Aged and Disabled, Intermediate Care Facility for Mental Retardation (ICFMR), and Traumatic Brain Injury. The Bureau of Aging and In-Home Services, the agency overseeing the Medicaid Waiver program in Indiana, agreed to pursue having AT assessments become a service that is reimbursed by Medicaid under the waiver program as waiver programs come up for renewal through the federal Centers for Medicare & Medicaid Services (CMS).
Missouri. The Missouri Medicaid reimbursement rate for hearing aids for adults was increased this past year. The previous rate was so low that adults in need of hearing aids often found themselves unable to find vendors willing to take Medicaid.
Oklahoma. Oklahoma ABLE Tech successfully worked for adequate funding for HB 1518, Appropriations for Various Health Service Agencies, which ensures Medicaid provider rate increases. This increase will enhance all service delivery to Medicaid recipients including AT services. Oklahoma was successful in obtaining this rate increase. The approved budget also funded the Tax Equity and Fiscal Responsibility Act (TEFRA) as a part of the state Medicaid Plan for the first time in Oklahoma. TEFRA is a category of Medicaid that provides care to certain disabled children in their homes rather than providing care for them in institutions. This program formerly was known as the Katie Beckett waiver.
In February 2001 the State of Oklahoma Department of Human Services, Developmental Disability Service Division (DDSD), increased eligibility for the Home and Community Based Waiver and the In-Home Support Waiver to include children ages three to five. Prior age eligibility had been six years of age. These waivers extend Medicaid services to children with severe disabilities, using the child's income not the parents'; thus, the policy extends Early and Periodic Screening, Diagnosis and Treatment (EPSDT) to a new population. It also extends coverage to include items that are not paid for by Medicaid, such as home modifications or vehicle modifications.
Pennsylvania. Pennsylvania's Initiative on Assistive Technology (PIAT) staff worked with a coalition of human services advocates to ensure that AT would be a covered benefit under new health care programs established and financed with Pennsylvania's tobacco funds (from the Tobacco Settlement Act, Act 77 of 2001). As a result, AT is a covered benefit in the Adult Basic Coverage (ABC) Insurance program (subsidized basic health care insurance for uninsured adults ages 19 to 64 who have incomes under 200% of the federal poverty level). AT now is a covered benefit in the Medical Assistance Workers with Disabilities (MAWD) program (at least 16 years of age, less than 65, employed and receiving compensation, have countable income below 250% of the federal poverty level and have $10,000 or less in countable resources).
PIAT staff worked with a coalition of human services advocates and the Department of Public Welfare to expand home and community-based waivers to additional populations. These waivers include the provision of resources for assistive technology (including home modifications). Such waivers include the new PA Department of Aging's Assistive Technology/Risk Reduction Home Modification Program, and expansion with additional dollar allowances for the Office of Social Program's Independence Waiver.
Texas. The Texas Technology Access Project helped expand health insurance coverage, including DME and AT related services, for uninsured children and adults through supporting successful Medicaid eligibility simplification legislation. This legislation eliminates barriers to Medicaid enrollment that are not necessarily based on federal law. The AT Project also supported legislation requiring the state to study TEFRA options to provide Medicaid coverage for children with severe disabilities at risk of institutionalization whose parents do not qualify for Medicaid due to "excess" income and resources. This legislation was not signed by the governor.
The Texas project also worked to increase Medicaid managed health and long-term care access and quality for children and adults with disabilities and special health care needs, including AT-related benefits, through legislation. The legislation however, was not signed by the governor. It would have required increased public participation and oversight of Medicaid managed care as well as improved the process for identifying adults and children with disabilities and chronic conditions to ensure appropriate services.
West Virginia. The West Virginia Assistive Technology System (WVATS) encouraged modification of the state Medicaid Home and Community based waiver program to include environmental accessibility adaptations as a service category. This is the first waiver program in the state to include technology.
Wyoming. The Wyoming state legislature approved the expansion of the Medicaid waiver program to include assisted living facilities, an increase in the number of home and community-based waivers available, and Medicaid coverage that is more extensive, including the purchase of assistive technology equipment and services. Wyoming's New Options in Technology (WYNOT) supported these efforts.
