The Promise of Assistive Technology to Enhance Activity and Work Participation (2017) / Chapter Skim
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7 Coverage for Relevant Products and Technologies
7 Coverage for Relevant Products and Technologies
Pages 311-404
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The first section of the chapter reviews public funding sources, including Medicaid, Medicare, the Veterans Health Administration (VHA) , special education programs (for transition-aged youth)
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• Products and technologies that pertain to hearing -- hearing aids • Products and technologies that pertain to communication and speech -- both speech-generating devices (SGDs) that are dedicated and dual-purpose devices (i.e., laptops or tablets that can be used as SGDs and for personal computing)
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States receive federal Medicaid funding, known as federal financial participation (FFP) , for both the provision of health care services and certain administrative functions.6 Medicaid Eligibility Groups and Benefit Categories Medicaid programs vary from state to state with respect to both the individuals who are eligible to enroll and the health care services covered.
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Once the spend-down or cost-share amount has been paid or incurred, full Medicaid eligibility is established.7 Finally, the Section 1619(b) and Medicaid Buy-In work incentives allow for Medicaid eligibility at significant levels of earned income and are important for working individuals with disabilities who lack private insurance or Medicare or who have insurance that does not cover needed services, such as home health services or durable medical equipment (DME)
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As discussed in greater detail later in this chapter, it is vital that transition planning for these youth take into account the fact that their eligibility for some optional Medicaid benefit categories may end when they turn 21. Of the mandatory services available to beneficiaries of any age, the home health benefit, which includes medical supplies, equipment, and appliances, is often the primary source of AT for eligible individuals with disabilities.11 In 2016, CMS defined these services as follows: Supplies are health care related items that are consumable or disposable, or cannot withstand repeated use by more than one individual, that are required to address an individual medical disability, illness or injury.12 Equipment and appliances are items that are primarily and customarily used to serve a medical purpose, generally are not useful to an individual in the absence of a disability, illness or injury, can withstand repeated use, and can be reusable or removable.13 Also defined in federal law are several optional benefits that may be a source of AT devices and services.14 For example, prosthetic devices are defined as 10 42 USC § 1396d(r)
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HCBS state plan option programs can be a good source of AT, CMS has clearly advised states that access to certain medical equipment cannot be limited by offering these items only through waiver programs if they also meet the definition of home health medical equipment.21 For example, Texas Medicaid previously 504 (8th Cir.
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."23 The broad definitions of these Medicaid benefits are particularly important to individuals seeking AT, as all service categories within the state plan must be "sufficient in amount, duration, and scope to reasonably achieve [their] purpose."24 According to CMS, "because of the unique nature of medical supplies, equipment, and appliances, scope limitations within the applicable federal and state definitions are not consistent with the sufficiency of the benefit."25 This means that states cannot simply exclude items of medical equipment from the home health benefit, claiming that such items are not within the scope of the benefit.
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clarified this basic principle in policy guidance to the states addressing the scope of medical equipment available through the mandatory home health benefit (Richardson, 1998) .31 Known as the DeSario Letter (Richardson, 1998)
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1997) , that private-duty nursing and home health services cannot be restricted to services furnished in the home.
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The beneficiary's physician is the "key figure in determining utilization of health services," and it is this physician who "certifies the medical necessity of the services furnished."48 In 2016, CMS reaffirmed this fundamental principle in the preamble to the revised home health rule, explaining that approval of medical equipment and supplies must be based on the physician's judgment of medical need, consistent with accepted standards of medical practice.49 The Medicaid Act does not define "medical necessity" for beneficiaries aged 21 or older. Typically, state Medicaid programs define this term in 45 81 Fed.
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Is not more costly than other equally effective treatment options.50 For children and youth under age 21, medical necessity is defined in federal law and refers to the requirement that requested health care, diagnostic services, treatment, or other measures be necessary "to correct or ameliorate defects and physical and mental illnesses and conditions."51 Thus, for children and youth under 21, Medicaid services must be provided if they are needed to correct, compensate for, or improve a condition or prevent it from worsening.52 Generally, an item of medical equipment is medically necessary when it addresses an individual's medical or functional needs and there is no less costly, equally effective alternative device. States sometimes go beyond their own general medical necessity standard, however, and establish equipmentspecific criteria that dictate the circumstances under which a particular item will be considered medically necessary.
