Assistive technology includes a variety of devices that help people with disabilities increase, maintain or improve their functional abilities, such as seeing, hearing, walking/mobility, verbal and written communication and learning. The devices also vary in terms of price and complexity. Funding for assistive technology, including adaptive positioning equipment, can be complex and burdensome for people with disabilities and their families and for the therapists who often help them obtain the equipment that meets their needs. Having background information and developing a strategy ahead of time can save time and effort and can help avoid denials and lengthy appeals.
Positioning equipment is necessary for people who cannot support themselves while sitting, standing, or lying down. Examples of positioning equipment include, but are not limited to: bolsters, pillows, wedges, standing frames, side loungers, seating systems, specialized seat and back cushions, commode chairs, and bath/shower chairs. Some positioning equipment is free-standing, while others can be incorporated into a mobility device, such as a manual or power wheelchair or mobile walker.
Know your funding source
Part of the challenge of getting funding for positioning equipment is that funding sources are not designed or managed the same way. A person may have access to public and/or private financing sources. Private sources (i.e., private insurance, clubs, and service organizations) are not under government control, while public funding sources are controlled by federal or state statutes, statutes, or laws (e.g., Medicaid, Education Act Individuals with Disabilities). The US government then classifies public sources as discretionary or entitlement programs. Within discretionary programs, a case manager or counselor is often responsible for determining whether the program will provide equipment because such programs are not required to provide all services to all eligible children and often have a monetary limit available. in a given year. In contrast, benefit programs are responsible for providing benefits to all children who meet eligibility criteria. Governments control benefit programs by limiting eligibility criteria or reducing the cost, duration, and scope of services covered by the program.
Some of the most common funding sources for child positioning devices are:
- Medicaid (Title XIX of the Social Security Act), including early, periodic and screening screening, diagnosis and treatment (EPSDT) programs and state waiver programs
- Early intervention programs (birth to age three) and local school districts, as part of the Individuals with Disabilities Education Act (IDEA)
- Private insurance
- Clubs and service organizations
Before making a recommendation to any funding source, do your homework. Understand what type of program it is, how it works, and what the appeals process is. Having this information ahead of time will increase your chances of success. For example, Medicaid is a federal/state health assistance program for select low-income people or children who come from low-income families. Medicaid coverage varies from state to state, so it is important to know the mandated services in your state before writing a letter of medical necessity to request positioning equipment. Another example is funding through school districts as part of the Individuals with Disabilities Education Act (IDEA). Recommendations for funding through IDEA go through the local school district responsible for the child’s individualized education program (IEP). The IEP team decides what assistive technology is included in the IEP, so knowledge of the IEP process is essential. Although assistive technology may be included in the IEP, the school district is not necessarily responsible for paying for the equipment. IDEA allows school districts to access and use other funds that may be available to the child to secure the equipment the child needs, especially if the child will use it in settings other than school (i.e., home or community).
Communicate and coordinate with the team.
Children often use positioning equipment in different settings, so coordinating recommendations with family and team members in these settings is essential to avoid duplication and expedite requests. For example, a child may need support at home and during school. The child may have therapists who work with him at home or on an outpatient basis and also in the school setting. Without consistent communication, therapists from different settings may individually request the same equipment for a child, which can result in unnecessary delays, denials, or duplication of equipment.
Test equipment
Another important part of getting funding is working with equipment suppliers to get positioning equipment used in testing. Tests to evaluate the effectiveness of the equipment and the child’s reaction to it are a fundamental part of the evaluation process. Testing allows for data collection and documentation of specific changes in posture and function and also a comparison between different positioning equipment. Without testing, documentation may lack the objective data necessary to justify the recommended equipment.
Document appropriately
Finally, documentation (i.e., certificates, letters of medical necessity, letters of justification) should be clear and concise. Although there are no magic words that guarantee that an insurance company or program will pay for recommended equipment, using terms and language that are familiar or unique to the company or program increases the likelihood of success. For example, if requests are submitted to Medicaid or private insurance, the justification must be written in terms of “medical necessity.” If a request is submitted to a child’s school district, then documentation must demonstrate the impact on the child’s educational goals and performance. It may be helpful to supplement written documentation with photographs or videos of the child using the positioning equipment.
Funding is often a barrier to purchasing assistive technology, including positioning equipment. It is critical to understand the differences between funding sources and use a coordinated approach when making recommendations for such teams. By using the tips outlined, you can avoid unnecessary delays and successfully navigate funding sources more efficiently and effectively to provide children with the equipment they need.