State Children's Health Insurance Program (SCHIP)
The State Children's Health Insurance Program (SCHIP) provides new funds for states to cover uninsured children. This program was created under the Balanced Budget Act of 1997 and represents the largest single expansion of health insurance coverage for children and seeks to improve the quality of life for millions of vulnerable children who are under 19 years of age.
Indiana. Assistive Technology Through Awareness in Indiana (ATTAIN) and the Council of Volunteers and Organizations of Hoosiers with Disabilities (COVOH) worked in collaboration with the Indiana Hospital Association and Children's Health Insurance Program (CHIP) to expand CHIP services under SB561 to include uninsured parents by utilizing the Hospital Indigent Fund. The collaboration was also successful in ensuring the inclusion of durable medical equipment (DME) and AT as covered benefits under CHIP. The enrollment in CHIP has exceeded expectations. As a result, benefits are expected to decrease as enrollment increases. ATTAIN will monitor to ensure DME will continue as part of the benefits package.
Texas. The Texas Technology Access Project successfully opposed attempts to reduce the state's CHIP benefits package, including substantial DME/prosthetics benefits.
Private insurance is an important payment source for certain types of assistive technology that are classified as durable medical equipment. With this payment source it is not always clear what types of equipment are covered, who is eligible for coverage, and who makes the approval decisions.
Kansas. The Assistive Technology for Kansans Project encouraged a change in the cap for durable medical equipment (DME) in private insurance. As of February 2001, durable medical equipment (DME) is now covered for children ages 3-5, and for individuals over the age of 21.
Indiana. Assistive Technology Through Awareness in Indiana (ATTAIN) assisted with the successful passage of SB 229 to establish a health care educator in the department of insurance to educate individuals about policy coverage and about the grievance procedures available when coverage has been denied, such as DME and AT.
Other legislation (SB 365) was passed this session. It provides for a health insurance grievance review process both internally and externally for individuals who have been denied health care coverage by all insurance policies except for those under the Employee Retirement Income Security Act (ERISA).
Missouri. Both the House (HB 341) and the Senate (SB 285) saw the introduction of bills that would require health insurers and managed care entities to provide coverage for hearing aids. Among the bill's stipulations were that hearing aid benefits should not be subject to any greater deductions or co-payments than those for other similar services provided by the plan.
Texas. The Texas Technology Access Project supported legislation to establish a health benefits consumer assistance program in the office of public insurance counsel. This legislation was not signed by the governor. This program would have assisted consumers who wish to appeal the denial, termination, or reduction of healthcare services by a health plan, including Medicaid and Medicare.
Recycling is a process that takes used, excess, or abandoned equipment and refurbishes and redistributes it. Reused AT creates a supply of equipment that is less expensive than new devices.
Kansas. The Assistive Technology for Kansans Project has developed a pilot program to study the feasibility of reusing DME in conjunction with Kansas Medicaid. Legislators and state officials have expressed interest in this effort.
South Dakota. For the past two years $1.2 million has been authorized for AT devices and services to support individuals with specific neuromuscular disabilities, specifically for individuals with amyotrophic lateral sclerosis, multiple sclerosis, and muscular dystrophy. As many of the individuals served under this program have a very limited life expectancy, many AT devices have been returned and are being recycled to other individuals. This year, $240,000 was authorized to pick up equipment no longer needed, to refurbish and redistribute it, and to provide training in its usage. This new authorization will provide funding for the program's third year. South Dakota Assistive Technology Project (DakotaLink) is the primary provider for the delivery of this neuromuscular program and DakotaLink provides services to more than 160 neuromuscular clients.
Section 508 of the Rehabilitation Act and State Agencies
In 1998, Congress amended the Rehabilitation Act and strengthened provisions covering access to information in the federal sector for people with disabilities. As amended, Section 508 of the Rehabilitation Act requires access to the federal government's electronic and information technology. The law applies to all federal agencies when they develop, procure, maintain, or use electronic and information technology. Federal agencies must ensure that this technology is accessible to employees and the public. The law directs the federal Access Board to develop access standards that will become part of the federal procurement regulations. State AT Projects now are ensuring that the electronic and information technology of state and state-assisted agencies also meets federal Section 508 standards. In doing so, states will provide access to the state's electronic information and data for individuals with disabilities.