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Medicaid Coverage of Selected AT Devices As state Medicaid programs begin to amend their home health benefit to comply with the recently revised federal regulation, access to funding for AT devices should become more uniform across the states.53 Compliance with the new rule should lessen disagreements about Medicaid coverage of a particular item of equipment, turning the focus to the beneficiary's medical need for the requested device. Powered wheelchair with tilt, seat elevation, and integrated standing feature A custom powered wheelchair configured in this manner meets the four elements of the home health medical equipment definition as it (1)
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Litigation to resolve these types of issues has been necessary in several states.55 Myoelectric upper-extremity prostheses Myoelectric limbs also meet the four elements of the federal medical equipment definition and thus, theoretically, should be covered through the mandatory home health benefit,56 although states vary in this regard. Additionally, these devices meet the federal 55 See footnote 69.
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Such devices clearly meet the four elements of the home health medical equipment definition and theoretically should be covered through the mandatory home health benefit in every state.58 For individuals who may not qualify for home health services, such as those residing in nursing facilities, these devices also meet the definition of prosthetic devices and speech-language pathology services and can be covered through these other benefit categories when included in the state plan. By contrast, a dual-purpose device is one that both generates speech and performs the functions of a personal computer.
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In most cases, hearing decisions must be issued within 90 days of the request for a hearing.62 Typically, Medicaid beneficiaries who receive an adverse hearing decision can seek judicial review of the agency's final decision in state court.63 Litigation in federal court is also an option for challenging state Medicaid requirements that deprive beneficiaries of the AT devices and services they require.
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For example, Medicaid beneficiaries in Arizona, Florida, Louisiana, Missouri, and Rhode Island have litigated their right to access incontinence briefs through the home health medical supply benefit.65 In Indiana and New York, Medicaid beneficiaries have litigated the issue of access to compression stockings and orthopedic shoes.66 Lawsuits have also been brought in Louisiana, Pennsylvania, Rhode Island, and Vermont to obtain hearing aids and eyeglasses.67 For individuals requiring more advanced technology, beneficiaries in Connecticut, Florida, Georgia, Mississippi, Texas, and Utah have had to challenge various barriers to coverage for SGDs in court.68 The same is true for complex custom wheelchairs, which have been the subject of 64 29 USC § 3001 et seq. 65 Alvarez v.
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Timely implementation and enforcement of the new federal home health regulation may reduce or eliminate many of these barriers. These new requirements, in conjunction with medical necessity determinations that reflect current standards of practice, should increase access to the AT devices individuals with disabilities may require to sustain their health, support their independence, and strengthen their quality of life.
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. However, Medigap policies do not cover items that are not covered by original Medicare (e.g., mobile augmentative and alternative communication technologies, hearing aids)
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Hearing aids, for example, an item that is otherwise excluded from Medicare coverage, may be available through a Medicare Advantage plan, depending on the plan selected. Medicare Part D, the prescription drug benefit, has been a part of the program since 2006.
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For example, if Medicare pays for a powered wheelchair with an approved rate of $10,000, Part B will pay $8,000, and the beneficiary will be responsible for a $2,000 copayment. For individuals who qualify for the Qualified Medicare Beneficiaries program, state Medicaid agencies pay this copayment (SSA, 2011)
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A summary of coverage policy for the four categories of selected equipment follows. Powered wheelchairs, including those with a seat elevator, tilt-in-space, or integrated standing system Medicare coverage of powered wheelchairs is governed by NCD 280.3 (CMS, 2005c)
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Under NCD 280.3, Medicare will not pay for a powered wheelchair needed for reasons other than to accomplish MRADLs or for one to be used outside the home. This outright exclusion of MAE, including powered wheelchairs, when needed only outside the home greatly limits the ability of many Medicare beneficiaries to participate in the workforce.
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. they will be denied as not reasonable and necessary." Generally, a Group 4 wheelchair base is needed to support an integrated standing feature, making a standing powered wheelchair unavailable through Medicare.
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If the Medicare beneficiary is enrolled in a Medicare Advantage plan, the supplier must work with the beneficiary and his or her physician to fully document medical necessity for the device (CMS, 2016c, Section 10.12.3) .86 In such cases in which there is no NCD or LCD to guide the decision-making process, CMS guidelines allow Medicare Advantage plans to make coverage determinations by applying an objective process based on authoritative evidence (CMS, 2016c, Section 90.5)
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This is particularly important given that Medicare covers these devices when medically necessary, including when necessary for "job functioning." Hearing aids Unlike Medicaid, original Medicare has express coverage exclusions, with the noncoverage of hearing aids being incorporated in the Medicare Act.87 Although Medicare Part B covers diagnostic hearing and balance exams if ordered by a physician or other medical provider, it does not cover "hearing exams, hearing aids, or exams for fitting hearing aids" (CMS, n.d.-d)
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. As discussed earlier, Medicare Advantage plans may cover hearing aids, depending on the plan selected.
