Pros and Cons Funding Assistive Technology Services and Systems

     Public Source of AT Funding

Pros

·         Purpose set by legislation

·         Focus on functions usually impacting significant groups in society.

·         Have the most money and more likely to award large grants/contracts.

·         More likely to pay all projects cost and/or cover indirect costs.

·         Easier to find information about and to stay current on project needs/interests.

·         Application processes and deadlines are public information and very firm.

·         Use prescribed formats for proposals

o   Many use “common” application forms.

·         Possibilities or renewal known up front.

·         Plentiful staff resources

o   Most projects have specific contact person.

·         More likely to have resources for technical assistance.

·         Funds available for wider array of organization (for – profit and nonprofit).

·         Accountable to elected officials if administrative staff don’t follow the rules.

Cons

·         Are much more bureaucratic.

·         Lengthy proposal requirements and complex application, administration and compliance procedures.

·         Often require institutional cost-sharing and matching.

·         Reviewers tend to favor established applicants

·         Sometimes difficult to sell new ideas and high-risk approaches

·         Cost to applicants much higher

o   Expensive application and compliance procedures

·         Changing political trends and affect security of some programs

o   Availability of funds can change rapidly

Private Sources of AT Funding

Pros

·         More likely to focus on emerging issues, new needs, populations not yet recognized as “special interests.”

·         Often willing to pool resources with other funders.

·         Wide range in size of available grants—some can make very large awards, others are strictly for small local projects

·         More willing source of start-up or experimental funds.

·         Full length, complex proposals not always necessary

·         Can be much more flexible in responding to unique needs and circumstances

·         Able to void bureaucratic requirements for administering grants.

·         Can often provide alternative forms of assistance, i.e., software/hardware donations, materials, expertise, etc.

·         Fewer applicants in most cases.

·         Can generally be much more informal and willing to help with the proposal process.

Cons

·         Average grant size usually much smaller.

·         Priorities can change very rapidly, continuation support can be difficult to predict

·         Applicants have limited influence on the decision making process.

·         Information on policies and procedures must generally be researched, can be time consuming.

·         Less likely to cover all project costs and most do not cover indirect costs.

·         Limited staff

o   Fewer opportunities for personal contact and/or site visits.

·         May not be clear about reasons for rejection

o   Hard to improve for 2^nd attempt

Funding Process and Guidelines for Procuring

Sometimes called assistive devices, independent living aids, and adaptive equipment, assistive technology (AT) can help your loved one live more independently. It may also make your job as a caregiver easier and more enjoyable. If you’re caring for someone with dementia, you may be worried about their falling, wandering or getting lost. Certain types of AT can help. A loved one with a physical or cognitive (thinking) impairment can use AT to make the activities of daily living, such as dressing, bathing, grooming, eating and toileting, a little easier. There are different types of AT that may be helpful to you and your loved one. In addition, it addresses how to find AT, how to pay for devices, and how to decide what devices or home modifications you might need. With so many vendors and manufacturers producing AT, it can be confusing to decide which products to buy. There are a few public agencies which keep a complete list of AT products and manufacturers and can help you find the right products for your loved one. Because these agencies do not sell equipment, they are a more trustworthy source of information than contacting manufacturers directly.

AT Funding

The area of assistive technology has grown tremendously in recent years, and many manufacturers now provide a wide range of products and devices. It can be confusing, however, to determine which products might be right for your loved one. Here are a few basic tips to help you in this task:

·       Focus on the actual tasks your loved one wants or needs to do when choosing devices. While this might seem obvious, it’s easy to get drawn into buying a product that looks good but doesn’t really address your loved one’s needs.

·       Generally, it is best to pick the simplest product available to meet the need. Simpler devices are often easier to use, less expensive, and easier to repair and maintain than more complex devices. For example, if someone does not have difficulty remembering to take their medications, but gets confused about which pills to take at which times, a weekly pill organizer that can be filled by a caregiver would solve the problem. Purchasing an automated pill dispenser with alarms to remind the person to take medications would be more complicated than necessary and would certainly be more expensive than the simpler pill organizer.

·       Ask experts that provide care to your loved one, like rehabilitation specialists or physical and occupational therapists, about which type of technology might be best.

·       Ask other people with disabilities what products they have found to be helpful.

·       Ask to use the device on a trial basis to see if it is truly going to meet your loved one’s needs.

·       Ultimately, your loved one’s opinion about a certain piece of AT is the most important. The device needs to be comfortable, attractive, and simple to use.

