Reflection Funding for Assitive Technology

Assistive technology devices and services from haiglerc

Glossary of Terms for Funding Assistive Technology Services and Systems

Glossary of Terms	Definitions	Examples
Appeals Process	The means whereby the ATP can appeal a funding denial.	After you file your appeal, you will receive a letter acknowledging your hearing request. You will eventually receive a date and time for your hearing with an administrative law judge; Medi-Cal is represented by a county representative (non-attorney).
Diagnosis Codes	Describes the person’s condition or medical reason for the services being requested; the key to establishing medical necessity.	Assessment codes include, but are  not limited to: 92540‐92548, 92550, 92552‐92568, 92570 ‐92596, 92601‐ 92604, 92620, 92621, 92625, 92626, 92627, 92640, 92700, 95907‐95913, 95925, 95930, 95937, 95940, 95941, V5008, V5010, V5011, V5014, V5020
Fee for Service	The traditional method of payment for health care under which providers are paid a certain rate per unit of service.	AT assessment costs vary depending on numerous factors, for example: the extent of solutions sought, whether classroom observations are needed, whether a written report is required, and IEP meeting attendance. Formal AT assessments with a written report generally range from $1300 to $2000 -- sometimes less, occasionally more -- depending on the factors mentioned above. Once we discuss the scope of what you need, I can provide an estimate (e.g., "no more than xx hours").
Managed Care	Any method of health care delivery designed to reduce unnecessary utilization of services and provide cost containment while ensuring that high quality care or performance is maintained.	A state's managed care plan must afford individuals with disabilities access to the durable medical equipment and assistive technology that they require to live the most independent, inclusive, and healthy lives feasible in their community of choice. Covered services must include professional assessments of a beneficiary's need for such equipment as well as set-up, maintenance and user training.
Medicaid	A health insurance program, established in 1965 by Title XIX of the Social Security Act, administered at the state level for persons who are unable to pay the costs of their medical care.	Whether a particular AT device or service is covered by a state's Medicaid program will depend upon which categories of service are included in the state plan and how each category of service is defined in federal and state law or policy. Understanding the definitions of the categories of services included in a state's Medicaid plan is the first step is establishing whether a device is actually "covered" by the state.
Medical Necessity	A specific criterion for funding under Medicare, Medicaid, and private insurance that requires identification of a medical diagnosis or condition that is specifically coupled to the functional impairment being addressed by the device.	The Medicaid Act, through the EPSDT benefit, requires states to cover all medically necessary services for Medicaid-eligible children and youth under age 21 and provides an expansive definition of medical necessity for these beneficiaries. Under EPSDT, state Medicaid programs must provide "necessary health care, diagnostic services, treatment and other measures . . . to correct or ameliorate defects and physical and mental illnesses and conditions." Services must be covered if they correct, compensate for, or improve a condition, or prevent a condition from worsening - even if the condition cannot be prevented or cured.
Medicare	The health insurance program operated by the United States federal government, covers individuals age 65 and older and those adults under age 65 who are blind, and totally and permanently disabled and have received Social Security Disability Insurance benefits or Adult Disabled Child benefits for a least 24 months.	Medicare coverage is limited to services that are "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."
Plan for Achieving Self-Sufficiency (PASS)	A program that allows individuals to put aside income for equipment or services that will assist them in achieving a vocational objective.	For example, you could set aside money to go to school to get specialized training for a job or to start a business. A plan is meant to help you get items, services, or skills you need to reach your goals. This can include the Assistive Technology you need! Best of all, the money, saved in a separate bank account designated for the PASS, is disregarded when Social Security is determining your monthly benefit amount.
Procedure Codes	A numerical system used to describe the services that the provider carried out and is billing for; the most commonly used procedure coding system is the Common Procedure Coding System of the Health Care Financing Administration.	97112 Nueromuscular Reeducation: This code is used for seating and access intervention that includes neuromuscular training to improve postural stability/control for function, and/or access issues. This code could be used for the placement of lateral trunk pads, for example. 97504 Orthotics Fitting and Training: This code is utilized for interventions involving splints, corsets, or the fabrication of custom-molded seating systems. This code is used for the hands-on application of the orthotic component, whether for the body or the chair. This code can also be used for training in the use of the custom device. 97530 Therapeutic Activities: This code is utilized for exercise to improve manual wheelchair propulsion, transfers, and posture. This functional code that can be for functional-related wheelchair activities and the practitioner’s documentation should be clear about the functional outcome. 97535 Self Care: This code is utilized for fitting of AT and/or training/positioning which will affect activities of daily life (ADL) and safety. This code may also be used for home environment and modification analysis. This code can be used for power wheelchair training. It is also used for parent/caregiver training. 97537 Community/Work Integration: This code is utilized for access and/or control training involving AT devices, transportation issues, and worksite assessments. It is also used for wheelchair training related to the outdoors, such as negotiating curbs, grass, gravel, inclines, etc. 97542 Wheelchair Management: This code is used for fitting and training of users or caretakers in the use of mobility and seating equipment. This code includes propulsion skills. Due to the low RVU for this code, it is not currently used often, as the reimbursement may not cover the therapist’s actual treatment time costs.
Public Funding Sources	Government funding at the federal, state, or local levels.	The local public school is a public funding source.
Third-Party Payer	Funding source that is public or private and covers the cost of devices and services.	A third party payer is any public or private program, agency or company that pays for the devices or services used by an individual. Public programs are sometimes a source of funding.
Tricare	Formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), is a health care program of the United States Department of Defense Military Health System.	TRICARE coverage to "[a]ny rehabilitative therapy to improve, restore, or maintain function, or to minimize or prevent deterioration of function, of a patient when prescribed by a physician." The existing statute only referenced coverage of "outpatient care," with no specific reference to rehabilitation therapies. This new language expands significantly the range of therapies that will be considered covered benefits for TRICARE enrollees with disabilities and chronic conditions.