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Appealing Medicare Decisions The appeal process for Medicare DME denials may vary depending on whether an individual receives original Medicare or is enrolled in a Medicare Advantage plan. The time periods for requesting an appeal also vary depending on the level at which the most recent decision was made.
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. Rehabilitation and Prosthetic Services encompasses a number of national programs relevant to the categories of assistive products and technologies discussed in this report, including physical medicine and rehabilitation, prosthetics and sensory aids service, and audiology and speech pathology.
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Upper-extremity prostheses More than 50,000 individuals with major limb loss receive care through the VA (Office of Rehabilitation Services, 2016)
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. Hearing aids Hearing loss, most commonly high-frequency sensorineural, is among the top three service-connected disabilities (Office of Rehabilitation Services, 2015a)
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Special Education Programs as an AT Funding Source for Transition-Aged Youth The Individuals with Disabilities Education Act (IDEA) guarantees, in every state, that all eligible children receive a free appropriate public education -- at no cost to the child or the child's parents -- designed to meet their unique needs.90 IDEA applies to eligible children aged 3 to 21, or until the child receives a regular high school diploma.91 Since the focus of this report is on the use of AT to achieve employment outcomes, the discussion in this section addresses the AT available to "transition-aged students" -- in particular, AT that will support education, training, and/or the ultimate employment goal.
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. Any item or service the student will receive, including any AT device or service, must be included in the IEP.94 Special education is defined as instruction specially designed to meet the unique needs of the child.
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, employers, or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of individuals with disabilities."101 IDEA also requires that students receive their special education assistance in the least restrictive environment appropriate to their needs.102 101 29 USC § 3002(5)
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Transition Services Requirement No later than age 16, a child's IEP must include a transition services plan.104 Transition planning requires that schools develop long-range plans for students to prepare them for postschool life; begin to make connections with adult service providers while students are still in school; and look to others, such as the state VR agency, to provide services. When a Special Education Program Is Required to Provide AT Devices and Services In determining whether a special education program is likely to pay for an AT device or service, the key question is whether the AT is needed to ensure that the student receives a free appropriate public education.
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A special education program is unlikely to fund a powered wheelchair with expensive custom items such as those noted above. A myoelectric prosthesis would meet the definition of an AT device.
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." This decision reinforces an important principle of special education law. Even if an item meets the definition of an AT device, it need be funded by the school district only if necessary to achieve a free appropriate public education.
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116 See 34 CFR § 300.105(b) (allowing special education students to take AT devices home when doing so is necessary to ensure that they benefit from their education)
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The department agrees that coordination between school districts and state VR agencies to enable students with disabilities to continue using AT devices as they move from one program to another is an efficient, costeffective means of facilitating the transition from school- to work-related services and fully supports this type of cooperation.122 The Importance of AT Services for Evaluation, Education, and Training As a practical matter, it is unlikely that transitioning students can rely on a special education program to fund AT devices they can retain after leaving school. This is particularly true for the very expensive custom 122 OSEP Policy Letter to S
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The special education system also could be required to provide training, as an AT service, to the student and in some cases to school staff to allow the student to adapt to using an item such as a powered wheelchair with specialty features or a myoelectric prosthesis. To the extent that this AT service allowed the transitioning student to benefit fully from a recent AT acquisition, it would increase the likelihood of success in postschool training, higher education, and ultimately employment.
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Studies of promising practices for transition-aged youth with disabilities suggest that facilitators of successful employment outcomes include, but are not limited to, increasing collaboration and coordination among providers serving these youth (Oertle and Trach, 2007) , encouraging youth participation in the workforce during the high school years (Wittenburg and Maag, 2002)
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. Ensuring services for successful employment and/or vocational preparation and continued access to appropriate assistive products and technologies is vital to promoting a successful transition from high school to pathways to employment.
