The AT Messenger ....bringing technology to you Published by the Delaware Assistive Technology Initiative (DATI) Vol. 5, Issue 5 Sept/Oct 1997 Another Winning Line-up for This Year’s DATI Conference DATI’s Annual Conference, Assistive Technology: More Power to You returns to Clayton Hall in Newark on November 12. Plan to join us for the non-stop action that begins with a remarkable keynote speaker and offers practical AT approaches and strategies throughout the day’s presentations and exhibits. Those of you who have attended a DATI conference in the past know that the speakers are top-notch, the exhibits feature the latest in devices and services, and you never go home with an empty stomach! If there is a single thread that ties all of this year’s featured presentations together, it is the “can do” spirit of the presenters. All of our speakers have met challenges head-on and have refused to take the path of least resistance. Jimmie Heuga, this year’s keynote speaker, knows all about taking charge of his life. At the age of 15, he was the youngest male ever to make the U.S. Ski Team, and he won medals in World Cup and Olympic events in the years that followed. Two years after retiring from the Ski Team, he was diagnosed with multiple sclerosis (MS) and was advised to live a sedentary life. The quiet life did not suit Heuga, who began deteriorating physically and mentally. Six years after the diagnosis, he decided to take matters into his own hands. He developed an exercise program of cardiovascular endurance and, utilizing his natural athletic talents, he began stretching and strengthening exercises. Next, he established realistic goals for his personal wellness program. With this program, Heuga was able to regain his health within the constraints of MS. He is not cured, as there is no known cure for MS. His resolve, however, has allowed him to lead a full and active life focusing on his abilities. Mr. Heuga is an avid proponent of getting the most out of life, and he will share his philosophy and experiences with attendees.His ideas are life-affirming and thought-provoking, and should make for an unforgettable keynote address. Many other treats are in store for participants. A team of educators will talk about alternatives to writing for individuals whose physical, sensory, or cognitive limitations make handwriting a difficult pursuit. A team from Easter Seal will discuss solutions to challenging seating situations. Jimmie Heuga will conduct a small-group session on the importance of exercise, complete with examples of adaptations that support swimming, biking, and other healthy pursuits. Other sessions will address technologies and strategies that support personal transportation, computer access, and those with visual limitations. Joan Bradley, a retired nurse, will talk about her return to a busy and communicative life following an aneurysm. DATI staff will demonstrate the effectiveness of the project’s systems change work as it relates to the new Medicaid policy for augmentative and alternative communication devices and systems. The full conference schedule and registration materials are included in this issue of the AT Messenger. Mark your calendars for November 12—plan to join your friends and colleagues for a day of learning and sharing. Space is limited, so return your registration without delay. Hope to see you there! Assistive Technology: More Power to You Schedule of Events 8:30-9:00 a.m. Registration & Exhibits 9:00-10:00 a.m. Opening & Keynote Address 10:00-10:30 a.m. Break for Exhibits 10:30 a.m.-Noon Breakout Sessions 1-3 Noon-1:00 p.m. Lunch 1:00 p.m.-2:30 p.m. Breakout Sessions 4-6 2:30-3:00 p.m. Break for Exhibits 3:00-4:30 p.m. Breakout Sessions 7-9 Contact Hours and/or Continuing Education Units Applications have been submitted to: Delaware Examining Board of Physical Therapy Delaware Examining Board of Occupational Therapy Delaware Board of Speech/Language Pathologists, Audiologist, and Hearing Aid Dispensers Delaware Board of Nursing Delaware Department of Instruction Overnight Accommodations Closest to Clayton Hall Conference Center At Interstate 95 & Rt. 896, Exit 1... Comfort Inn, 1120 S. College Ave., 800-441-7564 Howard Johnson, 1119 S. College Ave., 800-654-2000 At Interstate 95 & Rt. 273, Exit 3... Best Western, 260 Chapman Rd., 800-633-3203 Hampton Inn, Three Concord Lane, 800-426-7866 Holiday Inn, 1203 Christiana Rd., 800-465-4329 McIntosh Inn, 100 McIntosh Plaza, 800-444-2775 All addresses are Newark, Delaware. Directions to Clayton Hall Conference Center Clayton Hall is on Rt. 896 in Newark, just north of the University of Delaware’s Main Campus. From either direction take Interstate 95 to the 896 North exit for Newark and the University campus. Follow signs for 896 North until you come to the entrance to Clayton Hall on the right. Assistive Technology: More Power to You Schedule of Events 8:30-9:00 a.m. Registration & Exhibits 9:00-10:00 a.m. Opening & Keynote Address 10:00-10:30 a.m. Break for Exhibits 10:30-Noon Breakout Sessions 1-3 1) The New Medicaid AAC Policy: A Model for Equipment Selection and Coverage 2) Re-animating the Physically Challenged 3) Alternative Writing Solutions that Work Noon-1:00 p.m. Lunch 1:00 p.m.-2:30 p.m. Breakout Sessions 4-6 4) Walking, Talking, and Playing Bridge: AAC Following an Aneurysm 5) On the Road Again... 