Developing a Funding Strategy

The quest for the funding of assistive technology can be long and arduous. There are many possible funding sources that might be able to help you purchase what you need depending on a variety of criteria. Do you meet this-or-that eligibility requirement? Does the device fit under what this source will pay for? Is there any money left in the budget this year? Finding the proper funding source and getting a "yes" is seldom easy. It will take a lot of effort and perseverance on the part of you and/or your advocate. So, be prepared.

One thing that will help before you depart on your quest is a funding strategy. This strategy will include the identification of what sources are most likely to assist you and how you can best convince those sources to do so.

The Steps to Funding Assistance
In developing your strategy for funding the assistive technology that is needed, take a systematic and logical approach. We offer nine steps as a method for guiding your efforts.

These steps are:
Step 1: Define the need
Step 2: Document the need
Step 3: Identify and secure needed equipment
Step 4: Determine if alternative equipment will meet your needs
Step 5: Determine funding sources
Step 6: Collect and submit the required paperwork
Step 7: Authorization is received
Step 8: Search for co-payment options
Step 9: The appeals process.

Step 1: Define the Need
This step involves the identification of activities in which you would like to participate or complete where technology can assist you. You need to describe the difficulty encountered as you try to perform a task. For example: unable to produce legible handwritten communication, hold the telephone handset to your ear, or unable to get out of your home in your wheelchair.

Step 2: Document the Needs
Documentation will be very important throughout the funding process. The first thing you will want to document is the need for assistive technology. It is another thing to prove that need to someone else. You should obtain the assistance of a professional in developing this documentation if you have not already done so. This professional might be a teacher, a speech therapist, a physical therapist, an occupational therapist, an assistive technology technician, or a rehabilitation engineer. The necessary documentation may include input from some combination of these professionals. One or more of these individuals will probably assist you throughout your request, but you must begin with the documentation of need.

Step 3: Identify the Equipment and/or Services Needed and Secure Necessary Prescriptions and Other Justifications.
Once the need has been identified and documented, you must outline the assistive technology and related services required to fill this need. This will include specific recommendations from the professionals.

These recommendations may come in the form of a written evaluation, a medical prescription, or whatever other justification you may need. The extent, detail, and scope of this written justification may hinge on what funding sources you decide to pursue. Later in the process you may find that you will have to come back to this step and to provide further documentation.

Part of this step also involves the pricing of the equipment and the identification of where you will be able to purchase it. This can be very important because the funding source will almost certainly be concerned with cost and because the identified dealer of the equipment may be able to help you along in the process. Some funding sources, such as Medicaid and Medicare, only purchase equipment from designated Durable Medical Equipment (DME) dealers. If you plan to approach one of these sources, you will have to locate such a dealer.

Some questions to ask at this step are:

• What type of assistive technology will achieve the targeted level of functioning?
  
• Where can I obtain this assistive technology? How much does it cost? Can it be rented?
  
• What services are needed to prescribe, train and follow-up with the aid or device?
  
• What professionals are available who can help justify the medical necessity for the assistive technology?
  
• Can the equipment manufacturer or local vendor provide any special assistance?
  
• Is there a case manager assigned to the case? How can one be secured?
  
• Are there others who can help advocate for my needs?

No matter which funding sources are being approached for securing assistive technology, it is of utmost importance to demonstrate and document the need. The following is a list of supportive materials that are often essential in documenting these needs:

Physician's prescription for the assistive technology (equipment, device and/or services). For Medicare, Medicaid, and some other sources, there must be a determination of medical necessity in order to receive authorization for assistive technology. This necessity exists when the item is a part of the physician's course of treatment and when a physician is supervising its use directly. (Note: a therapist or other appropriate individual may be providing the treatment, but the treatment has to be prescribed by a physician.) The physician is required to provide a signed prescription. We strongly recommend, and it is usually required, that the physician also write a letter substantiating this medical necessity.