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of 2014 are implemented. WIOA and the federal regulations of 2016 that implement it now require a state VR agency to provide "pre-employment transition services,"131 serving students with disabilities aged 16 to 21 unless the state decides to provide such services to a different age range under IDEA.132 Coupled with the new WIOA mandate to serve "youth with disabilities" up to age 24133 and the continuing mandate for special education programs to serve this population through age 21 or when they exit the public school program (as previously discussed)
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can have no bearing on the scope of services the individual receives."140 Once an individual has been determined eligible for services, the VR agency must provide funding for all services reasonably necessary to meet the person's approved employment goal subject to his or her obligation to first seek any "similar benefits" that may be available, as discussed below. The VR agency may not place "any arbitrary limits on the nature and scope of VR services to be provided to achieve an employment outcome."141 The VR regulations, published by the federal Rehabilitation Services Administration (RSA)
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are exempt from the similar benefit requirement.147 The VR agency may ask an individual to apply to either Medicaid or Medicare (if eligible for one of those programs) to fund, for example, a powered wheelchair or an SGD, even though those items are exempt from the similar benefit requirement if classified as rehabilitation technology.
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In some cases, the device sought may serve both a medical and a vocational purpose. The result may be the possibility of different funding sources each suggesting it is the other funder's obligation to pay for the device.
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If the individual has original Medicare coverage only, with neither Medicaid nor a private insurance plan that would cover hearing aids, the VR agency will likely be the only possible payer. • Dual-purpose tablet or laptop serving as an SGD and personal computing device -- In the case of individuals who are supported by the VR agency in a college or community college program as a step toward their vocational goals, funding for a personal computing device (laptop or tablet)
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for 9 consecutive months.153 A beneficiary can meet the "9 consecutive months" criterion by working 9 of 10 consecutive months at the SGA level if "statutorily blind," or by working any 9 of 12 consecutive months at the SGA level if the non-SGA months are for reasons beyond the individual's control and unrelated to his or her disability.154 The CR provisions allow a VR agency to fully recoup the cost of very expensive AT, such as a powered wheelchair with an integrated standing feature or a myoelectric arm or hand, as long as these earnings requirements are met. The CR program allows for payment to the VR agency with no need to show that the SGA-level work resulted in a termination of benefits.
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The word "appliances" has been interpreted to "include many types of medical equipment, also called Assistive Technology" (Iowa Compass, Center for Developmental Disabilities, 2016)
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PRIVATE FUNDING SOURCES Self-Pay Purchasing AT on one's own is always an option. However, many assistive products and technologies cost thousands of dollars, eliminating self-pay as a full payment option for many individuals.
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This form is available at www.ssa.gov/online/ssa-545.pdf (accessed January 22, 2017)
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The PASS proposal can be approved for as long a period as necessary, with a beginning date and reasonable ending date as necessary to meet the occupational objective.164 If the PASS will pay for items related to an undergraduate program, for example, a reasonable time frame might be 4 or 5 years and possibly longer if the objective requires a master's degree. Items That Can Be Funded Through a PASS Money set aside through a PASS can be used for anything that is related to achieving the individual's approved occupational objective.
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As discussed in the section on public funding above, some of the selected items in each of the four AT categories could potentially be funded through Medicaid, Medicare, a special education program, or a state VR agency. All of the AT devices selected for discussion in each of the four categories could be funded with money deposited into a PASS account as long as they had a demonstrated connection to the chosen occupational objective.
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, which will allow him to achieve a higher degree of functional hearing in a classroom setting when he becomes a teacher. This scenario assumes that the person's state VR agency will pay for the vehicle modifications but not the vehicle itself; that neither Medicaid nor Medicare will pay for the second wheelchair, each claiming that his needs are met through the powered wheelchair; and that neither Medicaid nor Medicare will pay for the binaural hearing aids, each claiming that his needs are met by the current single hearing aid he uses.
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An AFP may be a source of funding for AT when no other funding source exists. It may be able to extend or arrange for credit when the individual with a disability or his or her family would not ordinarily meet the standards of creditworthiness.
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• Creditworthiness issues -- Although a loan program will want to have reasonable assurance that loans will be repaid, some pro grams, unlike traditional lenders, will offer loans to individuals without a good credit rating. Items Purchased with Loan Funds The items commonly purchased with loan funds include many that are not easily funded through traditional funding sources, such as Medicaid, Medicare, a state VR agency, or special education programs.
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Many private insurance plans may also specifically exclude coverage of hearing aids. For FY 2010, the four most common categories of AT purchased through AFP loans were vehicle modifications and transportation; hearing; environmental adaptations and home modifications; and mobility, seating, and positioning in that order (U.S.
