Funding of Assistive Technology Resources in Pennsylvania IM4Q Annual Statewide

1. Funding of Assistive Technology Resources in Pennsylvania IM4Q Annual Statewide Training Conference Harrisburg, PA July 24, 2012

2. Thinking Green! Your presenters strive to support an environmentally friendly atmosphere. If you would like an electronic or alternate format copy of this presentation, please email us at ATinfo@temple.edu

3. Your presenters today Jamie A. Prioli RESNA ATP Pennsylvania’s Initiative on Assistive Technology, Institute on Disabilities Susan Tachau Executive Director Pennsylvania Assistive Technology Foundation Phone: 1-888-744-1938 Email: stachau@patf.us Phone: 1-800-204-7428 Email: Jamie.Prioli@temple.edu

4. About PIAT At School  At Work  At Home  In The Community • Device Demonstrations • Device Loans • Reused and Exchanged Equipment Partnership (REEP) • Public Awareness Activities • Telecommunication Device Distribution Program (TDDP) • Information and Assistance • AT Training and Technical Assistance • Website: disabilities.temple.edu • Phone: 1-800-204-7428

5. About PATF Non-profit, statewide, organization that provides: • No-interest, mini-loans for the purchase of assistive technology [$100 to $1,000] • Low-interest loans for the purchase of assistive technology: traditional and guaranteed (“backed” by PATF) [$1,000 and above at 4% interest rate] • Information & Assistance about assistive technology (AT) funding resources • Financial education • Website: www.patf.us • Phone: 1-888-744-1938 (toll-free) PATF Independence is priceless... we help make it affordable

6. Getting assistive technology funded In pennsylvania

7. Getting Assistive Technology Funded in Pennsylvania Assistive technology devices, including repairs of assistive technology, may be funded by the following: • Medicaid Home and Community Based Waivers • Medical Assistance (Medicaid) • Medicare • Tricare • Private health insurance • Office of Vocational Rehabilitation

8. Getting Assistive Technology Funded in Pennsylvania Assistive technology devices, including repairs of assistive technology, may be funded by the following: • Area Agency on Aging • Telecommunication Device Distribution Program • Individuals with Disabilities Education Improvement Act (IDEA 2004)

9. Getting Assistive Technology Funded in Pennsylvania Medicaid Home and Community Based Waivers • Help persons with disabilities to live in the community rather than in institutions. • Aging (persons age 60 or older) • COMMCARE (adult with traumatic brain injury) • Consolidated (person with intellectual disability age 3 or older) • Independence (adult with physical disability) • OBRA Waiver (adult with developmental disability) • Infants, Toddlers and Families (child birth to age 3) • Person/Family Directed Support (person with intellectual disability age 3 or older)

10. Assistive Technology (AT) For People Who Have an Intellectual Disability Home and Community-Based Waivers and Base Dollars (county): • Person/Family Directed Support Waiver • Consolidated Waiver • Limited County Dollars (FY 2012 – 2013 pilot program with up to 20 counties)

11. What’s New in the Waiver World For AT? The Person/Family Directed Support Waiver and the Consolidated Waiver were renewed with changes (including to service definitions & reimbursement rates), effective July 1, 2012. AT devices and services are provided in 4 distinct areas: • Assistive technology • Home accessibility adaptations • Vehicle accessibility adaptations • Durable medical equipment

12. Participant Services Within the Waivers * with a possibility for an increase (the “exceptions policy”) Durable medical equipment—”An item or device listed in the Medical Assistance program fee schedule that can withstand repeated use; which are used primarily and customarily to serve a medical purpose; which are customarily not useful to a person in the absence of illness or injury and which are appropriate for home use.” 55 Pa code, chapter 1153

13. Services Are Allowable Assistive technology “services” are an allowable expense in the waivers. “Services” include direct support to a participant in the selection, acquisition, or use of an assistive technology device (including repair, design, installation, training).

