Assistive Technology for Older Adults

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What Is Assistive Technology?
Assistive technology (AT) is a device or service that makes certain tasks easier for people with disabilities. Assistive technology devices include hearing aides, communication devices, stair lifts, wheelchairs, adapted computers, van conversions and many other items. AT also includes home modifications and adaptations such as ramps and grab bars in a hallway or bathroom.

Assistive technology services are any service that directly assists persons with a disability in selecting, getting, or using an AT device. Examples of AT services could be evaluations, repair, funding, maintenance, adaptation of devices, training or technical assistance.

There are many laws that give eligible adults legal rights to AT. Some of the more important of these are described in this brochure. Each law defines certain rights and gives consumers the power to challenge decisions if their rights are wrongfully denied.

MEDICARE
If you are eligible for Medicare, you qualify for AT if it is medically necessary.
Medicare Is Divided Into Two Parts:
Part A deals with hospital insurance and care.

Part B deals with doctor's fees, durable medical equipment, including many items of assistive technology, and other aspects of outpatient care. You must pay a small monthly premium to enroll in Part B and receive funding for AT. If you are also eligible for Medicaid, there is a program that will cover the cost of your Part B premium. Medicare will pay for certain items of AT as durable medical equipment. Under Medicare, durable medical equipment is defined as equipment that: ¿ Can withstand repeated use, ¿ Is primarily and customarily used to serve a medical purpose, ¿ Generally is not useful to you in the absence of an illness or injury, and ¿ Is appropriate for use in your home.

If you are denied assistive technology under Medicare, the appeals process can begin with an informal review of your application and advance to a court hearing if necessary.

For assistance on DME coverage, services and appeals contact Palmetto Government Benefits Administrator at 800-213-5452.

For general information about Medicare contact the Senior Health Insurance Counseling Program (SHICP) of the Oklahoma Insurance Department at 405-521-6628 or 800-763-2828.

MEDICAID/SoonerCare
Medicaid is a government program that provides funding for health services. It's administered through the Oklahoma Health Care Authority and eligibility is determined at the county Department of Human Services (DHS) office. If adults are on certain types of Medicaid programs, they are entitled to AT through the definition of Durable Medical Equipment (DME) or Prosthetics and Orthotics. In order to receive DME the device and/or service must be considered a "medical necessity".

There are many ways to receive Medicaid. An older adult may be eligible for Medicaid through:
¿ Supplemental Security Income Program (SSI)
¿ Home and Community Based Waiver
¿ In Home Support Waiver
¿ ADvantage Waiver

If your request for DME from Medicaid is rejected, you have the right to request a hearing at the county DHS office. If the request for a hearing is made within 10 days of the date on the notification of denial of termination of services, the services you have been receiving will continue unchanged pending the outcome of the hearing.

AMERICANS WITH DISABILITIES ACT and SECTION 504 of the REHABILITATION ACT Both of these federal laws help guarantee your rights to AT. They prohibit discrimination on the basis of disability. This means they require certain entities to offer reasonable accommodations.

For persons with disabilities, the ADA and Section 504 are most important in the public setting. Any program receiving federal financial assistance, has an obligation to offer "reasonable accommodations" -- which can include AT -- to make their services available to persons with disabilities.

Employers are required to make "reasonable accommodations" for employees or applicants with disabilities. These accommodations may include AT. These federal laws also require that persons with disabilities have access to public programs such as public colleges. Persons are entitled to reasonable accommodations to make these programs accessible.

THE LAW PROHIBITS DISCRIMINATION AGAINST INDIVIDUALS WITH DISABILITIES AND REQUIRES ACCESS TO PUBLIC PROGRAMS SUCH AS SENIOR CENTERS.