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A person, as defined by IRS rules, includes a trust or an estate. The maximum combined contributions cannot exceed the current year's IRS gift tax-exempt amount -- $14,000 in 2016.171 Use of Funds in an ABLE Account for Qualified Disability Expenses The designated beneficiary is permitted to withdraw money from the ABLE account to meet qualified disability expenses (QDEs)
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• Binaural hearing aids -- If the individual's only insurance coverage were through Medicare, which excludes hearing aids from cover age, the ABLE account could be the best way to fund the item.
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. How ABLE Accounts Affect Continued SSI Eligibility The SSI program has issued policy provisions governing the treatment of money placed in ABLE accounts, the funds held in those accounts, the status of SSI and Medicaid when the total value of an ABLE account exceeds $100,000, and the use of ABLE funds to meet designated disability expenses (SSA, 2016d)
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."176 However, no provision in the law or the proposed regulations references how any specific federal benefit program will implement this provision. The discussion here is limited to the interrelationship between ABLE accounts and four other AT funding sources discussed herein: Medicaid's Buy-In Programs for working individuals, Medicare Savings Programs (MSPs)
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It may also depend on the ability to show that the item is needed to benefit from a child's special education program or the ability to convince the state VR agency that the item is needed to progress toward an occupational objective when the state VR program has enough money remaining in its budget
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The searches may also lead to websites that compile lists of potential charitable funding sources for AT. For example, the United Spinal Association's "Spinal Cord Resource Center Page" provides a range
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Examples of allowable AT requests include manual and powered wheelchairs, computer equipment (presumably including the dualpurpose laptop/tablet and SGD) , and hearing aids.
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Foundation for Sight and Sound Through its Help America Hear Program, the Foundation for Sight and Sound provides new high-quality hearing aids, nationwide, to men, women, and children with limited financial resources (Foundation for Sight and Sound, 2016)
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. Powered wheelchairs and accessories The Tufts Health Plan (2017d)
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. However, the Tufts Health Plan covers "medically necessary audiology evaluations and related services for hearing disorders" as specified in its policies, including coverage for hearing aids for members aged 21 and younger in Massachusetts and adults in New Hampshire and Rhode Island in accordance with state requirements (Tufts, 2017a)
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Since private disability insurance is a potential source of funding for certain assistive products and technologies, a brief discussion is included in this chapter. Greater detail on private disability programs is provided in Chapter 8.
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. Private disability insurers do not provide assistive products and technologies unless the devices directly support occupational functioning (Jackson, 2016; Tugman and Kramschuster, 2016)
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The third definition applies to people whom others regard as having a substantially limiting impairment.181 This means that others treat the individual differently, including committing actions prohibited by the ADA, because of an actual or a perceived impairment that is not both "transitory and minor."182 Individuals who seek employment fall under Title I's ADA protections if they are "qualified individuals with disabilities." Qualified individuals with disabilities are those who satisfy "the requisite skill, experience, education and other job-related requirements of the employment position" they want and "with or without reasonable accommodation, can perform the essential functions of such position."183 The ADA defines reasonable accommodations as modifications to the job application process to allow for access to the process, modifications to the work environment or the way work is usually performed that enable a person to perform the essential functions of the job, and/or other modifications that allow an individual to enjoy all of the privileges of employment.184 Absent undue hardship, employers must make reasonable accommodations for individuals who meet the "actual disability" and "record of" definitions185 if requested. The employer also needs to be aware that the individual is a person with a disability, which requires that the employee or potential employee disclose his or her disability.186,187 179 29 CFR § 1630.2(g)
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Employers are not required to provide items considered personal items, such as wheelchairs, hearing aids, augmentative communication devices, and prosthetic devices, that are specifically excluded from the definition of reasonable accommodations under the ADA. It is important to note as well that air carriers are exempt from the ADA, although the act covers airports and the services provided within them.
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Employer Accommodations Subject to the limitations concerning undue hardship and personaluse items, the ADA provides that "reasonable accommodations" made by employers may include -- (A) making existing facilities used by employees readily ac cessible to and usable by individuals with disabilities; and (B)
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, for example, is a centrally funded program that provides reasonable accommodations for Department of Defense employees with disabilities. The program's mission "is to provide assistive technology and accommodations to support individuals with disabilities and wounded, ill and injured Service members throughout the Federal Government in accessing information and communication technology" (CAP, 2017)
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HEALTH LITERACY, EDUCATION, AND KNOWLEDGE OF ASSISTIVE PRODUCTS AND TECHNOLOGIES Health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (HHS, 2000b, 2007, p.