Arizona. Broad-based support was achieved for the passage of SB 1397, which ensured applicability of Section 508 to state agencies. This bill was approved by the Senate Government Committee, but died in the Appropriations Committee. Arizona Technology Access Program (AzTAP) reported that the bill would be tried again in the next session, which began in January 2002. AzTAP, working with several groups as part of the Arizona Accessible Website Workgroup, was influential in the development of Section 508 information technology accessibility standards for state government agencies. These standards emphasize accessible Web sites.
Indiana. Access to Information Technology (HB 1926) was passed this session. Through this legislation, the Information Technology Oversight Commission is charged with developing state standards that comply with federal Section 508 standards, as defined in the statute. All public agencies will be responsible for complying with the Indiana standards. Assistive Technology Through Awareness in Indiana (ATTAIN) will provide training to consumers and state agencies regarding information access and continue to assist individual state employees with disabilities in obtaining access to electronic and information technology.
Kentucky. After passage in the 2000 General Assembly, Kentucky's Accessible Information Technology Law (KRS 61.980-988) was implemented on June 21, 2001. This was the date of enforcement for the federal Section 508 accessibility standards to which Kentucky law was linked. The Kentucky Assistive Technology Services (KATS) Network is taking a leadership role to facilitate information dissemination about the law's requirements for accessible information technology at the state level and to provide technical assistance for its implementation. This single piece of legislation will have a major impact on the future provision of AT and IT in Kentucky.
Louisiana. The Louisiana Assistive Technology Access Network (LATAN) advocated for accessible information technology at the state level. As a result, LATAN is named as a mandated agency, through legislation, to be included on the Advisory Council on Technology Access for Individuals with Disabilities. This Council advises the state Chief Information Officer regarding IT accessibility. The Council is required to be composed of at least a majority of individuals with disabilities.
Missouri. Based on a Missouri state statute (RSMo 191.863), Missouri Assistive Technology Project (MoAT), in conjunction with the Missouri Office of Information Technology, has responsibility for developing a set of information technology standards for application to Missouri state government and higher education entities that are defined as covered entities. Among the information and electronic information technology areas to be covered by these standards are software applications, operating systems, Web site design, and telecommunication products. Section 508 standards as developed by the federal Access Board have been reviewed by the state's Information Technology Advisory Board. The Board and MoAT are planning to adopt and adapt these standards into a larger state IT access standards document developed for the implementation of e-government.
North Dakota. The information technology division now has been made an executive branch of state government. The Chief Information Officer has initiated a task force to look at accessibility issues. Individuals on the task force include a consumer advisory representative, a protection and advocacy (P&A) attorney, the ADA State coordinator, and the project director of the North Dakota Interagency Program for Assistive Technology (IPAT). This taskforce has been meeting since early 2001. The priorities of the taskforce are: Web sites, phone systems, state procurement guidelines, training, and 508 standards as state policy. Section 508 standards for Web sites already have been accepted as statewide policy to be implemented by all state agencies. The governor has signed off on the Web site accessibility policy.
West Virginia. The Information Technology Access Act (SB 476) was passed in West Virginia in 2001. This bill requires access to information technology for individuals who are blind or visually impaired through state procurement of needed technology. The bill requires all purchases to be made in accordance with standards for equivalent access of both visual and non-visual means. The director of the purchasing division of the Department of Administration now is responsible for proposing legislative rules to set standards to create contractual language requiring all devices of information technology purchased by the state to meet equal access standards. WVATS and advocacy groups in West Virginia plan to broaden the language of the IT Access Act to include other disabilities.
Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.
Texas. Texas Technology Access Project supported successful legislation to establish telehealth pilot programs for certified health professionals, acting within their scope of practice. This plan will allow AT practitioners to more efficiently reach clients with disabilities.
Telephone Distribution Program
This type of program provides "special telephone equipment" free to persons with hearing, speech, or other disabilities. The programs usually are funded by a surcharge levied on all telephone subscribers. Different programs provide different equipment for different disabilities. Examples of equipment may include amplified handsets, light signalers, hands-free telephones, and TTYs.