6) Freeware and Shareware: Software for the Mac and PC to Make Computing Easier 2:30-3:00 p.m. Break for Exhibits 3:00-4:30 p.m. Breakout Sessions 7-9 7) Challenging Seating Situations: How Do We Solve the Problem? 8) Low and High-Tech Low-Vision Aids 9) Outreach Programs and Research on Information Access Tools DATI Annual Conference Breakout Sessions 1) The New Medicaid AAC Policy: A Model for Equipment Selection and Coverage Beth Mineo & Ron Sibert When the DATI began six years ago, Delaware Medicaid did not routinely cover augmentative communication devices and services. It did not have a policy relative to AAC devices, nor were its personnel familiar with the full range of AAC options and best practice considerations. Today, Medicaid evaluates AAC-related requests relative to a comprehensive policy that addresses assessment and prescription requirements, equipment purchase and/or rental, and equipment repair. This session will highlight some of the new, very consumer-responsive provisions of the policy as well as Medicaid’s expectations regarding the form and content of the documentation submitted to them. The speakers also will share insights about how the application of the policy’s model practices to other types of equipment can yield favorable coverage decisions. 2) Re-animating the Physically Challenged Jimmie Heuga, The Jimmie Heuga Center This session will emphasize the importance of safe, moderate exercise in the lives of those who are physically challenged by a chronic condition. This is the concern of the medical programs and research conducted for persons with Multiple Sclerosis by the Jimmie Heuga Center in Vail, Colorado. The discussion will include Jimmie’s current activities of swimming and bicycling, with an emphasis on setting realistic goals. 3) Alternative Writing Solutions that Work Debbie Whitby-Norman, Sharon Keller, and Barbara Brooks, Colonial School District This session will explore solutions for students needing an alternative method for written communication. Discussion will focus on the process of selection and implementation of these solutions into the inclusive classroom setting for students with learning disabilities, visual and physical impairments as well as cognitive challenges. Case studies will be presented through videotape and discussion. 4) Walking, Talking, and Playing Bridge: AAC Following an Aneurysm Joan Bradley, Retired R.N., B.N.A., R.N.F.A., C.N.O.R. and Tracey A. Bombara, M.S. CCC-SLP, Easter Seal Joan has had a very successful 48-year career in nursing. She served in the U.S. Army Nurse Corp, as a clinical instructor at Jefferson Medical Center, as the school nurse at the Wesley College Health Center, and in the Operating Room at Kent General Hospital. She co-authored the national Core Curriculum for the RN First Assistant, and was an adjunct faculty member at Delaware County Community College. She raised a family of five children, and was a regular participant in community and church activities. But all of this changed in September 1991 when a cerebral aneurysm ruptured while Mrs. Bradley was teaching. This presentation will provide information on Mrs. Bradley’s search for an AAC system, the procedures used to decide on the most appropriate system for her, her dedication to learning to use the system, and the degree to which she has been able to use a system in her daily life. 5) On the Road Again... Deborah Biggs, TTI Mobility Products and Dan Basore, Moss Rehab Driving Program The ability to drive a car represents freedom and equality for individuals with disabilities. This presentation will focus on adaptive equipment for the car, van, sport utility vehicle, RV, and truck and will include options available for drivers with transfer capabilities as well as drivers from the wheelchair. Hand controls, high-tech driving systems, zero effort steering, as well as wheelchair lift systems will be discussed. The process of driver recertification will be explained and available funding options for mobility equipment will be provided. 6) Freeware and Shareware: Software for the Mac and PC to Make Computing Easier Ed Salisbury and Don Erhart, AT Specialists and Patty Hove, Assistant Coordinator, DATI/Easter Seal ATRCs Participants will learn how to find inexpensive and sometimes free software for the Macintosh and IBM compatible computers without even leaving their home. Through on-line services, the Internet, and bulletin board services, thousands of freeware and shareware programs are available for education, recreation, and adaptive access to computers. Bring a blank 3-1/2” floppy disk and take home a collection of our favorites. 7) Challenging Seating Situations: How Do We Solve the Problem? Nancy Chipman Ranalli, PT; Jill Bauder Moynahan, OTR/L; and Michael Meyreles, Rehab Engineer, Easter Seal This session will include case studies of clients that are difficult to seat in the standard wheelchair setup. Information will be provided on evaluation procedures and problem-solving techniques used to develop the most appropriate seating/wheelchair specifications. Session attendees are encouraged to bring questions regarding their own experiences with difficult seating situations. Attendees should have a basic knowledge about seating and positioning as information provided will be at the intermediate level. 