• Letter of medical necessity from the physicians.
  
• Letters of medical necessity from the other professionals involved in the case (physical therapist, occupational therapist, speech therapist, etc.).
  
• General discussion by the involved professionals of medical diagnosis that may further provide specific medical information and needs.
  
• Photograph of the individual, if it helps to demonstrate the need.
  
• Literature concerning the assistive technology with specifications as they pertain to this individual.
  
• Explanation of the individual's functional skills without the equipment and how s/he will be improved with the assistive technology.
  
• Specifications of the equipment including cost and photograph or catalog picture.

When deciding what equipment and/or services are to be secured, it must be determined if the charge is reasonable and a customary rate. The funding source might have to be convinced that the assistive technology is cost effective. To assist in determining if a request is reasonable, consider the following:

Is there a way this piece of equipment can be made or fabricated?
Can it be borrowed from an "Equipment Loan Closet" or library?
Is the expense reasonable when compared to the therapeutic benefit?
Is the equipment or service more costly than another option or alternative?
Does the item serve the same purpose as equipment that is already available to the consumer?
If there are no alternative devices that can be found that will meet your particular need, be sure that you have facts well documented. Remember, do not let the cost of the assistive technology preclude the selection of the of the right aid, device, or adaptation for the person with a need. This process of matching the technology to the needs of the individual is crucial to the successful use of the technology once it is acquired. Trials with desired equipment and alternative equipment are the best way to determine a match! Document the results of each trial.

Step 5: Determine Funding Sources
Now that you have determined what you need, you can begin to look for help in paying for it. You may choose to pay for it yourself, if you are able, but there may be sources with the responsibility or the willingness to help you, so do not act too hastily. On the other hand, you may be unable to contribute anything toward the purchase of the technology.

Do you have private insurance and will it pay for the technology? What insurance will pay for differs on a policy-by-policy basis. To check if assistive technology is fully or partially covered by an insurance company, check the policy regarding the qualifying criteria or contact your insurance agent. If you have questions about exclusions or clauses in a policy that you think may not be legal, contact the Insurance Division of the Minnesota Department of Commerce, (651) 296-2488, or (800) 657-3602.

Are you eligible for public funding? If so, from what agencies? Do these agencies have restrictions on what they will pay for and how much they will contribute? Does your particular disability qualify? Under the Americans with Disabilities Act (ADA), employers; state, local governments, and other places of public accommodations may have some responsibilities to provide assistive technology to individuals with reasonable accommodations and to otherwise make their services and programs accessible. Postsecondary educational institutions that receive federal funds are included in this mandate.

Are there private sources out there that can help? Yes, there are many, but they can be hard to find and even harder to access. Keep in mind that private sources often have very narrow eligibility requirements and limited funds.

Do you want to get a personal loan for the technology? This could be done as a last resort or to avoid a lot of bureaucracy and red tape. See Assistive Technology of MN.

Before you approach any one source, it would be helpful to make a list of all possible sources then prioritize it. This will give you ready options should you have difficulty with your primary choice. The key, again, is to be well prepared; with choices, with documentation, with determination.

You may want to seek assistance in identifying and approaching funding sources. Possible help could come from the include the Durable Medical Equipment (DME) dealer (when you purchase the equipment from a dealer, they should be more than willing to help), a case manager, a social worker, a case worker, a health care professional, or one of the professionals that helped you identify the technology in steps 2 & 3. It is important to involve as many support people as possible.

Some questions to ask at this stage are:

• What is the most likely source of funding? For example, you should look at personal health insurance, Medicaid, Vocational Rehabilitation, the Department of Veterans Affairs, etc.) As mentioned, succeeding entries in this booklet containing information on the most common funding sources will help you determine the most likely source or sources.
  
• Have you dealt with this source before? Were you successful? What problems did you encounter? Who was the contact person?
  
• Is there possibly more than one source of funding available?
  
