FUNDING ASSISTIVE TECHNOLOGY THROUGH EDUCATION, VOCATIONAL REHABILITATION, AND MEDICAID

Jami M. Goetz
University of Colorado at Denver
School of Education
Campus Box 106
P.O. Box 173364
Denver, Colorado 80217-3364
Voice (303) 556-6022

Kim Erickson
The Legal Center for People with Disabilities and Older People
455 Sherman St., Suite 130
Denver, CO 80204
Voice (303) 722-0300

Web Posted on: November 30, 1997

The value of assistive technology for individuals with disabilities has been demonstrated over and over again. Human service professionals agree that assistive technology can benefit many individuals. The problem that frequently arises is how to finance the technology. Many devices and services are expensive and finding funding can be difficult. This presentation deals with the rights and responsibilities for funding assistive technology with the big three funding sources: Education, Vocational Rehabilitation, and Medicaid.

The definitions for assistive technology devices and services are as follows: Assistive technology device is "any piece of equipment or product system whether acquired commercially off the shelf, modified, or customized that is used to increase, maintain or improve functional capabilities of individuals with disabilities". Assistive technology service is "any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device including evaluation, purchasing or leasing, selecting, designing, fitting, customizing, maintaining, repairing, coordination with other services and therapies, and training or technical assistance".

Medicaid

"To enable each state, as far as practicable under the conditions in such state, to furnish:

• 1) Medical assistance for eligible individuals; and
• 2) Rehabilitation and other services for independence or self care" is the Medicaid statement of purpose (42U.S.C. Section 1369).

Medicaid does not use the same definition for assistive technology as Education and Vocational Rehabilitation. Instead they refer to Rehabilitation services.

Rehabilitation services, prosthetic devices and durable medical equipment mean any medical or remedial devices or services recommended by a physician or other licensed practitioner of the healing arts, within the scope of his practice under state law, for maximum reduction of physical or mental disability and restoration of a recipient to his/her best possible functional level. Included in rehabilitation services are Home Health Services. Home health services are provided to the recipient at their place of residence and on their physicians orders. These services as defined by 42 C.F.R. Section 440.70 include

• a) nursing servicers (required);
• b) home health aid services (required);
• c) medical supplies (required); and
• d) therapy (optional).

Another service provided under Medicaid is Preventive Services. These services are provided by a physician or other licensed practitioner of the healing arts within the scope of his practice under State law to

• a) prevent disease, disability, and other health conditions or their progression;
• b) prolong life; and
• c) promote physical and mental health and efficiency.

Additionally under federal regulation 42 C.F.R. Section 440.110, physical and occupational therapy services can be provided. The services are prescribed by a physician and provided to recipient by or under the direction of a qualified therapist. It includes any necessary supplies and equipment. Supplies and equipment could include assistive technology devices. The same federal regulation provides services for individuals with speech, hearing, and language disorders. These services include

• a) diagnostics;
• b) screening; and
• c) preventive and corrective services.

Again any necessary supplies and equipment.

Finally, under Medicaid is the Early and Periodic Screening, Diagnostic, and Treatment (E.P.S.D.T.) program. E.P.S.D.T. is designed for children with an early identification of having a disability or being at risk. E.P.S.D.T. provides such other necessary health care, diagnostic services, treatment, and other measures described in subsection (a) of this section (42 U.S.C. 1396d(a)) to correct or ameliorate, defects and physical and mental illness and conditions discovered by mental illness and conditions discovered by the screening services, whether or not such services are covered under the State plan. In other words, children who are indentified as needing services under E.P.S.D.T. are entitled to the full range of services available from Medicaid whether the individual state plan subscribes to them or not. Assistive technology devices and services can be purchased under this program.

While Medicaid services must have a medical bases federal regulation 42 U.S.C. 1996b(c) states that treatment of educationally related services is not restricted. This means that if a device is also used in an educational setting, that does not restrict Medicaid from paying for it.

Special Education

Education is a frequent source for funding assistive technology devices and services. Under the Individuals with Disability Education Act (IDEA) assistive technology has the same definition as listed above (20 U.S.C. Chapter 33, Section 1401 (25)). Assistive technology may appear in an IEP in the following areas:

• 1) the annual goals and short term objectives;
• 2) the enumeration of supplementary aids and services necessary to maintain the student in the least restrictive educational setting; and
• 3) the list of related services necessary for the student to benefit from his or her education.

Assistive technology must be listed on the IEP in order for the school to be required to pay for it. The school may choose to pay for assistive technology if it is not listed, but in the case of a dispute, the family should insist that it be included on the IEP. The free appropriate public education requirement is satisfied by providing personalized instruction with sufficient support services to permit the child to benefit from that instruction. Because the public education is to be free, parents can not be required to pay for assistive technology that is needed for meeting education goals, nor can they be required to use their personal insurance to pay for devices or services.

Vocational Rehabilitation

The purpose of vocational rehabilitation is to help individuals with disabilities secure employment that is consistent with their capacities and abilities. In Vocational Rehabilitation, the term "rehabilitation technology" means the systematic approach to technologies, engineering methodologies, or scientific principles to meet the needs of and address the barriers confronted by individuals with disabilities. These areas include; education, rehabilitation, employment, transportation, independent living, and recreations. The term includes rehabilitation engineering, assistive technology devices, and assistive technology services. More specifically, rehabilitation engineering is the process of making environments and consumers and industrial goods accessible to individuals with disabilities, including the process of designing and developing new assistive technology devices and products.

Rehabilitation Technology Services are not subject to the comparable benefits search requirement. This means that it is not required to spend time searching for the best price or for similar devices that might also do the job. In addition, rehabilitation systems must provide rehabilitation technology services and devices to individuals who require them to achieve their rehabilitation goals. Assistive technology is to be available throughout the rehabilitation process which includes application, eligibility determination, training, and job placement.

Funding assistive technology can be a frustrating experience for families and service providers. It is critical that those individuals who are trying to secure funding be aware of the laws and regulations that govern the payment for assistive technology by education, vocational rehabilitation and Medicaid. The better families understand the laws, regulations, and policies of the big three funding sources, the better their chances of receiving assistive technology funding.