Pros and Cons of Delivering Assistive Technology

Matching Electronic Device Characteristic to the User’s Needs and Skills

Assistive products can be divided into those used to make existing mainstream products accessible and those required to overcome the barriers due to partially or totally inaccessible infrastructures and environments. While there will probably always be a need for some assistive devices, the application of design for all principles to the design of mainstream products will remove the need for some of them. For instance, screen readers are required to make computer operating systems accessible to blind people. However, many of these operating systems now incorporate screen readers and improvements in the functionality and performance of these incorporated screen readers will probably eventually remove the need for additional screen readers as assistive devices. However, for the foreseeable future there is likely to be a need for assistive devices in the form of Braille displays and keyboards and eye control input devices, since including them in standard computer setups would increase price and complexity. The mobility of physically disabled people generally requires a combination of accessible infrastructures and environments and a mobility or support device. The accessibility of infrastructures and environments is improving with the removal of barriers and the addition of ramps and lifts. However, for the foreseeable future the use of personal mobility or support devices such as wheelchairs and walkers is likely to be the best solution in terms of the use of resources and the state of technology.

Evaluating the Match between Characteristics and the Consumer’s Skills and Needs

Consumer product design is a fairly mature field in which a number of methodologies have been developed, though there is always a role for further developments. The fact that there are frequently even greater differences between the end-users and designers of assistive than other consumer products makes the use of user-centered design particularly appropriate for assistive products. Existing design approaches can be used for assistive product design, including the design of one-off products. However further work will be required on the development of methodologies for accessible and usable design, though this should become good practice for all consumer products, not just assistive ones. Further work is also required in the area of end-user involvement, with a particular focus on methods which are suitable for disabled and elderly end-users.

Effects of Errors in Assistive Technology Systems

This is technical work in the assessment of need for assistive devices in order to solve accessibility, mobility, and participatory problems created by disabilities. Ensures proper design, optimum fit, and function. Designs and fabricates advanced assistive technology systems including but not limited to wheel chair positioning systems, augmentative communication systems, and electronic aids to daily living. Work involves the use of a wide variety of tools, materials, and equipment to design, construct, and/or modify assistive devices. Operates an assortment of tools and equipment to design, fabricate, modify, and/or repair wheelchairs and associated rehabilitative support equipment in accordance with prescribed specifications. Directs, trains, and provides technical instruction to staff in the fabrication, modification, and/or repair of assistive devices and/or their components. Performs maintenance and repairs on tools and equipment and ensures optimum operating conditions. Monitors and ensures adequate inventory of laboratory tools, equipment, and supplies; maintains the work area in a clean and orderly fashion. Determines appropriate assistive device.
Evaluates assessment and initial design.