• Will a vendor be an advocate and provide pre-approval and billing services?
  
• Are there individuals with disabilities who can be contacted for hints and suggestions? Have they been successful in receiving payment for assistive devices?
  
• Will the device or service enable you to enter or continue employment (this is a prerequisite for funding from Vocational Rehabilitation and helps assure funding from private insurance and some other sources), live more independently or improve your overall health? Depending on the funding source, you may have to prove one or more of these benefits. How can the potential funding source be convinced of this advantage?

Is it possible for two different funding sources to coordinate payment that will equal or approach the total cost?

If you became disabled through a work-related accident, is the cost of the device or service the responsibility of worker's compensation insurance?

Is there a local civic or charitable organization, foundation, or association in your area that can help raise the necessary funds?

When approaching funding sources, it is important to note that there is no one specific method to assure funding. Traditional sources that have provided funding for assistive technology in the past are currently undergoing a period of adjustment. This is clearly a time when "precedence setting" may occur. If the assistive technology is new to the marketplace, the funding source may take a conservative "hands-off" attitude. Knowing these things, it will be important to plan your strategy and show patience and respect when dealing with prospective funding sources. Some helpful hints are:

• Be polite and pleasant, but always be business-like.
  
• Communicate in writing whenever possible and keep a copy for yourself.
  
• Maintain a routine connection with the funding source and do not permit time gaps of three or more months between communications.
  
• Encourage a positive working relationship by directing letters or calls to the same person each time.
  
• Offer your cooperation and willingness to provide proof of medical necessity and to show how the technology will benefit the consumer and the funding source.
  
• When questioned, try to educate and inform in an assertive fashion, emphasizing long-term monetary benefits to the funding source.
  
• Never threaten with legal action, unless you know that you are being discriminated against. This is an often-heard threat and will not intimidate any agency or insurance company.
  
• When someone (a case manager, therapist, durable medical equipment (DME) dealer, etc.) goes out of her or his way to help, express your sincere thanks and appreciation.
  
• Thoroughly document all written and verbal communications.
  
• Remain patient and diplomatic while being persistent and enduring.
  
• Document, document, document. Keep records of names of people to whom you spoke, what was said, and to whom you were referred to next.

Gathering the right information is essential to developing your funding strategy. The following information should be included:

• Information about the individual needing the assistive technology including, age, disability, medical diagnosis, employment status, income level, etc.
  
• Information about the individual's family status including parents, children, private insurance coverage, family physician, etc.
  
• Information about the educational level of the individual including the highest grade level reached, special education services, etc.
  
• Public services that have been accessed previously including Medicaid, Medicare, local school districts, Social Services, Vocational Rehabilitation, etc.
  
• Assistive technology recommendations including the name and manufacturer of the equipment, the cost, the amount that the individual or family can contribute, why a particular piece of equipment was selected, and how the equipment will improve the functioning of the individual.

Step 7: Authorization is Received
When this occurs, written approval will be given for the amount of money that has been authorized toward the purchase of the specified assistive technology. If the amount is received in full, the vendor will then be able to process the order and secure the equipment. If the required amount of money is not approved, you can look for other funding denied, you can begin the appeals process.

Step 8: Search for Co-payment Options
If the funding source ha not authorized for the full amount of the cost of the technology, what are your options? You may have to personally pay for a portion of the assistive technology. Where will it come from? Is there any money available? Can you secure a personal bank loan or home equity loan? Other options to consider would be additional funding sources. Typically, private insurance companies will not cover costs simultaneously being covered by the public systems, for example, Medicare, Department of Veterans Affairs, etc. This is a good time to seek out assistance from private community and philanthropic organizations.