14. Getting Assistive Technology Funded in Pennsylvania Medical Assistance (Medicaid) • Government-funded health insurance for eligible children and adults, including many persons with disabilities. • Many – but not all – forms of assistive technology are covered by MA • Apply for Medical Assistance at the local County Assistance Office

15. Getting Assistive Technology Funded in Pennsylvania Medical Assistance (Medicaid) • Depending on the level of eligibility or age, the types of assistive technology that may be covered include: • Medical supplies • Durable medical equipment • Prostheses • Orthotics • Surgical supplies • Wheelchairs • Augmentative communication devices

16. Getting Assistive Technology Funded in Pennsylvania Medical Assistance (Medicaid) • Depending on the level of eligibility or age, the types of assistive technology that may be covered include: • Eyeglasses • Hearing aids • Other medical supplies for children under age 21 through Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) • If MA pays for the individual to be in a nursing facility or ICF, the facility MUST provide the necessary AT devices and services, including repairs

17. Getting Assistive Technology Funded in Pennsylvania Medical Assistance (Medicaid) • Always talk with the Primary Care Physician to discuss needs and to know what documentation is required to seek AT coverage through MA. • Devices and services must be medically necessary • Certain documentation must be provided to the health plan • The PCP should ask the individual’s health plan for any coverage rules regarding the specific AT device or service that is being prescribed

18. Getting Assistive Technology Funded in Pennsylvania Medical Assistance (Medicaid) • For information and assistance, contact the MA managed care health plan’s Special Needs Unit • NOT the same as Member Services!!! • Ensures that the individual has information about and access to physicians, specialists, and services they need

19. Getting Assistive Technology Funded in Pennsylvania AAC and Medicaid • Medicaid pays for a range of speech generating devices (SGDs) as prosthetics and/or durable medical equipment • AAC services covered under speech therapy and/or rehabilitation • Getting AT and/or AAC through Medical Assistance (MA) - - - must be medically necessary and not “experimental”. • Payer of last resort

20. Getting Assistive Technology Funded in Pennsylvania Prior approval request process for MA • Speech-language pathologist (SLP) and family assist provider (vendor) in gathering needed documentation. • Provider (vendor) submits prior approval request for device to MA (fee for service or MA MCO) • Documentation should demonstrate medical necessity (doctor’s prescription for specific devices, SLP report, letter of medical necessity, etc.)

21. Getting Assistive Technology Funded in Pennsylvania Medicare • Government-funded health insurance for persons: • Aged 65 or older • Receiving Social Security Disability payments (and their dependent adults with DD) • Receiving railroad retirement payments based on a disability • Persons with named diseases (end stage renal disease; ALS) • AT may be funded through Medicare Part A and Part B

22. Getting Assistive Technology Funded in Pennsylvania Medicare • Medicare Part A is generally provided at no cost • AT that may be funded under Part A includes medical appliances and equipment, or durable medical equipment • Medicare Part B is provided at a monthly cost, or premium • AT that may be funded under Part B includes durable medical equipment (power wheelchairs and augmentative communication devices), prosthetic devices, and orthotic devices • Services are usually funded under other categories

23. Getting Assistive Technology Funded in Pennsylvania Medicare • Requires a doctor’s written prescription for the AT device or service • Item must be medically necessary • May be required to submit a Letter of Medical Necessity • For SGDs: SLP provider must have CCC (and license)

24. Getting Assistive Technology Funded in Pennsylvania Tricare • Health insurance for active and retired military personnel and their dependents • Benefits include durable medical equipment • Pays for prosthetics, including augmentative communication devices • For a list of covered devices and services, visit http://www.tricare.mil/

25. Getting Assistive Technology Funded in Pennsylvania Private Health Insurance • May pay for assistive devices and services • Check with the insurance to see if AT is covered and if prior authorization is required • Requires a prescription from the doctor ordering the AT device or services • Letter of Medical Necessity may be required

26. Getting Assistive Technology Funded in Pennsylvania Office of Vocational Rehabilitation • Provides services to help individuals with disabilities prepare for, start, and maintain employment • OVR offices may arrange for a free evaluation of AT needs • Local OVR offices, including the Bureau of Blind and Visual Services, can help “customers” choose and get AT recommended by the evaluation • Based upon the individual’s financial resources, they may have to pay for part of the cost of AT devices and services