Arkansas. Act 530 passed and expanded the Arkansas Rehabilitation Services Telecommunications Access Program to include the purchase of telecommunications systems for anyone with a disability. The original legislation allowed deaf/blind, deaf, hard of hearing and speech impaired access. This program is funded by a tariff on telephone lines. Arkansas Increasing Capabilities Access Network (ICAN) developed information about the bill to educate legislators and the governor's staff and testified at both Senate and House committee meetings.
Iowa. The Iowa Program for Assistive Technology (IPAT) began working with a coalition on legislative changes needed to expand the Telephone Equipment Loan Program service to include any person with a disability. The current program only provides vouchers for a "core" group of consumers, which is limited to persons with hearing or speech problems. IPAT has provided technical assistance about the expansion to the Iowa Utilities Board, which is responsible for administering the program.
Pennsylvania. Pennsylvania's Initiative on Assistive Technology (PIAT) has worked with the General Assembly to expand the definition of "disability" under the Telecommunications Device Distribution Program to include all people with disabilities who require technology to independently access telecommunications services.
Texas. The Texas Technology Access Project helped increase the availability of basic telephone access equipment to individuals with all types of disabilities by supporting successful legislation that removed application fees for the specialized telecommunications assistance program and which increased program marketing and outreach activities.
Many state governments are delivering government services through the Internet that is accessed via computers at home, work, school, or in the community. These online services may provide access to some individuals, but may also present barriers to others.
Indiana. Assistive Technology Through Awareness in Indiana (ATTAIN) supported HB 1100, which passed in 2001 and provides for audio and video Internet coverage of the Indiana General Assembly. This coverage will allow citizens of Indiana, including those with disabilities, increased access to the legislative process.
One Stop Career Centers
"One Stop" centers provide individuals with information about, and access to, job training, education, and employment services at a single neighborhood location.
Georgia. The Georgia Department of Labor requested over $400,000 to make all 53 of the state's One Stop Career Centers (Work Force Investment Act) accessible to persons with disabilities. Georgia Tools for Life provided information about the need for accessible centers and also advised on the equipment to be purchased for the One Stop Centers.
Indiana. Assistive Technology Through Awareness in Indiana (ATTAIN) obtained a $20,343 grant to develop and provide program accessibility guidelines to the 15 One Stop Centers in the state and to assess them for compliance with these guidelines. Vocational Rehabilitation Services and the One-Stop Centers of Indiana provided the grant.
Ticket to Work and Work Incentives Improvement Act (TWWIIA)
This Act seeks to address many of the obstacles faced by people with disabilities as they seek sustained employment. It expands Medicare and Medicaid coverage for certain categories of employed individuals with disabilities. This is significant because individuals with disabilities have continually identified "loss of health care coverage" as one of the major problems that needs to be overcome to allow them to return to the nation's work force.
Arkansas. Arkansas Increasing Capabilities Access Network (ICAN) worked with Medicaid to develop the rules and regulations for an Arkansas Medicaid Buy-In Program for working adults with disabilities. The program provides for, among other things, the availability of a special savings account (up to $10,000) for the purchase of essential items such as technology. This program was implemented in March 2001.
Indiana. Assistive Technology Through Awareness in Indiana (ATTAIN), Council of Volunteers and Organizations of Hoosiers with Disabilities (COVOH), and the Indiana Medicaid Action Coalition (IMAC) collaborated to pass the Ticket to Work and Work Incentives Improvement Act (TWWIIA), HB 1950. This legislation establishes a Medicaid Buy-In program that allows individuals to earn up to 350% of the federal poverty level to retain their Medicaid, including AT benefits, while working. This legislation also includes a provision for individuals to continue to be eligible for Medicaid as they accrue up to $20,000 in retirement, independence, and self sufficiency accounts for use in acquiring AT and other items.
Kansas. Persons with disabilities seeking employment face the loss of medical coverage when earned income makes them ineligible for Medicaid, and when preexisting conditions prevent them from accessing their employers' health insurance. Assistive Technology for Kansans Project (ATK) participated in successful advocacy efforts led by the State Independent Living Council of Kansas and other disability organizations to support passage of Medicaid Buy-In by the state legislature. ATK is providing input into the new regulations and implementation of the Buy-In program. ATK is interested in provisions of the program that include coverage of durable medical equipment as outlined in the existing state plan.