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Average health literacy increased with educational level, beginning with high school: 49 percent of individuals who "never attended or did not complete high school" demonstrated below basic health literacy, while just 15 percent of high school graduates and 3 percent of college graduates (bachelor's degree) demonstrated below basic health literacy.
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FINDINGS AND CONCLUSIONS Findings 7-1. Financial access to assistive products and technologies and quali fied providers varies significantly across reimbursement and funding sources in the United States.
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• Private health insurance coverage for assistive products and technologies varies depending on the plan and, in some cases (e.g., hearing aids) , the state in which the beneficiary resides.
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Employers are not required to provide items considered personal, such as wheelchairs, hearing aids, aug mentative communication devices, and prosthetic devices, which are specifically excluded from the definition of reasonable accommoda tions under the Americans with Disabilities Act.
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2012. Unlike most insurers, United Healthcare is offering big discounts on hearing aids.
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2017. State insurance mandates for hearing aids.
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NCAId=143&DocID=CAG 00274N&bc=gAAAABAACAAAAA%3d%3d& (accessed January 23, 2017)
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n.d.-d. Your Medicare coverage: Hearing & balance exams & hearing aids.
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http://askjan.org/media/lowcosthighimpact.html (accessed January 23, 2017)
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2010. MarkeTrak VIII: The efficacy of hearing aids in achieving compensation equity in the workplace.
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n.d. Medicare must continue to evolve -- add coverage for hearing aids.
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. Analysis of financial access to com mittee-selected assistive products and technologies: Discussion of funding sources for wheeled/seated mobility devices, upper extremity prostheses, and products and technolo gies that pertain to hearing and to communication and speech.
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2017. Affordable hearing aids now available to UnitedHealthcare vision plan customers nationwide.
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http://www.benefits.va.gov/benefits (accessed January 23, 2017)
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398 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 7-1 Summary of Payer or Coverage Options for Assistive Devices Relevant Coverage or Standard Payer Coverage Parameters Educationally relevant School system Must promote educationally relevant goals in the student's individualized education plan (IEP) Medically necessary Private insurance Devices must be required because of a medical condition Medicare/Medicaid
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COVERAGE FOR RELEVANT PRODUCTS AND TECHNOLOGIES 399 Limitations: Limitations: Policy-Related Device-Related Limitations: Geographic Devices are taken away May not be the most High-tech devices may not when students graduate effective device be available in rural and frontier areas and equally across the country Individuals trained in assessment of the need for appropriate assistive devices and/or the use of high-tech devices are not available nationwide Policies specifically exclude Private insurance and Trained clinicians may not devices designed to perform Medicaid may not cover be available nationwide work tasks the cost of clinicians able to assess the need for to train people to use the appropriate assistive devices devices and/or teach people to use the devices Medicare limits devices to May limit the type of device those used in the home covered (e.g., standard rather than custom wheelchair; low-tech prosthetic devices rather than devices that meet the person's need to be able to return to work) Medicare and private insurance do not pay for hearing aids or communication devices continued
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to achieving the person's occupational objective from a specific approved plan
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related to occupational objective an occupational objective; good when other funding sources are not available continued
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military veterans with disabilities Job-Specific Employers Designed to enable a person Workplace Reasonable to perform his or her job; Accommodations not necessarily a device Qualified Disability Expenses Achieving a Better Life Covers AT and personal Experience (ABLE) support services Accounts Assistive Technology Act Statewide programs but Equipment used to not necessarily a payer or "increase, maintain, provider or improve functional capabilities of individuals with disabilities" (29 USC Sec 3002(4)
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that a device remain in the workplace and not be used outside the workplace Up to $100,000 in ABLE Could cover any of the Devices and access to accounts is an exempt devices considered in trained clinicians who resource for SSI purposes; this report with a limit of can assess the need for can be used for items $100,000 appropriate assistive devices not considered medically and train users are not necessary by Medicaid and available nationwide; not all Medicare in the limited states participate in ABLE number of states that have accounts at this time set up their ABLE account programs to date "Required state-level Generally does not Devices and access to activities include: state provide actual devices; trained clinicians who financing activities, device provides loaner devices for can assess the need for reutilization programs, demonstration or temporary appropriate assistive devices device loan programs, use, recycled devices, and train users are not and device demonstration etc.; may not meet the available nationwide programs. Required state individual's need to return leadership activities to work; provides loans to include: training and purchase AT items technical assistance, public awareness and information and assistance activities, and coordination and collaboration." (Domin et al., 2016)
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