Assistive Technology Outcome Having an impact on The Quality of Life

In an aging society, it is increasingly important to understand how assistive devices can be used by older people to maintain quality of life despite chronic disabilities. Assistive technology is a mainstay of physical therapist practice, but the potential for device use to affect psychosocial well-being is not yet understood at the population level. The results from many research efforts on the use of assistive devices are reviewed and summarized. Further, conceptual and methodological issues related to the use and abandonment of assistive technologies are discussed. Overall, this review should be helpful to professionals making device recommendations, documenting the need for a device, and assessing short- and long-term device utilization. The available literature lends support to a model of matching person and technology that considers environments of device use, characteristics of the user's preferences and expectations, and device features and functions. To ensure that assistive technologies enhance users' quality of life, future emphases should focus on consumer involvement in the selection and evaluation of appropriate assistive technology, and ways to make technologies more widely available and affordable.

HAAT Model for Assistive Technology

Life Roles/Performance Area	Activities	Difficult Tasks to Perform	Contexts	Prior Technology History
1.      College Student Education	1.      Reading class assignments in textbook	1a. Holding the  book 1b. Turning the pages	1a. Home 1b.Library	1.      Has used mouthstick and bookholders in the past; encounterd problems positioning book and mouth beconing tired from holding mouthstick.
Intervention Goals		Directions:
1.      Evaluate alternates for holding reading material and turning pages in order to increase student’s independence in reading.		1.      Identify consumer’s life roles and performance areas. 2.      Identify activities consumer is interested in performing. 3.      Identify the specific tasks the individual has difficulty performing. 4.      Identify the contexts in which these activities are carried out. 5.      Determine if consumer has used technology in the past for the activity and what the outcomes were.