Missouri. SB 236, which included Medicaid Coverage for the Working Disabled, passed in 2001. This legislation is part of Missouri's blueprint for implementation of the Ticket to Work and Work Incentives Improvement Act. The bill includes a provision that will allow individuals who had been receiving Medicaid to keep their coverage (up to 250% of the poverty rate) in the event they are able to gain employment. This ensures that AT Medicaid benefits will be continued.
Ohio. The AT Ohio Project worked with a coalition of other organizations toward the adoption of the Medicaid Buy-In portion of the Ticket to Work and Work Incentives Improvement Act. A joint legislative Ticket to Work Program Evaluation Committee recommended in its final report that Ohio establish a Medicaid Buy-In program. Because of tight budget constraints, administrative start-up costs were not included in the biennial budget bill. The Ohio Department of Job and Family Services, however, currently is conducting two studies (funded by a Medicaid Infrastructure Grant from the federal Centers for Medicare & Medicaid Services) to evaluate the administrative changes required to implement a Medicaid Buy-In program in Ohio and to study the implication of adding personal care as an optional Medicaid state plan service. AT Ohio and other coalition members will work to ensure that the Buy-In option is included in the next biennial budget.
Oklahoma. Oklahoma ABLE Tech worked to pass HB 1484, a Medicaid Buy-In option under the Ticket to Work and Work Incentives Improvement Act (TWWIIA) program. No appropriations were passed for this option. Without funding there likely will be no change. ABLE Tech and a coalition will continue working to obtain the passage of appropriations for the Buy-In option. The state Medicaid agency has just received a TWWIIA grant, which should provide the needed funding.
Texas. The Texas Technology Access Project shared leadership in gaining successful legislation to authorize a state Medicaid Buy-In under the federal Ticket to Work and Work Incentives Improvement Act for. The Buy-In includes coverage benefits for durable medical equipment (DME). The legislation also directs the state to apply for a Medicaid Infrastructure Grant (MIG). The MIG will be used for Buy-In development and evaluation as well as planning for improved employment supports, including technology and personal assistance services, for workers with disabilities. The state Medicaid agency has asked the Texas project to participate in MIG oversight.
Alternative Financing Mechanisms
Alternative financing mechanisms are programs created by states to provide for the purchase of assistive technology devices and services by persons with disabilities.
Kansas. Assistive Technology for Kansans Project (ATK) was active in the successful passage of SB 332, which authorized Individual Development Accounts (IDA) to cover assistive technology. Kansas is the first state to give permission for the use of individualized development accounts for AT. In Kansas, individuals who earn 200% of poverty or less are able to save earned dollars that are matched on a one-to-one or greater ratio for four primary purposes: home ownership, education and training, micro-enterprise, and now assistive technology. This permits the individual to save for AT and not have these dollars count against asset determinations. Business and corporate partner donors must be found to support the matched dollars. Despite the $200 million shortfall in the state legislature, a phase-in has been extended for tax credits for donors to this program.
New Mexico. The New Mexico Technical Assistance Project (NMTAP) requested a special appropriation of $535,000 from the state legislature. This appropriation was targeted for the expansion of the Project's AT loan program, which was started in 1998. This program has been operating out of the NMTAP and has provided a number of very successful long-term, low interest loans for purchases of AT and vehicle modification. The governor vetoed the special appropriation bill, despite passage in both the House and the Senate. A renewed effort for an appropriation will be made in 2002.
Pennsylvania. As a result of Pennsylvania's Initiative on Assistive Technology (PIAT) staff work with the state administration and the General Assembly, the FY 2001-2002 budget included $890,000 for the Assistive Technology Lending Library (a resource for Pennsylvanians of all ages and disabilities to borrow assistive devices for short-term loans before deciding which device to purchase); $1,061,000 for the Independence Capital Access Network (a grant program for small business owners, which provides up to $50,000 for necessary assistive technology devices for employees who have disabilities); $5,000,000 for the "Access" home modification program; and $400,000 for the loan guarantee program (PA Assistive Technology Foundation) for the purchase of AT devices and services. These same amounts are included in the proposed FY 2002-2003 budget (to be voted on in June 2002).
