TIMELY ACQUISITION OF ASSISTIVE TECHNOLOGY
Consumers testifying on Capital Hill during reauthorization of the Tech Act told of lengthy waits for delivery of assistive technology devices ranging from six months to several years! It became evident that, despite the progress made since the enactment of the Tech Act legislation in 1988, there still remained a lack of coordination of systems that ensured timely acquisition and delivery of assistive technology devices and services, particularly with respect to children.
Barriers to timely acquisition include delays due to
This issue of the TAP Bulletin focuses on strategies to ensure timely acquisition and delivery of assistive technology devices and services, particularly for children.
Tech Act projects have been systematically working to pinpoint specific problem areas by:
STRATEGY: Equipment Programs
Many Tech Act projects have established equipment loan programs to provide immediate short-term loans of assistive technology devices directly to consumers who need them. For example, parents may borrow a variety of assistive technology devices to try-out with a child before making a purchase. Individuals who are temporarily disabled, or those who are waiting for delivery or repair of a device, may also have access to the equipment. Professionals may borrow equipment for purposes of client assessment or demonstration. Devices available through loan programs include augmentative and alternative communication devices, computers, switches and environmental control items, adapted toys, sensory aids, job accommodation items and devices for activities of daily living.
Equipment loan programs reduce time required for acquisition of needed devices and services; permit individuals to acquire hands-on experience with equipment before making a purchase; and, facilitate training associated with assistive technology devices and services through knowledgeable Tech project personnel located at regional/outreach centers.
Alternately, equipment exchange or recycling programs are other efficient methods to improve timeliness for persons who do not meet eligibility requirements to purchase new equipment through third party payers. For example, the New Jersey Technology Assistive Resource Program's Assistive Equipment Recycling Center, Back In Action, matches buyers with seller in three weeks, on the average, as opposed to six to twelve months if eligible for public funding for new equipment.
The Kentucky Assistive Technology Service Network (Tech Act Project) maintains an internet Web page to provide information and highlight availability of assistive technology equipment and services. The web site is all text and was designed by a person who is blind, and therefore, very accessible to persons with visual impairments. Consumers from around the world can easily access information 24-hours a day at http://www.katsnet.org.
STRATEGY: Funding Programs
Alternative funding sources can provide individuals with disabilities with a means of direct purchase of assistive technology devices and equipment in a timely manner. In 1995, approximately $65,891 in low or no-interest financial loans was directly loaned to 429 persons with disabilities to purchase assistive technology devices or services. Devices purchased included page turning devices, computer-driven environmental control systems and electric scooters. Financial loan programs have been initiated and established by Tech Act projects in more than twenty states. Tech Act project funds have been typically utilized as "seed" money to start-up or guarantee loans and public-private partnerships to perpetuate the loan programs are often secured. (See TAP Bulletin Nov/Dec 1994)
STRATEGY: Streamlined Request Procedure
The Nebraska Assistive Technology Project was instrumental in the coordination of statewide efforts to design and implement a universal referral form that, once created, would be utilized across all state agencies and service organizations. Its purpose is to streamline eligibility determination and service delivery for consumers.
Previously, consumers were asked to complete separate agency applications, and with each agency requesting different information, it was a lengthy process. Consumers repeatedly expressed confusion and frustration with a process that extended for more than a year as applications were channelled through various agencies seeking funding approval for assistive technology devices or services.
Nebraska's Request for Coordinated Devices and Services Form was the result of cooperative efforts among more than a dozen funding agencies and organizations. Established procedures include a mechanism to allow tracking the form through the statewide system in order to ensure timely responses and identification of any problem areas that may be slowing down the system's referral process.
The Nebraska Assistive Technology Project initiated the development of the universal application form with support from the Disabled Persons and Family Support Group, an interagency group charged with responsibility of reviewing funding requests for AT. Consensus was achieved on a single set of information that would satisfy requirements across all agencies. The result is that the same information is collected from each applicant, regardless if the request is for a device, service, home or vehicle modification. Referrals to other agencies are facilitated if the consumer chooses to sign the optional multiple release on the back of the form, thus allowing one agency to forward an application immediately to the next agency. Consumers provide requested information only one time to complete the form. The form is then used for referral among participating funding sources for which the individual is eligible.