Glossary of Terms Delivering Assistive Technology

Glossary of Terms	Definitions	Examples
Assessment	A process through which information about the consumer is gathered and analyzed so that appropriate assistive technologies can be recommended and a plan for intervention developed.	Assessment provides information needed to adjust teaching and learning while they are still happening.  The process serves as practice for the student and a check for understanding during the learning process.  The assessment process guides teachers in making decisions about future instruction.
Client-Centered Practice	Client-centered care is a philosophical approach to service delivery and service development, ensuring that service systems are developed in partnership with older people and/or their careers.	Client-centered practice can be developed on an organizational scale, for example having a client-centered practice organizational policy; at a work unit level, for example ensuring all patients have a care plan developed that incorporates patient goals and at an individual staff member level, for example therapy times are arranged around the patient's preferred showering time.
Criteria for Service	The recognition of a need for assistive technology service triggers a referral for services.	·         Interpersonal and communication skills ·         Excellent written and verbal skills ·         Ability to work in a team ·         Good time management skills ·         Highly developed analytical and problem solving ·         skills ·         Relevant tertiary qualifications
Criterion-Reference Measurement	A measurement in which the person’s own skill level in using the system is used as the standard.	A test or other type of assessment designed to provide a measure of performance that is interpretable in terms of a clearly defined and delimited domain of learning tasks.
Device Characteristics	General properties of the hard technology portions of an assistive technology system.	Any measurable property of a device measured under closely specified conditions characteristic.
Expert Systems	Computer-based software that assists in the decision-making process for assistive technologies.	Expert systems are designed to solve complex problems by reasoning about knowledge, represented primarily as if–then rules rather than through conventional procedural code.
Functional Performance Measures	Measurements that address whether the individual can accomplish tasks that she could not do without assistive technology.	FPM is an instrument developed from grounded theory, and measures daily function in persons with Alzheimer Disease.
Follows-along	The portion of the service delivery process in which a mechanism for regular contact with the consumer is established to see whether further assistive technology services are indicated.	·         Reevaluate ·         Maintenance ·         Repair As Needed
Follow-up	The portion of the service delivery process that determines whether the system as a whole is functioning effectively.	·         Maintenance ·         Repair As Needed
Health-Related Quality of Life	The impact of health services on the overall quality of life of individuals; represents the functional effect of an illness and its consequence therapy.	HRQoL is a multi-dimensional concept that includes domains related to physical, mental, emotional and social functioning. It goes beyond direct measures of population health, life expectancy and causes of death, and focuses on the impact health status has on quality of life. A related concept of HRQoL is well-being, which assesses the positive aspects of a person’s life, such as positive emotions and life satisfaction.
Implementation Phase	The portion of the service delivery process in which the recommended technology is ordered, modified, and fabricated as necessary; set up, delivery to the consumer; and initial training takes place.	It has one key activity: deploying the new system in its target environment. Supporting actions include training end-users and preparing to turn the system over to maintenance personnel. The purpose of the Implementation Phase is to deploy and enable operations of the new information system in the production environment.
Needs Identification	The portion of the assessment during which more detailed specification of the consumer’s assistive technology needs is made.	Is the process of determining what and how a customer wants a product to perform? Needs are non-technical, and they reflect the customers’ perception of the product, not the actual design specifications, although frequently they are closely related.
Norm-Referenced Measurements	The ranking of the performance of the individual or system according to a sample of scores others have achieved on the task.	Norm-referenced refers to standardized tests that are designed to compare and rank test takers in relation to one another. Norm-referenced tests report whether test takers performed better or worse than a hypothetical average student, which is determined by comparing scores against the performance results of statistically selected group of test takers, typically of the same age or grade level, who have already taken the exam.
Operational Competence	Skills required for the individual and his aides to use the basic features of the assistive technology device.	Competencies are defined as the characteristics of an individual which underlie performance or behavior at work.
Outcome Measures	Used to evaluate the end results of the assistive technology intervention.	Outcome measures can be the assessment of the benefits of an intervention such as amplification or the goals and objectives that are established after the initial diagnostic work-up of a client. Measuring client outcomes as a QI activity obligates audiologists to address the efficacy and efficiency of client interventions.
Performance Aid	Activities of daily living, work, and productive activities, and play and leisure.	Performance Aids include technical manuals, decals, flowcharts, or other means of aiding or listing the steps for performing a task. Performance aids remove the cognitive load requirement from the performer and places it in an artifact.
Qualitative Measurement	.A measurement in which an intelligible feature that can be used to characterized the thing under investigation is obtained.	Qualitative measurements means the quality or identity of an objects. Qualitative measures don't have a definite value, Like color red, pink, purple).
Quality-of-Life Measures	Assess the effectiveness of assistive technology devices and services in the broader social context of the impact on the user’s overall life.	QOL is the general well-being of individuals and societies. QOL has a wide range of contexts, including the fields of international development, healthcare, politics and employment. Quality of life should not be confused with the concept of standard of living, which is based primarily on income. Instead, standard indicators of the quality of life include not only wealth and employment but also the built environment, physical and mental health, education, recreation and leisure time, and social belonging.
Quantitative Measurement	A measurement in which an indefinite amount or number is obtained or the measurement may be in terms of a physical parameter such as weight	Quantitative measurements means the quantity or amount of an objects. Quantitative have a definite value, like height (4ft, 16mm).
Referral and Intake	The portion of the assessment in which consumer or someone close to him, has identified a need for which assistive technology intervention may be indicated and contacts an ATP; basic information is gathered and a determination of the match between the services provided and the identified needs of the consumer is made; finding is also identified and secured at this stage.	·         Needs Identification ·         Skills Evaluate o   Sensory o   Physical o   Cognitive o   Language ·         Device Characteristics
Strategic Competence	Skills in the use of strategies that maximize the effectiveness of the assistive technology system	Strategic competence is knowing how to recognize and repair communication breakdowns, how to work around gaps in one’s knowledge of the language, and how to learn more about the language and in the context. Strategic competence asks: How do I know when I’ve misunderstood or when someone has misunderstood me? What do I say then? How can I express my ideas if I don’t know the name of something or the right verb form to use?
Technology Abandonment	A situation in which the consumer stops using a device even though the need for which the device has been obtained still exist.	Technology abandonment may have serious repercussions for individuals with disabilities and for society.
User Satisfaction	The consumer’s perception of the degree to which the assistive technology system achieves the desired goals.	User satisfaction helps you to measure the overall quality of the service experience.
User Satisfaction Measures	Measures that address whether the assistive technology services and devices provided meet the consumer’s needs from the consumer’s point view.	It is a measure of how products and services supplied by a company meet or surpass customer expectation. Customer satisfaction is defined as "the number of customers, or percentage of total customers, whose reported experience with a firm, its products, or its services (ratings) exceeds specified satisfaction goals.