The U.S. Department of Justice enforces ADA provisions prohibiting discrimination on the basis of disability in state and local government services and in public accommodations and commercial facilities. If you are denied access required under the ADA or Section 504 you can file a complaint with: U. S. Department of Justice Civil Rights Division Public Access Section P. O. Box 66738 Washington, DC 20035-6738 800-514-0301 800-514-0383 TTY

The U.S. Equal Employment Opportunity Commission enforces the employment provisions prohibiting discrimination under the ADA. For assistance contact: U. S. Equal Employment Opportunity Commission 1801 L. Street, N.W. Washington, DC 20507 800-669-4000 800-800-3302 TTY

PRIVATE INSURANCE For adults 65 and older on Medicare you still may have private insurance through an employer or on your own with a Medicare Supplemental Plan. If your employer group plan has 19 or less members, Medicare is your primary insurance and you may be paying for Part B premiums for insurance coverage beyond hospitalization. If your employer group plan has 20 or more members, Medicare will be your secondary insurer. Generally there would not be a need to pay for Part B until you retire. Be sure and notify Social Security of your upcoming retirement date in order to begin the needed Part B coverage. There is a six-month open enrollment period for individuals to purchase Medicare supplemental insurance upon retirement. If you have private insurance-either through an employer or on your own-and meet the specified criteria in the insurance contract, you are legally entitled to AT.

What Is Important To Remember About Your Private Health Insurance?
If you have insurance under your employer - The Employee Retirement Income Security Act (ERISA) is a federal law that regulates employee benefit plans. Under this law employees are entitled to information about what is covered under an employer health plan. You also have the right to ask for a review of any denial of benefits and appeal to the courts.

If you have insurance on your own - If you have obtained your Medicare Supplemental insurance on your own (not through an employer), the Senior Health Insurance Counseling Program (SHICP) of the State Insurance Commission can assist you at 405-521-6628 or 800-763-2828.

UNDERSTANDING YOUR RIGHTS
Did You Know Receiving Assistive Technology Is Not A Matter Of Charity, It's A Matter Of Rights?
As an individual with a disability, you may have a right to the AT you need. Many funding sources-whether they are government programs or private insurers-must make their decisions based on whether you meet certain conditions. Because AT can be a right, you have recourse if your request for funding is turned down.

If You Are Seeking AT Through A Government Program:
¿ You have the right to apply for funding.
¿ You have a right to a written explanation of why your request should be denied.
¿ You have the right to appeal. This means you have the right to a review by a person not involved with the initial decision.

Find Out Why
Once you understand why your application has been rejected, you'll know more about how to appeal the rejection or proceed through due process. If an agency denies your request for funding, it's usually for one of four reasons:
1. You are not eligible for the program-you don't fit the definition of the population served by the agency.
2. The program or agency does not cover the particular device or service you are requesting.
3. Your request does not meet the criteria for coverage of the particular service or device, e.g., medically necessary.
4. You need to establish prior rejection by other agencies to qualify for the program.

How To Be Prepared For An Appeal: What You Can Do
To be prepared to appeal a negative decision, you need to keep records pertaining to your case. In a file or notebook, keep track of all paper work and phone conversations. Take notes and write down contact names and the date and time of phone calls and meetings. You should also try to speak to the same contact person each time you call or visit a funding agency.

Remember, Persistence Often Pays Off When Seeking AT
You should apply in writing. Nothing can happen if you don't first formally apply to an agency for funding. You have the right to submit a written application or prescription.

You Need To Be Aware Of Deadlines
In applying for AT or appealing a decision, it's important to pay attention to deadlines. You usually need to pursue your case within a certain limited time frame, so be sure you get reliable information.

Help Is Available
Remember, when you are seeking funding for AT, don't be discouraged by rejection. You may be pursuing something that you are entitled to under the law. For information on the various funding agencies and programs or to receive help on an appeal, call ABLE Tech INFO-line 1-888-885-5588 (voice/TTY).

Assistive Technology.. for Older Adults is a publication of Oklahoma ABLE Tech. This publication may be duplicated without the written permission of ABLE Tech provided that the source is appropriately credited. ABLE Tech would like to thank the Iowa Program for Assistive Technology, Infotech, for sharing their information for this publication. ABLE Tech is funded by the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education Grant #H224A500007. This publication does not necessarily reflect the position or policy of NIDRR/ED, and no official endorsement of material should be inferred. If you need this material in an alternative format call 800-257-1705 or visit our website at http://okabletech.okstate.edu/. Oklahoma ABLE Tech 1514 W. Hall of Fame Stillwater OK 74078-2026
Brochure added 4/10/00