8) Low-and High-Tech Low-Vision Aids Neil Semmel, Delaware’s Division for the Visually Impaired This presentation will include discussions on low-vision aids, such as magnifiers, telescopes, reading and writing aids; DVI’s program for Delaware residents with low-vision or who are blind; and high-tech low-vision aids such as speech and large print programs for IBM compatible and Mac computers in DOS, Windows 95 and Mac environments. 9) Outreach Programs and Research on Information Access Tools Kenneth Barner, Director of SEM, a project of The Applied Science & Engineering Laboratories The University of Delaware's Science, Engineering, and Math Program focuses on methods and tools for engaging individuals with disabilities in the sciences. This session will give an overview of current and past outreach programs and discuss ongoing research projects designed to give individuals with disabilities greater access to the tools of science. Children’s Computer Software Resource Patty Hove, ATRC Assistant Coordinator Like music? Like painting? Drawing? Then Thinkin Things 2 is the program for you! Oranga Banga the orangutan plays with his band, but is just waiting for you to listen to his song, change the instruments or create a song by using original sounds, wacky sounds, or recorded sounds. Learn about rhythm, enhance auditory discrimination, or work on observation skills. Through colorful graphics and rewarding sounds, Thinkin Things 2 makes learning fun. If a three-piece band is not your “gig,” visit Toony and his xylophone. Toony plays a song for you, or plays part of the song until you learn the entire song. Toony provides an exciting way to build auditory memory skills, to remember and repeat patterns, and to learn about parts of a song that combine to make a whole song. Thinkin Things 2 also brings out the artistic side in an individual with its 2-3D Blox and Snake Blox activities. Visual creativity is encouraged through experimenting with placing two-dimensional pictures onto three-dimensional images. Through tools, you can paint objects with different colors in various textures and shapes. If you’re not afraid of “snakes,” use a masking tool to separate prepared pictures into foreground and background layers in the activity Snake Blox and create artful animations. The school version has instructions in how to customize the software for students, and how to adapt the program for students with special needs. Putting Classroom Computers to Work: Multimedia, Internet, and More by Ed Salisbury, Kent County ATRC The computer can be a valuable tool to students in all grade levels. Educational software can enhance or augment the curriculum. Multimedia software brings a multi-sensory learning approach to education that is beneficial to all students, and may be particularly helpful to those with learning disabilities. The computer can be a means of access to printed material for those with visual impairments, as well as a writing tool for those with physical limitations. Many schools have computers available for use by students either in the classroom or in a lab situation. In many instances, these computers are under-utilized due to unavailability of appropriate software or limited computer knowledge among teachers and staff. Sometimes computers are inaccessible to students with disabilities, and there may be concerns as to the safety of data contained on the computer’s hard drives. With increased use of the Internet as a research tool, there is concern about the appropriateness of much of the material to which students have access. Fortunately, there is a variety of hardware and software available to assist teachers in making computers fun and useful tools in their classrooms. The ability to find and access software quickly and easily is very helpful when computer time is limited. To simplify access to common application programs, a menu, or launching, system can be used. This is especially helpful in the DOS environment. Once a menu system is set up, students select the program wanted simply by pressing the appropriate letter or number. Someone with knowledge of DOS will need to set up and customize the menu system for student use. The Macintosh operating system includes a feature call Launcher. Launcher displays the application’s icons selected by the teacher as buttons in a window. Clicking on a button with the mouse loads the associated program. Buttons can then be organized into categories which are accessed by mouse. Launching, as well as menu programs designed for DOS, Windows, and Windows95, can be purchased in utility packages as well as downloaded from the Internet and various bulletin board systems. Technology is available to assist the teacher who may have only one or two computers in the classroom. One problem in using a single computer with a group of students is the difficulty in providing full viewing access to everybody. To solve this problem, a PC-TV converter can be purchased. This small unit attaches a Macintosh or PC to a standard television. Another option is to purchase an LCD projection panel. This device works with a high wattage overhead projector to project the monitor image to a standard movie screen. Some LCD systems include an internal light source which eliminates the need for an overhead projector. Although considerably more