Texas. The Texas Technology Access Project supported successful passage of a $20 million state appropriations rider for "technology grants to assist persons with disabilities in communicating" to be funded through the state’s Telecommunications Infrastructure Fund. The Legislature’s intent is that these grants be given for the purpose of researching, developing, or implementing innovative technologies and telecommunications infrastructure specifically for use by persons with disabilities. The AT Project advocated that to the fullest extent possible, the funding should assist people at a hands-on, direct level through a wide range of technology and technology supports that meet individual needs.
State funding is an appropriation provided by a state legislature specifically for assistive technology services for persons with disabilities.
Arkansas. A permanent state assistive technology program was created with the approval of the Arkansas Rehabilitation Services Assistive Technology Plan. This AT Plan places the Arkansas Increasing Capabilities Access Network (ICAN) within the framework of the general Arkansas Rehabilitation Services agency.
Georgia. The Georgia Tools for Life Project received $209,000 for project staff to offset reduced federal funding. The Consortium of AT Resource Centers was successful in securing an additional $50,000 in state line-item funds for the regionally located resource centers.
Indiana. The Indiana Division of Disability, Aging, and Rehabilitative Services of the Family and Social Services Administration provided a $117,371 grant to Assistive Technology Through Awareness in Indiana (ATTAIN). This grant will help expand ATTAIN's state-of-the-art AT library by adding assessment services, short-term loans during the assessment phase, training, and demonstrations for individuals eligible for vocational rehabilitation services.
Louisiana. Louisiana's Assistive Technology Access Network (LATAN) worked on the Governor's Advisory Council on Disability Affairs, which has resulted in the inclusion of AT access as part of the Governor's Disability Strategic Plan. AT legislation also was included as part of the Governor's legislative package. This legislation was not passed.
Ohio. A $100,000 two-year grant ($50,000 per year) was appropriated to the Assistive Technology of Ohio (AT Ohio) Project for statewide AT activities. AT was included for the first time as a line item in the state biennial budget. AT Ohio will be working with the administration and the legislature to increase AT funding for the Project and for special education in the next budget.
Oklahoma. Oklahoma ABLE Tech received a new appropriation of $100,000 from the Department of Rehabilitative Services (DRS). The funding provides for assistive technology services for capacity building activities. This is the first year that funds were requested and it is likely that funding will continue in upcoming years. This funding also provided Oklahoma with the state match for the federal Alternative Financing Program under Title III of the AT Act. The AFP provides funds for a low-interest loan program for AT devices and services.
West Virginia. The West Virginia Assistive Technology System (WVATS) supported passage of the State Independent Living Act (SB 525), which established the statewide independent living (IL) council, and provides for a state plan for the provision of IL services, including AT services, to people with disabilities. This plan will be jointly developed by the council and the Division of Rehabilitation Services.
Tax credits for the purchase of assistive technology reduce the overall cost of technology for both individuals and businesses.
Iowa. The Iowa Program for Assistive Technology (IPAT), through a contract with AT Legal Services at the University of Iowa College of Law, wrote the administrative rules, procedures, and forms, for the implementation of the AT Tax Credit. This bill, which was passed in 2000, offers an annual $2,500 credit to businesses that purchase assistive technology or make modifications for employees with disabilities.
Missouri. HB 643, Tax Credit for AT Expenses and Home Access Modifications, was introduced but did not pass. It would have provided a tax credit for out-of-pocket assistive technology and home modification expenses accrued by individuals.
A tax credit for Universal Access and Visitability in Home Construction (HB 359), which would establish an income tax credit of $2,500 to individuals who build homes with a set of six universal design features, was introduced this session. The bill's intended outcome was to encourage the construction of more homes with accessibility features. This bill did not pass.
State Sales Tax Exemptions
Eliminating the sales tax on purchases of AT reduces the cost of an individual item, which in turn, makes the technology more affordable.
Ohio. AT Ohio worked successfully with legislators on HB 117, which expanded the sales and use tax exemption for items used to assist Ohioans with disabilities in operating motor vehicles or to modify motor vehicles for the transportation of wheelchairs.