27. Getting Assistive Technology Funded in Pennsylvania Area Agency on Aging • Local Agency may pay for home modifications and durable medical equipment, medical supplies, and assistive devices • Must be age 60 or older to qualify • All other resources must be exhausted before the Area Agency on Aging will pay for the AT

28. Getting Assistive Technology Funded in Pennsylvania Individuals with Disabilities Education Improvement Act (IDEA 2004) • Requires a school district to provide special education and related services to a child with a disability • States that the school district must provide services, including AT, to a child if necessary to provide a free appropriate public education (FAPE) • Child with a disability (3 or older) may receive AT devices and services as part of the IEP

29. Examples of How PATF and PIAT Can Help • A young man (24 years old) wants an iPad to help access the Internet to look for jobs and keep in touch with friends, as well as to begin a journal (with pictures), play games and read books. He also needs voice-recognition and voice-output software. • iPad demonstration from PIAT • Financial loan (Mini-Loan) for the iPad from PATF ($25/mo for 2 years) • Waiver funds for the software applications

30. PATF and PIAT Can Help Put Together a Package • A woman (36 years old) lives in SE PA and has an intellectual disability and cerebral palsy. She needs a telephone with large buttons, a ramp, a roll-in shower, a raised toilet seat and grab bars. • Investigate the Telecommunications Device Distribution Program (TDDP) for possible telephones. Before applying for a particular phone, it can be demonstrated or borrowed (from PIAT’s equipment Lending Library) to make sure it will work. • Use the case manager/supports coordinator to coordinate the home accessibility adaptations (ramp and roll-in shower). NOTE: If the cost of the shower and ramp exceeds $20,000, it may be possible to get a small grant from a disability-specific organization (i.e., UCP Philadelphia) to help cover the funding gap. If some of the expenses remain unpaid, a PATF loan may be able to pay for the balance! • Submit to Medical Assistance for payment for the raised toilet seat and the grab bars (Durable Medical Equipment).

31. OtherResources

32. Assistive Technology Financial Loans PATF provides no-interest or low-interest loans to people with disabilities for the purchase of assistive technology devices and services. PATF also provides Information and Assistance about other possible funding resources. Who does PATF serve? • Pennsylvanians of all income levels, disability diagnoses, ages PATF Independence is priceless... we help make it affordable

33. Pennsylvania’s Initiative on Assistive Technology (PIAT) • Reused and Exchanged Equipment Partnership (REEP) • Telecommunication Device Distribution Program (TDDP) • Device Demonstrations • Assistive Technology Lending Library

34. Assistive Technology Resources • RESNA Catalyst Project • 56 statewide AT Act Programs • 33 Alternative Financing Programs • 57 Protection and Advocacy for AT Programs • 19 Access to Telework programs • http://www.resnaprojects.org/ • Note: AT Act Programs in every state as well as Puerto Rico, US Virgin Islands, Northern Mariana Islands, District of Columbia, American Samoa, & Guam.

35. Pennsylvania Training and Technical Assistance Network (PaTTAN) • Short Term Loan (STL) Program (www.pattan.net) • Library of AT materials available to Local Educational Agencies (LEAs) for trial and evaluation • STL kits contain devices for: • Augmentative communication • Computer access • Written communications • Environmental controls • Technology for sensory impairment (hearing and vision)

36. Assistive Technology and Legal Assistance • Disability Rights Network of Pennsylvania (DRN PA) • Legal and “systems” issues around access to and acquisition of AT • Offices in Harrisburg, Philadelphia and Pittsburgh • Website: http://drnpa.org • Email: intake@drnpa.org

37. Disability-related organizations • National MS Society • Multiple Sclerosis Association of America (MSAA) • ALS Association • JEVS Human Services – Supports for Independence • Disabled Children’s Relief Fund

38. Questions?

39. Feel free to contact us Jamie A. Prioli RESNA ATP Pennsylvania’s Initiative on Assistive Technology, Institute on Disabilities Susan Tachau Executive Director Pennsylvania Assistive Technology Foundation Phone: 1-888-744-1938 Email: stachau@patf.us Web: www.patf.us Phone: 1-800-204-7428 Email: Jamie.Prioli@temple.edu Web: disabilities.temple.edu