Step 9: The Appeal Process
(...and what if they say no?!)
What if the funding source denies your request altogether? The appeal process is a fairly common practice when it comes to securing funding for assistive technology. Often, denial for funding is not due to equipment not being important or necessary, but rather a lack of understanding or knowledge by the reviewers at the funding sources. Try to determine if your request was denied due to a lack of funding source money or due to inadequate information. If it is a lack of information, persist and find out what additional information is needed. Submit this new information to the person who is handling your request (for example, case manager or DME dealer). Don't leave it to chance that the right person will get it. Make certain of it.

The appeal process can be time consuming and you want to find every possible way to lessen the waiting period. Nothing can be more discourage than to be told repeatedly that the assistive device or service needed is "not medically necessary" or "not covered." Agencies, companies, and other traditional funding sources are conservative when it comes to paying for equipment, products, and other devices or services that are the least bit questionable from their perspective.

Assistive products and devices are becoming available at a much faster rate than are the funds to pay for them. Much of this new and innovative technology can be very costly. The need for it will continue to be questioned by funding sources and denials are likely to increase. Consumers need to know about the assistive technology options that exist for them despite the cost and the poor prospect of getting a device funded. As a result of this knowledge, frustration may mount when it becomes obvious that the lack of funds is the only thing that stands between the consumer and an assistive device or service that will allow her or him to live more independently, receive an education, or gain employment.

You should not give up just because you get a "no" for an answer. You may very well have to exercise self-advocacy in order to affect a policy change. It may be necessary to demonstrate to funding sources that a certain assistive device or service will not only benefit you, but will also be cost-effective in the long run.

The quest for success in funding does not promise to be quick and easy. Persistence is the key. You must investigate and exhaust all possible avenues and alternative methods for funding. It may be necessary to challenge some decisions in the process. All have the right to legally and ethically advocate for themselves. If you get a negative answer, there are many things you can still do. Here are a few suggestions.

Working With State Agencies
If you apply for funding from a state agency and have been told that you do not qualify for assistance or if the particular device does not qualify, you can appeal this initial decision. All government agencies have internal appeal procedures and you can have your claim reviewed by mid-level management or, eventually, an agency director. In considering an appeal, you should ask the following:

How does this device enable me to enter employment, receive vocational training, live more independently, or otherwise improve my functioning in society? You undoubtedly built a case for this earlier when you first approached the source, but you need to look for ways to strengthen it. You can construct an appeal if you can demonstrate how the device will help you.

Do the agency's guidelines specifically exclude the device or has it been funded in some cases before? If an agency has funded a device in the past, thereby setting a precedent, it will be more difficult to deny your appeal.

Do you meet the agency's financial requirements and other criteria? If it is obvious that you do not meet their criteria, an appeal would be fruitless. On the other hand, if you can provide evidence that disputes someone's determination of your eligibility, it will greatly improve your chances.

Workers' Compensation Claims
If a disability was acquired through a work-related accident or illness, you may seek funding through the employer's Workers' Compensation Insurance carrier. It is advisable not to be too hasty in settling the claim. When there is permanent disability involved, workers' compensation carriers generally want to settle the claim as soon as possible. Let the disability maximize in order to know what kind of assistive devices or equipment will be needed and for how long. Let the insurance personnel know that you will not settle the claim or sign any waivers or release forms until there is ample medical evidence that the disability is permanent and unchanging. If there is an attorney involved, make sure she or he understands why the client may need certain assistive devices and the terminology associated with them. Be sure they know how the workers' compensation benefits are structured.

Health Insurance Plans for Groups
Employees who have disabilities often turn to their group health insurance plan to provide or at least assist with funding. If you have been denied on the first round, double check to see if you have provided them with the required medical documentation and appropriate forms. If something has been filled out inadequately or incorrectly, you may not be voluntarily notified by the insurance company. Assuming everything was correct, you can ask for an administrative review by a staff physician or nurse. However, keep in mind that a general physician employed by an insurance company may not necessarily be knowledgeable about these devices and how they can assist you in staying healthy or employed. Do not be afraid to ask that the claim be reviewed by a specialist in rehabilitation medicine.