costly than the PC-TV converter, the LCD systems can project a much larger image of higher sharpness and clarity. Another problem encountered in single computer classrooms is how to allow access to the computer by more than one student at a time. For group activities, especially in special education and early education settings, an alternate keyboard called the Intellikeys can be used in addition to the standard keyboard. The Intellikeys contains keys printed on plastic overlays which slide over a touch sensitive membrane. Overlays with different key sizes and arrangements are included with the Intellikeys. With the addition of the Overlay Maker program, custom overlays can be designed and printed on standard paper. To allow group participation, up to six Intellikeys can be connected to the computer at once. Overlays can be created to allow each student to participate in a particular part of the activity or to allow turn taking without having to pass a keyboard from student to student. The Intellikeys and the Overlay Maker program are available from Intellitools for Apple II, Macintosh, and IBM PC and compatible computers. Another piece of technology ideally suited for classrooms with limited computers is the AlphaSmart Pro. The AlphaSmart is simply a keyboard with an LCD display that can be used to take notes or compose documents. With a single keypress, AlphaSmart Pro files can be quickly uploaded to a computer’s word processing program via the included cable. Another challenge faced in classroom computing is accidental deletion of files and programs. A software program called At-Ease is included with some Macintosh computers and can be purchased separately. At-Ease allows the teacher to control the programs to which students have access and to prevent the deletion of any file or application on the computer’s hard drive. A shareware program called ProGuard for Windows disables the delete function from Program Manager as well as the ability to delete files from File Manager. Individual applications can be protected with a user defined password. Without the password, the student is unable to open the application. Younger students may benefit from several programs similar in function to At-Ease but with a graphical and non-intimidating interface designed for children. These programs include Kid Desk from Edmark and Launchpad from Berkeley Systems. Both programs include custom desktops with only those applications selected by the teacher available. Each student can have his or her own desktop with access to his or her own applications and files. Both of these software programs are available for Macintosh and Windows. Even with the use of the various software programs mentioned above, deletions may still occur. If this happens, all hope is not lost. A software program called the Norton Utilities for Macintosh can be used to scan the hard disk and recover files that have been deleted. Windows includes a feature similar to this called Microsoft Undelete. To increase the chances of one hundred percent file recovery, these programs need to be run as quickly as possible after the deletion has taken place. The computer can also be used as a tool for students with a range of disabilities. For students with difficulty completing worksheets due to a physical limitation, a scanner can be used to import the worksheet into the computer. A program like OmniForm from Caere is needed to define regions on the worksheet where text will need to be added. The student can then complete the worksheet using the keyboard as if he or she were using a standard database program. Depending on the physical limitations of the student, alternate keyboards such as the Intellikeys, Tash Mini Keyboard, or BAT one handed keyboard could be used in place of the standard keyboard. For students in the lower grades who may need to color or draw on the scanned worksheet, a paint or drawing program along with an appropriate mouse alternative can be used. Mouse alternatives may include a trackball, touch screen, joystick, Intellikeys, or a mouse activated by head movement such as the HeadMouse or HeadMaster. Students with difficulty writing due to a learning disability or physical impairment may benefit from word prediction software. Word prediction software like Co:Writer, Aurora, and HandiWord limit the amount of keystrokes needed to type words and phrases. As the student types, the software tries to predict not only the completion of the word but the next word in the sentence. The computer presents the student with a list of possibilities from which to choose. Students with visual impairments as well as some with learning disabilities may benefit from any of a number of talking word processors. These include Intellitalk, ULTimate Reader, and Write:OutLoud. With these programs, letters can be spoken as they are typed or entire documents can be read to the student using computer generated speech. A wide range of educational multimedia software is available for all types of computers. This software generally includes exciting graphics, realistic sounds, photo quality images, and animation. CD-ROM storybooks like the Broderbund Living Books Series maintain the young students’ interest while introducing them to early literacy. The Little Planet Publishing Series turns students into writers who can incorporate