Pennsylvania. Pennsylvania's Initiative on Assistive Technology (PIAT) was involved in the drafting of HB 21, which would exclude applying sales tax on equipment used to read or communicate. This bill did not pass last session. However the governor sponsored a "tax holiday" on computers and related software and peripherals during two one-week periods during the year.
South Dakota. South Dakota Assistive Technology Project (DakotaLink) worked to broaden the AT tax exemption beyond its current application for "medically necessary" equipment. The AT Project, together with the state's P&A agency, was unsuccessful in broadening the exemption in 2001. Activity on this issue will continue in 2002.
In July 1999, the Supreme Court issued the Olmstead v. L. C. decision. The Court's decision in this case clearly challenges Federal, state, and local governments to develop more opportunities for individuals with disabilities through more accessible systems of cost-effective community-based services. The Olmstead decision interpreted Title II of the Americans with Disabilities Act (ADA) and its implementing regulation, requiring States to administer their services, programs, and activities "in the most integrated setting appropriate to the needs of qualified individuals with disabilities."
Arkansas. Arkansas ICAN supported state resolution (SCR 7), which concerned Olmstead implementation. This resolution specifically described the incorporation of AT into the infrastructure to support movement of persons with disabilities out of institutions and into the community. As part of this effort, the home and community-based Waiver for persons with a developmental disability will be expanded from 2,000 individuals to 3,000 individuals over the next two years. Assistive technology is a key service available to recipients of this waiver.
ICAN was able to coordinate with the Governor's Olmstead Working Group to recommend the inclusion of a technology component in the ElderChoice Waiver, a home and community based waiver for the elderly. It is anticipated that this change will occur concurrently with the next waiver revision.
Indiana. Assistive Technology Through Awareness in Indiana (ATTAIN) was one of the groups that supported the 317 Plan, the Olmstead plan for the state, which received an additional $42.9 million in the 2001 legislative session. The 317 Plan assists individuals with disabilities living in institutional settings in moving into the most integrated setting within the local community. Currently there are more than 8,000 individuals on a waiting list to receive services through the Choice waiver program that moves people into the community. AT is an integral tool for individuals who live in the community.
Iowa. A diverse coalition, including the Iowa Program for Assistive Technology (IPAT), introduced the Personal Assistant Services (PAS) bill. The provision of AT was included in the PAS legislation by demonstrating a strong need for AT equipment and services to accomplish independence. The bill did not pass in 2001.
Louisiana. Louisiana Assistive Technology Access Network (LATAN) worked in partnership with many other agencies, organizations, consumers, and advocates on the implementation of the Olmstead decision in Louisiana. LATAN is a mandated partner, through legislation, of the Consumer Task Force, the lead group of the Disability Services and Supports System Planning Group, which is developing plans for long-term care and support in Louisiana.
Missouri. A Transition to Community Grant program is being established that will provide up to $1,500 to assist persons who are transitioning from a nursing home back into the community. The grants can assist with costs related to getting back into the community such as rent deposits or down payments, and other set-up costs. The state has sought grant monies to fund this program.
The state of Missouri has established a Personal Independence Commission to assist with Missouri's Olmstead Plan. The activities of this commission include facilitating communication and collaboration between state agencies and the disability community in providing persons with disabilities with home- and community-based options.
Texas. The Texas Technology Access Project worked within a broad coalition of disability advocates to support successful appropriations riders and legislation establishing the legislature's intent that funds follow persons leaving institutions for use in providing for community services and supports. This is a very significant step for the state, which has firmly held to separate funding for institutional and community services.
Home Modifications And Visitability
Home modifications, such as installing bathroom grab bars and ramps, and making doorways wider and kitchens easier to use, increase the likelihood that persons with disabilities are able to live more safely and comfortably in their residences. A current trend is to insert barrier free designs in new homes to ensure that the residents can be visited with little difficulty by persons with disabilities. The "visitable" home also increases the useability of a home if the able-bodied resident becomes disabled.
