Vol. 3, No. 6, Nov//Dec 1995	Previous Issues Subscribe to AT Messenger Download PDF Viewer
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FINANCING ASSISTIVE TECHNOLOGY

When Not To Take No for an Answer

Ron Sibert, DATI Funding Specialist

For people with disabilities, public and private medical insurance is still the most frequently used means of obtaining assistive technology devices and services. Unfortunately, however, claims for equipment are not always approved the first time around. Then, just as unfortunately, many people with legitimate equipment needs simply give up after being notified of denial. In many such instances, the decision could be reversed on appeal. In fact, a vast majority-more than 85%-of appeals are eventually settled or decided in the claimant's favor. This suggests that many more people could achieve positive outcomes if they simply tried a little harder. Recall that history is full of cases in which the actions of a single individual have changed whole systems, governments, societies...even the world. Why not one's own circumstances? Why do we so often observe people simply giving up after the first attempt?

I once heard that many people's first thought when considering how to respond to a challenge is to look at the odds against a favorable outcome. They actually begin by looking at how many ways their efforts could fail, and proceed to talk themselves out of trying. Sound familiar? Even though most of us may perceive this way of thinking to be a bit backward, it's still very easy to take a negative perspective-particularly when there is "additional work" to do. This article speaks to you persistent souls out there who dare to think otherwise and are willing to push a bit harder to make things happen.

Because the field of technology is vast and ever-changing, misconception and lack of awareness remain among the most formidable barriers to assistive technology access and funding. Of course, the additional work required here is to obtain and then share (or creatively apply) the missing information where it's needed. For instance, the Americans with Disabilities Act requires employers to make "reasonable accommodations" for their employees in ways that would not create an "undue hardship" for their firms. However, many employers have misconceptions about the law, their own rights and privileges, and those of their employees with disabilities. For example, many assume that work-site accommodations are too expensive and are therefore unreasonable. In fact, most accomodations can be purchased or fabricated for under $300. Also, according to the June 1995 Report on Disability Programs, there are three tax credits designed to help defray costs of providing accommodations. They are:

• The Disabled Access Tax Credit
• Targeted Jobs Tax Credit
• Tax Deduction to Remove Architectural & Transportation Barriers to People with Disabilities and Elderly Individuals

Detailed information about these tax credits is available from the Internal Revenue Service at (800) 829-3676. Seeking and bringing such information to a prospective or current employer could go a long way toward not only gaining access to equipment, but also fostering that all important trusting employer/employee relationship.

Medicare or Medicaid appeals and court decisions are also useful advocacy tools. Certain precedent-setting augmentative and alternative communication (AAC) device decisions are good examples. In August 1993, a Medicare administrative law judge (ALJ) ruled that the definition of prosthetics includes AAC devices, and approved funding for a special type: one composed of a computer and software. The ALJ based that decision on the Medicare Carrier's Manual, paragraph 2130 which says that devices that "replace all or part of the function of the permanently inoperative or malfunctioning body organ are covered when furnished on a physician's order." Prior to this decision, Medicare had not routinely covered AAC devices. In fact, it is still not commonly covered, and Medicare does not treat ALJ decisions as legal precedents. However, the decision itself is likely to provide a powerful argument for anyone pursuing a similar appeal.

Just recently, a U.S. District Court in Mississippi decided in favor of three youths for whom AAC devices had been prescribed, but coverage was denied by Medicaid. Although the original device recommendations had been based on clinical assessments performed by qualified speech-language pathologists, the Medicaid physician/medical reviewer denied them as not medically necessary-basically because he did not believe the claimants really needed to communicate. The court blasted the Medicaid administrators, ruling that the doctor's assessments were subjective (i.e., not clinically valid) and not adequate for making such decisions. Thus, Mississippi's Medicaid division was ordered to provide the recommended devices.

Note that not one of these decisions would have seen the light of day if the recipients of those devices or their representatives had quit after their claims were rejected.

Be aware of your insurers' appeal process/requirements, stay generally informed, and don't be afraid to apply what you've learned!

New Grant Benefits Students Statewide

The Applied Science and Engineering Labs has been awarded a $223,000 grant from the Department of Commerce, National Telecommunications and Information Administration (NTIA) to improve access to all types of educational opportunities for students with disabilities in each district in the state.

This project will bring to life a concept developed through the efforts of the Delaware Department of Public Instruction, the DATI, and several individuals representing school districts, institutions of higher education, and private AT service providers in Delaware.

The project works to increase educational opportunities through AT access in three ways simultaneously. First, families will be able to learn about ways that AT can impact educational progress through a series of open houses to be held at the DATI Assistive Technology Resource Centers in January, and via information-sharing mechanisms such as the World Wide Web and a fax-back system. Second, the feasibility of universal access to the Internet and the World Wide Web will be demonstrated in six school-based sites throughout the state. Third, the grant will support an intensive 16-month training series for designees from each district who will then serve as AT "point people" for their colleagues within their home districts. The series will cover all types of AT applications in day-long workshops, and will include several sessions pertaining to the use of the Internet and other telecommunications options. In fact, some sessions will be delivered electronically, and will use the Internet to encourage cooperative learning experiences among trainees in different areas of the state. The grant will supply each district designee with the necessary hardware and software for full Internet access and team collaboration via electronic mail.

Marcos Salganicoff and Beth Mineo will be co-directors of the new project. Dr. Salganicoff will oversee the design and deployment of the network and other information-exchange mechanisms, and Dr. Mineo will coordinate training activities and the involvement of the DATI sites.