voice annotations and graphics into their work. Literacy programs from a variety of software companies use a multi-sensory learning approach to teach reading skills. Authoring programs like Hyperstudio, and even Kid Pix with Companion, allow students to create slide shows for the whole class to see. Both programs allow students to include animation, voice annotations, and even sounds to their slide shows. With the addition of a color scanner or digital camera, students can even include photographs. The Internet is a valuable resource to both students and teachers. Several problems are often associated with using the Internet in the classroom. One problem is the need for the computer to be connected to a network or phone line for Internet access. Another concerns the appropriateness and accuracy of some material students may find on the web. Students may also be overwhelmed by too much information on any given topic. A software program called Web Whacker addresses several of these dilemmas. Web Whacker allows the teacher to download specific web sites and their associated links to the computer’s hard drive. The students can access these sites without the need for an Internet connection. Because the sites are accessed directly from the hard drive, pages appear quickly and completely. Only those sites chosen by the teacher can be accessed. For teachers who need to prevent viewing of sexually oriented or violent material, programs like Net Nanny, Cyber Patrol, and Surf Watch limit the students’ accessibility to sites with adult content. Computers can only be a valuable tool if they are being used. It is not always easy to integrate the computer into daily classroom use. But, with a little planning, creativity, and the addition of a minimal amount of hardware and software, the computer can help boost student achievement and enjoyment. Many software programs include testing and grading features, as well as the ability to print progress reports for each student. Most of the software and hardware mentioned above is available for preview and/or loan at your local Assistive Technology Resource Center. Funding Assistive Technology: Medicare Coverage Of Assistive Technology Persons who are at least 65 years old, permanently disabled, or who have end-stage kidney disease may qualify for Medicare. Medicare is composed of Part A and Part B coverage. All Medicare beneficiaries are covered under Part A, which pays for hospitalization. Part B, however, requires a monthly premium and an annual deductible. Part B coverage includes doctors’ services, home health care, and assistive technology. The Medicare term for assistive technology is “durable medical equipment” (DME). DME may be rented or purchased. As a general matter, payment under Part B will not be made for any item that is not “reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” If an item is covered, repair and maintenance of that item may also be covered. What Does “Durable Medical Equipment” Include? “Durable medical equipment” is defined as equipment furnished by a supplier or home health care agency that: (1) Can withstand repeated use; (2) Is primarily or customarily used to serve a medical purpose; (3) Generally is not useful to a person without an illness or injury; and (4) Is appropriate for home use. Iron lungs, oxygen, hospital beds, wheel chairs, walkers, and seat lifts are examples of DME. Certain items, such as most eyeglasses and hearing aids, are excluded by law. Medicare now publishes a quarterly appendix listing the procedures and services it covers. For items that are not listed, a Medicare carrier makes its own medical necessity determination. Coverage for equipment that is not primarily medical in nature, such as a bathtub lift, may be denied because it is deemed a “convenience” item. However, you may be successful in appealing the denial. What If Equipment Has Both Medical And Non-medical Purposes? If the equipment serves both medical and non-medical purposes, it is not generally classified as DME. For example, even though air conditioning may be prescribed to facilitate the blood circulation of a patient with heart disease, it is not primarily designed for a medical purpose and thus it is excluded from Medicare coverage. Similarly, water beds have both medical and non-medical purposes. However, because they were originally designed to prevent skin breakdown in bed-confined patients, a specialized mattress may be covered under Medicare if it is medically required. The distinction between covered and non-covered items is not always logical. Even if you are using equipment for a vocational or otherwise non-medical purpose, it may be covered if it is equipment generally used for a medical purpose. How Do I Prove That Durable Medical Equipment Is Reasonable And Necessary? Unless the DME is documented to be reasonable and necessary for diagnosing or treating illness or injury or improving the functioning of a malformed body member, coverage will be denied. You should obtain a detailed doctor’s prescription for the equipment which outlines how the equipment’s purpose and/or design meets these criteria. If Equipment Is Covered, Will Medicare Pay The Entire Amount Charged? Medicare will pay 80% of the reasonable cost of covered items. You are responsible for the other 20%, as well as the annual