Assistive Technology (AT)
Definition
The purpose of this service is to supplements the Medicaid State Plan Service for Durable Medical Equipment and supplies, which provides a broad range of special medical equipment and supplies. The Medicaid State Plan and all other resources must be explored and utilized before considering AT. Durable Medical Equipment covered by the Medicaid State Plan can be found at www.emedny.org under 'Provider Manuals'.
An Assistive Technological device may include an item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or to improve the functional capabilities of the waiver participants. AT service is a service that directly assists a waiver participant in the selection, acquisition, or use of an assistive technology device. This service will only be approved when the requested equipment and supplies improve or maintain the waiver participant's level of independence, ability to access needed supports and services in the community or, maintain or improve the waiver participant's safety.
Documentation must describe how the waiver participant's expected use, purpose and intended place of use have been matched to features of the products requested in order to achieve the desired outcome in an efficient and cost effective manner.
AT may be obtained at the time the individual becomes enrolled as a participant, no more than thirty (30) days prior to the initial NOD, or during the development of any SP. Requests for AT must be less than $15,000 per 12-month period. For example: If a participant needs more than one type of AT device during the twelve (12) month period, the combined cost for this period may not exceed $15,000. A contract for AT resulting in an amount of $15,000 or more per 12-month period must be approved by DOH.
Provider Qualifications
AT Services are purchased through vendors who sell the needed medical, communication and adaptive equipment or supplies.
Providers of Assistive Technology must be:
- Approved by DOH under Section 504 of Title 18 NYCRR;
- Providers of AT services to the HCBS waiver administered by OMRDD;
- A licensed pharmacy; or
- For Personal Emergency Response Systems (PERS), an approved provider of PERS which have existing contracts with the LDSS.
Providers of AT must ensure that all devices and supplies meet standards established by Underwriters Laboratory and/or comply with FCC Regulations, if appropriate.
The provider of this service is responsible for training the waiver participant, natural (informal) supports and paid staff who will be assisting the waiver participant in using the equipment or supplies.
Approval Process for AT Services
| Step 1 | The participant, his/her legal guardian, the SC, and anyone selected by the participant determine if any AT is needed during the development of any SP. This must be done in conjunction with an assessment by either an Independent Living Skills Trainer (ILST) or other professional who is knowledgeable about the full range of devices and/or technology to assist individuals with disabilities or seniors. |
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| Step 2 | The participant and SC explore and utilize all possible funding sources including: private insurance; community resources; non-Medicaid federal and state funding (e.g. Medicare); and/or other federal/State programs. These funding sources must be accessed with documentation of denial prior to requesting AT Services. |
| Step 3 | If NHTD funding is required for the device(s), the SC initiates the process for submission of the AT request to the RRDS using the Assistive Technology Description and Cost Projection form (refer to Appendix C - form C.9). Information that must be submitted includes but is not limited to:
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| Step 4 | The SC obtains bids from approved AT providers. The SC must select an approved provider based on reasonable pricing and obtain a written bid stating all terms and conditions of sale.
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| Step 5 | The SC completes the Assistive Technology Description and Cost Projection form and attaches all bids obtained. The SC reviews the form with the applicant/participant and both the SC and applicant/participant signs. |
| Step 6 | The SC submits the complete Assistive Technology Description and Cost Projection form along with the Initial or Revised Service Plan, or Addendum to the RRDS. |
| Step 7 | The RRDS reviews the Assistive Technology Description and Cost Projection form and may request more information. Approval is contingent upon available funding. The RRDS notifies the SC of the approval. |
| Step 8 | The SC notifies the AT provider. |
| Step 9 | The AT provider completes and signs the Waiver Services Final Cost form (refer to Appendix C - form C.11) with the participant; |
| Step 10 | The AT provider sends the Waiver Services Final Cost form to the SC who signs off and submits the form to the RRDS; |
| Step 11 | The RRDS reviews the Waiver Services Final Cost form and completes the RRDS Approval of Final Cost form. The RRDS provides a copy of the RRDS Approval of Final Cost form to the AT provider and SC; |
| Step 12 | The AT provider seeks reimbursement after receiving a copy of the NOD from the SC. |
Repairs
Repairs to AT which are cost effective may be allowed. Items that have worn out through normal everyday use (keyboards, switches, etc.) may be replaced using the same procedures that were followed to initially acquire the item. There are situations where replacement or repair will be contingent on establishing a plan that would minimize repeated loss or damage. The SC is responsible for working with the team to develop and implement a plan to prevent repeated loss or damage.
Reimbursement
AT must be provided by a DOH approved provider and included in the SP to be reimbursed.
AT is reimbursed based on the lowest of two costs: wholesale plus 50% or the retail cost. Repairs and replacement of parts are reimbursed at the retail cost. AT obtained no more than thirty (30) days prior to the initial NOD are reimbursed after the NOD is issued.