Identifying the AT Funding

PROS

• Students are able to work at their own pace.
• Students are able to accomplish more individually.
• Students are included into the regular classroom.
• By being included in the regular classroom it not only benefits the student with the disability, but also the other students and even the teacher.
• Students are able to achieve academic standards.
• Students are given the opportunity to socialize with more students.
• Technology can help students improve organizational skills and also writing skills.
• Technology helps students reach a higher level of education.

CONS

• Majority of assistive technologies are very costly.
• Many technologies cost thousands of dollars and many school districts do not have the funds to provide these technologies.
• To be able to use the technologies properly, training has to take place which is very time consuming.
• Technology can never be fully relied on. As we all know technology always has its flaws, and if a student’s assistive device is not working properly, the student may not be able to complete his or her tasks.
• By having many different assistive technologies, some students may abuse the use of technology by using technologies they do not necessarily need.

Justifying Funding for Assistive Technology Services and Devices

Assistive technology can be as simple as a hearing aid or cane, or as sophisticated as a voice-activated computer system or mechanical hoist to lift and turn someone in bed. Assistive technology devices are basically helpful products that improve a person’s ability to live and function independently. Some AT is considered “low-tech”–canes, magnifiers and pill organizers–while “high tech” assistive devices include computer applications, sensors and smart phone systems. AT is a rapidly growing area and is used by people with disabilities and older adults who want to stay in their communities and remain independent as long as possible. More than 15 million Americans with disabilities use some type of AT. In a 2003 AARP survey of persons over 50, one-third of people reported using AT in their daily activities. The top three most popular AT devices were:

·       Walker, cane or crutches

·       Aids for bathing or toileting

·       Wheelchair or scooter

Appealing the AT Funding Denial

Most Plans have an internal appeal process. This can also be called a complaint or grievance process. If you disagree with the Plan’s decision, you may be able to submit an appeal or grievance. The appeal process can be different for each Plan. Check your benefits booklet or call the Plan for information about their appeal process. The amount of time you have to appeal is usually limited. Your benefit handbook should have a section on appeals, complaints, or grievances that tells you how many days you have to file an appeal. The denial letter you get from the Plan also may tell you the time limit. File your appeal within these time limits or you may lose your right to appeal. Carefully review your benefit handbook. There should be a section about DME. Review any letters from your Plan so you understand why the DME was denied. You also can ask your Plan to send you copies of your claim file and copies of any policies or standards the Plan used to deny the DME. This information should be free.  Get copies of your medical records, letters from your health care providers, like your doctor, physical therapist, or occupational therapist, and any other information that supports your appeal.  In your appeal, explain why you think the decision is wrong and why the Plan should approve your equipment. If the Plan denied the equipment saying it is not medically necessary, get a letter from your doctor. The letter should say why the equipment meets the Plan’s definition of medical necessity and any other criteria. Criteria are the things the Plan looks at to see if the device is necessary.

Billing and Coding for AT Services

Current Procedural Terminology (CPT) ™ "… is a listing of descriptive terms and identifying codes for reporting medical services and procedures. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic services…"to report medical services for private and public health insurance systems for purposes of reimbursement, including claims processing. CPT also provides uniformity in language to provide reliable nationwide data collection. One use of this data collection is cost control and management in both private and public health care systems. The CPT coding system has a large impact on public and private health insurance reimbursements. Medicare’s payment schedule is based on what is called a Resource-Based Relative Value Scale (RBRVS), which in turn, is based on CPT coding. The RBRVS has replaced the practice previously used by many insurers that based payments on a percentage of billed charges, often called "a usual and customary" payment system. The RBRVS is used by most private health insurers, many state Medicaid agencies and several state workers compensation plans to determine reimbursements. The RBRVS will be discussed further in a section titled "How is a Relative Value Unit Assigned to a Code?”

AT Payment Practices

Some government programs and other funding sources will help pay for some medical equipment, also called “durable medical equipment” such as canes, walkers, wheelchairs and scooters, if prescribed by a physician or otherwise determined to be medically necessary. However, other independent living aids, like grab bars, bath mats and dressing aids, are typically not covered. The following funding sources and agencies may help you purchase certain kinds of aids:

·       Medicare

·       Medicaid, particularly waiver programs

·       Private health insurance plans

·       Public service organizations like United Way and Easter Seals

·       National Family Caregiver Support Program

·       Department of Veterans Affairs