Medicare Part B deductible. In certain well-documented cases of financial hardship, the supplier may waive the 20% co-payment. It is important to determine whether the supplier “takes assignment.” If so, that means the supplier agrees to accept as payment in full the reasonable cost of the equipment as determined by Medicare. You would then only be responsible for 20% of the reasonable cost of the item, assuming you had already paid your annual deductible. If the supplier does not take assignment, Medicare will still only pay 80% of the reasonable cost of the item as determined by Medicare. You would then be responsible for any remaining balance. Who Decides Whether The Equipment Will Be Rented Or Purchased? You decide whether to rent or buy equipment. However, Medicare payment is based on the carrier’s determination of whether it would be cheaper and more practical to pay on a lease-purchase, lump sum, or rental basis. Even if you purchased the equipment, Medicare may decide to pay on a rental basis. A carrier is required to notify you or the supplier as promptly as possible of the method of payment and maximum amount payable. In deciding whether to make rental payments as opposed to buying the equipment, the carrier will consider: (1) How long the equipment will be needed; (2) The criteria for reasonable charges; (3) The maintenance that the equipment will require; (4) The administrative costs involved in renting inexpensive items (less than $150); (5) The average length of time that such equipment is rented; and (6) Health Care Financing Administration guidelines. Rental will be considered practical if the total expected rental charges are less than the purchase price. It is important to remember that Medicare’s payment will be based on the reasonable purchase price, which may be less than the price charged. If Medicare decides to purchase the equipment and you cannot afford the 20% co-payment, you may plead financial hardship. However, financial hardship can be established only in extreme cases, and only where the supplier doesn’t offer installment arrangements. If you are low-income you may be eligible for the Qualified Medicare Beneficiary program. Under this program the State pays your Medicare premiums, deductibles and co-payments. Alternatively you may be eligible for the Specified Low-Income Medicare Beneficiary program in which the State pays your Medicare Part B premium (under this program the State does not pay co-insurance, deductibles, or Part A premiums). You can apply for these programs at the State Medicaid office. Can I Determine In Advance Whether Medicare Will Cover The Purchase Of Equipment? Medicare will not generally make a pre-purchase determination as to whether the desired equipment is reasonable and necessary and therefore covered under Medicare. This means that you risk coverage denial in purchasing DME. However, because some items are frequently subject to unnecessary use, in 1990 Congress decided to require advance authorization for certain types of equipment. These include seatlift mechanisms and motorized scooters. It is best to arrange with a medical equipment supplier to accept Medicare assignment. Then the supplier can submit the claim to Medicare before providing you with the equipment. If Medicare denies the claim, you will have lost nothing. Is There Any Benefit To Purchasing Used Equipment? If used equipment is purchased, Medicare will waive the usual 20% co-payment. However, the cost of the used equipment must be at least 25% less than the cost of the equipment new. Also, a warranty must be provided with commercially supplied used equipment. If you purchase used equipment from a private source, you must certify that it is acceptable. If you rent new equipment and later decide to purchase it, it will then be considered “used” equipment. What Happens When A Request For Payment For Part B Benefits Is Submitted? When a request for payment for DME under Part B is submitted, the carrier will make an initial determination. The initial determination includes decisions about whether items are covered, whether the deductible has been met, whether charges are reasonable, whether coinsurance has been properly applied, and whether the DME is medically necessary. The carrier will also determine the amount of benefit payable and to whom it should be paid. If your claim is denied, within six months of the initial determination you may request a paper review. Your request must be in writing and filed with the carrier, the Social Security Administration, or the Health Care Financing Administration. If you are not satisfied with the review determination, you may request a “fair hearing” before a carrier or hearing officer if the amount at issue is at least $100. (A more informal hearing may be requested if the amount is less than $100.) The fair hearing must be requested within six months of the review determination. You may appear at the hearing or waive your right to do so. Following the fair hearing decision, if the amount at issue is at least $500, you may obtain a hearing before an administrative law judge. If the amount at issue is at least $1,000, you may ask a court to review an adverse decision by an administrative law judge. It often happens that claims which were initially denied are permitted on appeal. Thus, it is usually a good