STRATEGY: Policy Changes
DakotaLink (South Dakota Tech Act Project) and its lead agency, the Department of Human Services, Division of Rehabilitation Services, has made it possible for certain individuals with disabilities to be approved for rehabilitation services on the same day an application is submitted. During Town Meetings and through satisfaction surveys sponsored by DakotaLink and the Division of Rehabilitation Services, consumers expressed dissatisfaction with the length of time typically required for the agency to determine service eligibility. Consumers shared personal experiences of lengthy waits for eligibility determination from rehabilitation services- beyond the sixty days stipulated in state regulation. Many consumers were empowered to speak out, in part, due to training received in self-advocacy programs delivered by DakotaLink. As a result, the Board of Rehabilitation Services initiated policy changes that will, under some circumstances, approve applicants for services on the same day an application is received. The effect of these policy changes have had a major impact on delivery of services in a timely manner, affecting more than 1,300 new applicants annually.
Vocational rehabilitation counselors in New Jersey, who are required to make decisions on accepting clients for services within 60 days, found it difficult to make decisions for clients requiring assistive technology because AT assessments were performed under contract with one vendor. Reports were delayed due to a backlog of consumers who were waiting for evaluations. The New Jersey Technology Assistive Resource Program (NJ Tech Act Project) working in conjunction with Vocational Rehabilitation successfully encouraged a shift to competitive fee-for-service systems that now approves seven vendors. The result has not only been a reduction in waiting time for consumer evaluations, but a 50% reduction in the cost of each assessment.
In Rhode Island, joint meetings among the Rhode Island Assistive Technology Access Project, Protection & Advocacy and the state Medicaid agency resulted in improved procedures for responding to requests for assistive technology. One change agreed to for immediate implementation will help individuals who are covered by both Medicaid and Medicare and reduce the amount of time required to obtain funding for a new wheelchair. Previously, a dually eligible individual (one who is covered by both Medicaid and Medicare) was caught in limbo. The state Medicaid agency would not approve payment until Medicare had been billed first. Generally, the only way to get a bill from Medicare for a wheelchair was to pre-pay, and then wait for reimbursement. By definition, Medicaid recipients are low-income individuals who cannot afford to pre-pay for a wheelchair and then await reimbursement.
Under Medicaid's new procedure, the agency will treat dually eligible individuals in the same manner as they treat individuals who have sole coverage under Medicaid. Dually eligible individuals can have the wheelchair vendor of his or her choice submit the wheelchair request to Medicaid. If the request is approved, the Medicaid agency will send the vendor a notice indicating the price the agency will approve for the item. The vendor can then provide the person with the chair because the vendor can rely on payment from Medicaid for the approved amount. The vendor bills Medicare, and subsequently bills Medicaid for any difference between the Medicare payment and the approved amount for Medicaid payment.
Many state Tech Projects have altered purchasing policies and procedures to ensure timely acquisition of AT, especially for children. For example, the Wisconsin Assistive Technology Program and its lead agency, the Division of Vocational Rehabilitation, rewrote its entire purchasing section of the policy manual to allow rehabilitation technology to be purchased easily and more quickly. The new vocational rehabilitation policy manual gave rehabilitation technology specialists and engineers the same standing as doctors and therapists, thus allowing their recommendations to be considered prescriptions and subject to the same purchasing rules as other equipment. The outcome is that these prescriptions generally do not go out for bid unless they exceed $3,000. This policy change has saved approximately four weeks in processing time, delivering AT to individuals in a more timely manner.
Minnesota STAR achieved policy change through passage of state legislation that provides a mechanism for reassignment of assistive technology (AT) devices so that the AT can move with a child through transitions from school to school, school district to school district, and school to post-secondary institutions or work. The statute assigns the development of the conditions of sale and establishment of a consistent pricing formula to the Commissioner of Children, Families, and Learning. School districts may decline to sell a device if they can demonstrate the technology is a general use device or can be modified for use by other students. Additionally, an amendment to Minnesota statute makes it a school district obligation to ensure the right of a child with a disability and their families to participate in decisions regarding assessment including assessment for assistive technology.
In South Dakota, two-thirty foot mobile units provide outreach to remote rural, underrepresented and Native American populations to ensure the timely acquisition and delivery of AT devices and provide utilization training to individuals and their representatives. Both units are fully accessible with wheelchair lifts to facilitate hands-on exploration, demonstration, training and self-assessment. The mobile units are equipped with devices ranging from very simple and low-tech needle threaders to sophisticated, high-tech voice operated computer systems. Additionally, each unit has the ABLEDATA database on CD-ROM to provide instant access to information for over 18,000 different devices for daily living, work, leisure or recreation needs. New equipment is continually added and updated. Mobile units travel statewide to places and events, including schools, adult service agencies, conferences, independent living centers, universities, hospitals, and Native American events. The assistive technology mobile units are staffed by technology specialists who are skilled in training, demonstrations, and repair or modification of devices. Multidisciplinary teams often utilize the AT mobile units to maximize visits to remote areas. Since its implementation over three years ago, DakotaLink has seen a need to expand evaluation services provided through utilization of the mobile unit.