Remember, there is always a chance for full or partial funding if the policy coverage does not specifically exclude a device or piece of assistive equipment. It is not uncommon for the claimant to eventually learn that he is better informed than the personnel with the group health plan.

Public Funding Sources
Mediated agreements are a highly successful way of solving problems in schools because people are more satisfied with and follow through better on agreements they help create. Mediator fees are paid by the Department of Education when issues to be resolved are the same as at a conciliation conference or a due process hearing. You can request a mediation by calling the Minnesota Special Education Mediation Service (MNSEMS) office directly at (651) 296-1256 or (651) 297-5353 TTY or (800) 627-3529 non-metro.

In the case of state agencies, if you have totally exhausted the appeal process and still are getting that "no," there are a few more options available to you. Two state agencies exist specifically to support your interest when you are having problems with some state agencies. The Client Assistance Program (CAP) will pursue your interest if you are in conflict with state vocational rehabilitation agencies. Protection and Advocacy (P & A) protects the rights of and advocates for persons with disabilities in disagreements with state agencies, private insurances, and others.

Both programs are offered through the Minnesota Disability Law Center.
You can contact:
Minnesota Disability Law Center
430 First Avenue North, Suite 300
Minneapolis, MN 55401-1780
(800) 292-4150 Toll Free or
(612) 332-1441 in the Metro area
(612) 332-4668 TTY

In addition, the Department of Human Services has an ombudsman who will review legitimate complaints from citizens against agencies within that Department. Medical Assistance services, a possible source of funding for assistive technology, is in the Department of Human Services.
You can contact:
Ginny Prasek
Pre-paid Medical Assistance
Department of Human Services
444 Lafayette Road
St. Paul, MN 55155
(651) 296-7561 or fax 297-3230

The general number for the Ombudsman's Office is (651) 296-1256, or (800) 657-3729.

One more option to consider is to contact your local elected officials concerning your complaint or disagreement. These officials depend upon you for your support and will almost always check into your situation to see if your complaint is legitimate. If they feel that it is, they may attempt to rectify it for you or at least get you another hearing with the agency. The lieutenant governor, state representatives, or local officials should be contacted if the issue involves a state agency.

To get a listing of state representatives or local officials, contact:
House Public Information Office
(651) 296-2146 (metro)
(800) 657-3550 (outstate)
Senate Information
(651) 296-0504 (metro)
TTY 296-0250

Federal Agencies
If you have been through the appeal process with a federal agency or program and still have not received authorization for funding, you may want to consider contacting your United Senators and Congress persons for assistance. Federal agencies or programs include the Social Security Administration, Medicare, and the Department of Veterans Affairs. You can also obtain the address and phone numbers of your senators and congresspersons from the list above.

Summary
The most important thing to remember throughout the entire process of obtaining funding for assistive technology is to be persistent. If you believe that you are entitled to technology that can enable you to achieve a higher quality of life, DO NOT GIVE UP!

Using the nine steps as your structure, you should be able to develop a comprehensive strategy for funding assistive technology. Persistence and preparation will be the keys to obtaining the equipment you need. Lewis Golinker, an attorney and funding expert from New York, has put it this way:
The formula for success in cases involving technology devices and services has three essential ingredients:

A heartfelt commitment by a professional (such as a physician, an occupational physical and/or speech-language therapist) to the potential of an assistive technology device or service to provide real benefits to a person with disabilities;
A refusal by the person with disabilities and the professional to take an initial "no" for a final answer; and
A willingness of the professional to participate in any administrative appeal, where high quality information is supplied.
"In the final analysis, those applicants who follow this formula are the ones most likely to be rewarded for their perseverance in the form of a favorable decision."

The "quest" for funding of assistive technology can be difficult, prolonged and frustrating. We hope this directory can help make that quest a little less difficult, not quite so prolonged, and not nearly as frustrating.