idea to appeal your claim. What If My Claim Is Submitted But Is Not Processed Promptly? The carrier must act on a claim with reasonable promptness. That means that if an initial determination is not made within 60 days of receiving your claim, you may request that a hearing officer make the initial determination. Medicare standards also dictate that carriers should respond to written inquiries within 30 days. Are There Special Requirements For Some Types Of Durable Medical Equipment? Some equipment must meet special requirements to qualify as DME. For example, power-operated vehicles that may be used as wheelchairs may be covered if a wheelchair is medically necessary and the patient cannot operate a manual wheelchair. A specialist must evaluate the patient’s condition and prescribe the vehicle to assure that the patient needs it and can use it safely. A seatlift chair is covered under Medicare when prescribed by a doctor for a patient with a neuromuscular disease such as Muscular Dystrophy. The patient’s condition must be so severe that the alternative would be chair or bed confinement. Medicare frequently denies coverage for seatlift chairs, but the reversal rate of these claims denials on appeal is high. Medicare will only pay for the seatlift mechanism and not the chair itself. Will Medicare Cover Durable Medical Equipment If I Am In A Nursing Home Or Hospital? Medicare covers DME for use in the home, which may include an institution used as a home. However, it does not cover DME for use in institutions that meet the statutory definition of a hospital or skilled nursing facility. This article was prepared by the Community Legal Aid Society, Inc. (CLASI). CLASI maintains specialized legal advocacy units such as the Disabilities Law Program and Elder Law Program. This is the first in a series of CLASI authored articles which will appear as a regular column in The AT Messenger. Delaware Recycles AT If you are interested in an item, please call the number listed next to the item. If you would like to add or remove an item from the list, call 800-870-3284, press 1 for English, and then press 3 for the DATI Central Site office. All prices are negotiable and all area codes are 302 unless otherwise noted. Devices Available: Ambulation/Mobility 2 Braces, Child, f/2 year old, $50, Dave, 455-1432 Brace, Child, one-unit, Free, Rosemary, 366-7553 Cane, 4-leg, $35, Kathy, 644-2214 Cane, 4-leg, $20, Connie, 653-7341 Cane, (2), Free, Evelyn, 994-0485 Crutches, Free, Evelyn, 994-0485 Gait Trainer, Rifton, adult-size, adj, $150, Sheila, 697-8404 Walker, Swedish Rollator w/wheels & attached seat, $300 or best offer, D.C., 629-9569 Walker, collapsible, $65, Howard, 994-5565 Walker, std, Albert, 322-6600 or 738-0422 after 6 p.m. Walker, $50, Connie, 653-7341 Walker (2), B/O, Sheree, 798-5572 Architectural Rancher, 3 BR, w/c accessible, no steps, $121K, Sam, 479-0819 Wooden Ramp, 3 steps, $200, Ellen, 856-6141 Augmentative Communication Lightwriter, Scanning (SL8), $500, Carolyn, 856-7946 Computers/Electronic Equipment B.O.S.S. 8000 Casio Organizer, $50, Carolyn, 856-7946 Educational Hooked on Phonics, books & tape, $150, Donna, 337-7642 Hearing Telecaption II Decoder, $25, Donald, 892-9038 TTY, Ultratec Compact, portable, $275, Melissa, 410-822-3949 Personal Care/Home Management Bath Chair, Tubby II Folding Bath Bench Chair, $70, Sandy, 328-2872 Bath Lift Chair, water powered, self operated, $300, Christine, 322-3766 Bath Support Seat, Child’s (2), $70 ea., Sandy, 328-2872 Bathtub Bench, New, $100, Sarah, 322-8112 Bedside Commode, $20, Sandy, 328-2872 Bedside Commode, Freestanding or over the commode, $45, Kathy, 644-2214 Commode, Child’s, High-Back, $85, Sandy, 328-2872 Commode, portable, $65, Howard, 994-5565 Commode, portable, w/arms, folds, neg., Albert, 322-6600 or 738-0422 after 6 p.m. Commode Portable, arm rests, back support, neg., Maryanne, 737-6215 Fluctuating air mattress w/pump, new for single bed, $95, Michael, 322-4543 Geriatric Chair, new, w/reclining chair, adj. foot rests, & attachable tray, $400, Sarah, 322-8112 Geriatric Chair, BioCare 5000, 3-position, neg., Carol, 610-358-2137 Hospital Bed, Electric, $1,200, Billie, 322-7863 after 6 p.m. Hospital Bed, Electric, $200, Richard, 610-565-3636 Hospital Bed, Electric, 3-position, $600, Stephen, 947-1637 Hospital Beds (3), Manual, Free, Harry, 855-1692 Hospital Bed, Electric, B/O, Sheree, 798-5572 Hospital Table, B/O, Sheree, 798-5572 IV Pole, $15, Sheila 697-8404 Knee Immobilizer, new, $30, Dick, 239-4243 Linear Pump, Wright, aids circulation, Free, Lucille, 836-1283 Mobilaire, Invacare Mobilaire 5 w/Sense 02, best offer, Robert, 325-4063 Oxygen Machine, $1K, Millie, 800-982-2248 Patient Lift, Invacare, hydraulic, $200, Debra, 366-1010 Peristaltic Gradient Sequential Compression Pump, neg., Joanne, 658-5878 Pulmo-Aide Compressor, $40, Millie, 800-982-2248 Restraint Belt, neg., Maryanne, 737-6215 Shower Bench, small, $20, Kathy, 644-2214 Shower Chair, no wheels, back or arms, neg., Albert, 322-6600 or 738-0422 after 6 p.m. Shower Chair, extended seat, no wheels, back, $25, Sheila, 697-8404 Shower Chair, nylon mesh seat, adj, reclines, $50, Sheila, 697-8404 Stair Glide, 10-12 steps, $700, Betty, 368-0526 Stair Glide, (2) Cheney, perfect condition, neg., Sandra, 239-7440 Stair Glide, Silver Glide II, neg., Jay, 