Kentucky. The Kentucky Assistive Technology Loan Corporation (KATLC) expanded its loan services in 2001. In addition to its original function of providing low-interest loans for the purchase of AT, the KATLC has entered into an agreement with the Kentucky Housing Corporation to provide additional loans to pay for home modifications such as ramps, accessible interior modifications, or the purchase of environmental controls for eligible individuals. Kentucky Housing Corporation's funding allocation for this program is $225,000. Kentucky Housing Corporation will lend up to $15,000 to qualified borrowers at a rate of four percent (4%) per annum for five (5) years. KATLC will process the applications, help determine eligibility, and assist the applicant in identifying a qualified contractor. This is a unique collaboration that greatly expands Kentucky's assistive technology loan program. Although KATLC is a stand-alone organization, it was originated as a Kentucky Assistive Technology Service (KATS) Network Initiative and continues to receive technical assistance from the state's AT Act Project.
Vermont. In 2001, the Vermont AT Project developed a visitability brochure to help inform architects, builders, remodelers' associations, municipalities, and lending institutions of housing visitability legislation passed in 2000 and of the many benefits for all people. The new law established areas in which many newly constructed houses must be made accessible to all.
The Individuals with Disabilities Education Act (IDEA) assures public education to students with disabilities. Under IDEA, school districts fund AT devices and services for children from 0 to 21 years of age.
Arizona. Arizona's AT Device Portability bill was introduced in the 2001 legislative session as part of the Omnibus Special Education bill. This bill would allow for AT devices purchased by one school district to follow the student when he or she moves to another school district. This bill died in committee.
Iowa. Iowa Program for Assistive Technology (IPAT) worked to expand the provision of AT devices and services to infants and toddlers with disabilities with successful passage of HB 462. This bill allows for the reimbursement of administrative costs directly to an Area Education Agency (AEA) for services provided by the agency under Part C of IDEA. AEAs are intermediate units that provide services to several school districts. This legislative change is significant because in past years these reimbursement costs were directed to the State General Fund, which created a disincentive for AEAs to deliver many Part C services, including AT services and devices.
Missouri. In 2001, both the Missouri House and Senate saw the introduction of bills that would have reimbursed school districts for excess costs incurred in educating students with sensory disabilities within local districts as opposed to sending them to the state's school for the blind or school for the deaf. Though neither bill passed, the Department of Elementary and Secondary Education received additional appropriations in the current Extraordinary Cost and Severe Disabilities Fund that are sufficient to provide this funding without legislation.
Oklahoma. Oklahoma ABLE Tech's AT Task Force recommended an increase in funding for special education for 2001. Although funding was not approved at the state level, Senate Resolution 1015 passed which "urged the President and Congress to fulfill the obligation to provide adequate funding for special education in the public schools."
Texas. The Texas Technology Access Project supported successful legislation creating a Master Technology certification program for public school teachers, including required competency in technology applications for students with disabilities. The Texas project also participated in rule development required in previous legislation (spearheaded by the project) to facilitate AT transfers with students who are changing schools or districts or making other transitions in which they would benefit from having continuing use of technology originally provided as part of their educational program.
Accessible Educational Technology
Educational media and materials used in the classroom need to be accessible to all students. Educational technology should be designed to provide multiple formats or to provide features that reduce the access barriers to benefit all students. Examples of features that enhance access include video captioning, audio descriptions of visuals, and allowing for voice recognition input.
Arkansas. Arkansas Increasing Capabilities Access Network (ICAN) supported Act 758, which passed in 2001, and requires anyone providing instructional books to post-secondary educational institutions to also provide these materials in a format that is compatible with commonly used braille translation and speech synthesis software.
Note: Assistive technology device means 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. Assistive technology service means any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device. 29 U.S.C. § 3002
Back to text
RESNA Technical Assistance Project, 1700 North Moore Street, Suite 1540, Arlington, VA 22209-1903. 703-524-6686 (V), 703-524-6639 (TTY), 703-524-6630 (FAX), http://www.resnaprojects.org/nattap.
This publication is available in alternative formats.
The RESNA Technical Assistance Project, Grant #H224B90005, is an activity funded by the National Institute on Disability and Rehabilitation Research (NIDRR), U.S. Department of Education (ED), under the Assistive Technology Act of 1998. The information contained herein does not necessarily reflect the position or policy of NIDRR/ED or the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), and no official endorsement of the materials should be inferred.
Back to Top