734-8400 Stair Glide, $300, Richard, 764-1714 Suction Machine Carrying Case, Free, Lisa, 410-893-8614 Traction Belt, Foam Padded, neg., Maryanne, 737-6215 Transfer Belt, new, $40, Dick, 239-4243 Transfer Bench, used twice, $50, Kathy, 644-2214 Transfer Bench, $65, Howard, 994-5565 Transfer Board, new, $30, Dick, 239-4243 Three/Four-Wheeled Powered Scooters Scooter, Rascal, 3 wheel, chair w/arms, horn, flag, double batteries, charger, $1,500, Kathy, 644-2214 Scooter, 3 wheel, electric all terrain, w/battery & charge, $1,500, Albert, 322-6600 or 738-0422 after 6 p.m. Vehicles/Accessories Hand Brake/Throttle, new, GM, $395, Barbara, 678-0515 Ramp, permanently attaches to a van, $60, Elizabeth, 422-2896 Van, 89 Ford E 150, blue, Braun w/c lift, automatic, $8K, Richard, 610-274-0242 Van, ‘88 Dodge Maxi Van, 2-tone brown, 50K, lift bed, toilet, storage, electric, $20K or $12K to qualified buyer, Franklin, 368-4675 Van, ‘87, Convertible, new w/c lift, 80K miles, $6,500, Howard, 994-5565 Van, ‘90 E150, white & gray, w/Crow River Lift, 72K miles, garage kept, b/o, Ken, 784-6266 Van, ‘85 Ford E150, Conversion, Vangater lift, 75K miles, $4K, Jenny, 633-3973 Van, ‘88 Ford E150 Van Ricon, sidedoor w/c lift, driver hand controls, remote control, 89K miles, Jaclyn, 325-2528 Van, ‘91, Conversion, w/c lift, 50K miles, $12K, Dick, 239-4243 Vanagon, ‘91, VW, remote w/c lift, transfer 4-way power seat, hand controls, ac, pw & locks, $12,500 firm, Janice, 757-824-0341 Wagon, ‘86, Nissan Maxima, pw, pb, ac, hand brakes, lift for scooter, $3,900, Michael, 478-7401 Vision Voyager CCD, Telesensory, $1,500, Nicholas, 645-6797 Wheelchairs/Accessories Adult, Electric, w/recharger, E&J, $1,500, Mary, 984-1225 after 6 p.m. Adult, Electric, Joystick Hoveround, reclines, hi-back, video and manual inc., neg., Josephine, 764-5324 Adult, Electric, Invacare, 16” wide, w/tilt & space recliner, removable joystick on tray, $7K, Jo/Jim, 610-622-4276 Adult, Electric, new w/battery & charger, $2K, Albert, 322-6600 or 738-0422 after 6 p.m. Adult, Electric, w/charger, manual inc., std, $900, Dolores, 856-3261 Adult, Electric, E&J xtra width, w/recharger, gel cushion, and joystick, $2,500, Dorothy, 875-7863 Adult (large), lightweight, $150, Leigh, 945-9523 Adult, Manual, $500, Rose, 335-4659 evenings Adult, Manual, 18”, Invacare w/footrests, $350, Cindy, 475-2904 Adult, Manual, Invacare, Jay Back, $600 Firm, William, 652-1914 Adult, Manual, Tracer 1000 Series, std, Lightweight, $150, Michael, 328-7753 Adult (small), Manual, no arms, $50, Betty, 368-0526 Adult, Manual, $550, Dick, 994-5565 Adult, Manual, w/tilt & space w/headrests, $300, Sheila, 697-8404 Adult, Manual, Rolls-Invacare, $150, James, 764-8008 Adult, Manual, large, B/O, Sheree, 798-5572 Adult, Travel Chair, lightweight, collapsible, std size, $350 Firm, Alice, 998-4537 Adult, Travel, Lightweight, 17”, w/footrest, $200, Connie, 653-7341 Child, Quickie P10, Electric, $1,200, Richard, 610-565-3636 Child, E & J, Electric, Barbie, $5K, Joanne, 215-335-0589 Child (6-18), Electric, Invacare 9000, $500, Susan, 610-793-1470 Child, Zippie by Quickie, Manual, Pink & Black, tilts, $500, Jamie, 945-8668 Child, Quickie, Manual, w/tray, $200, Vernessa, 655-9840 eve. Children’s, variety, Free, Kristen, 672-1960 W/C Arm Tray, $20, Dick, 239-4243 W/C Cushion, $35, Dick, 239-4243 W/C Full Tray, $30, Dick, 239-4243 Devices Needed: Accessible Home with w/c ramps and lowered cabinets, Sarah, 322-8112 Bathtub Recliner Chair, Michale, 368-1773 Bed Rails, Pam, 328-9366 Bicycle, pedal w/hands, Pat, 653-6892 Bike, Adult, 3-wheeled, Sandra, 875-8095 Headrest for w/c w/mounting bracket, Michael, 322-4543 Lift for Rascal Scooter, Dawn, 738-5336 Lift Chair (donation), Raymond, 349-5610 Phone Flasher for TTY, Tricia, 832-8082 Portable Ramps, Dave, 328-4143 Scooter, electric, heavy duty, Sarah, 322-8112 Scooter or electric wheelchair, xtra wide, Ruth, 422-5294 Shower Bench or Chair, small, Kristen, 658-0672 Standing Table, Ken, 831-2430 Tilt Table, Theresa 651-6015 Trackball, large, IBM compatible, Michale, 368-1773 Tricycle, Adult w/coaster brakes, Mary Anne, 998-2171 Tricycle, Adult w/ or w/o coasters, Loretta, 478-7912 Tricycle, Child’s, accessible, Marcy, 609-478-0656 TTY, Tricia, 832-8082 Van w/lift, Larry, 424-0536 Van Lift, Pat, 653-6892 Van Ramps, 7-10’, EZ access, Cindy, 284-9575 Van Ramps, Pat, 653-6892 Walker with Trunk Support, Michale, 368-1773 Wheelchair, Electric, 16” seat w/control on right side, Kristen, 672-1960 Wheelchair, Electric, adult (tall), Arlene, 856-5063 Wheelchair, 22”, collapsible, Barbara, 834-2267 Wheelchair, Adult, Manual, Frances, Cape Henlopen Senior Center, 227-2055 Wheelchair Parts, Meyra brand, Lisa, 410-893-8614 Wolf Communication Device, Liz, 429-4062 Wolf Communication Device, Kim/Karen, 323-9732 Note: If you are looking for items not on the list, please contact the Central Site office at 1-800-870-DATI. New items are added to the list regularly. To contact DATI’s Central Site office or the ATRC closest to you... Call 1-800-870-DATI Press #1 for English or Press #2 for Spanish then press... #3 for the Central Site office or #4 for the New Castle County ATRC or #5 for the Kent County ATRC or #6 for the Sussex County ATRC TDD callers—If you do not press #1 or 2 your call will be answered on a TDD line by someone at the Central Site office.