STRATEGIES FOR OBTAINING ASSISTIVE TECHNOLOGY DEVICES
by Tonia Trapp, Advocate

You may have thought to yourself on some occasion, If only I could have one of those high-tech devices, then I know I could achieve my goal. Or you may have said to yourself, If only my child could get their hands on one of those specialized pieces of equipment, then I am sure he would be able to excel in school. If you have ever had a thought like that, or if you think you ever might, then this article was written for you. We want to address consumers with disabilities, their parents, guardians or friends, or anyone else interested in knowing more about how to obtain assistive technology devices.
Assistive technology (AT), for purposes of this article, means any device or piece of equipment designed specifically to meet a person's disability-related need. Most AT devices are designed for people with physical or neurological disabilities. Examples of AT devices include, but are not limited to, wheelchairs and other mobility aids, specialized computer programs, communication devices, and specialized computer equipment.

TIPS FOR SUCCESS
Here are some general tips to help you be more successful and prepared as you begin the sometimes wild adventure of trying to get an AT device:

Write Everything Down. Keep records of all conversations you have with any agency, company, or other entity regarding the AT device you are seeking. Write down the date and time of the conversation, who you spoke with, what each of you said, what each of you agreed to do and by when. You can keep all that information in a diary form or any other format useful to you. Keep your records in chronological order so you can easily refer back to them later.

Write Follow-Up Letters After Key Conversations. If someone agrees over the phone to take a certain action regarding the AT device you are seeking, write a letter to the person you spoke with stating what that person agreed to do and by when. Keep a copy of that letter for yourself. That way, in addition to your own personal log of the conversation, you will have another document to show the responsibility of the agent in question.

Keep Copies of Everything. Don't throw away any document or scrap of paper you have that deals with the AT device. Keep copies of everything you receive from any agency and everything you send. You may need these documents later. Until you have the AT device in your possession, don't get rid of anything.
Access Every Available Resource. Don't be discouraged if the first agency you try is unable to help you. Be persistent. Call every agency you can think of that could help you. Some are listed in this article. If one agency cannot help, ask them to refer you to someone who can; sometimes you can get some very useful information that way.

Get All "No" Answers in Writing. If you or someone on your behalf has submitted a written request for the AT device, and if the agency from which you requested the device tells you verbally that they will not provide the AT for you, insist that the agency write you a letter to that effect. It is important that you have documentation to show which agencies have denied your request. Why? Because many agencies will not want to help you until you have already applied to certain other agencies first and been denied by them. We call this the "last resort" policy, meaning that many agencies want to consider themselves the last resort as a source of funds. Generally, they all want someone else to pay before they will pay. This can create problems when two or more agencies decide to argue about which of them should be the payer of last resort. You may get caught in the middle. See the next tip for advice on how to handle that situation.

Encourage Collaboration Between Agencies. If you find that two or more agencies are refusing to help you obtain AT, or if several agencies are telling you that they would help you except that each of them is your "last resort" agency, then try to get the agencies to talk to each other about your case. Sometimes several agencies will split the cost of an AT device rather than one agency paying the entire sum. The notion of sharing the cost may be appealing to the agencies you are dealing with, so pitch it to them that way.

Advice About Forms Completed by Doctors. It will be necessary for your doctor to complete and submit paperwork when you want to request AT from certain agencies such as Medicaid and Medicare. Examples of these forms include the MAD-303 for Medicaid, and the Certificate of Medical Necessity for Medicare. When your doctor writes on a form the kind of AT device you need, make sure the description is as specific as possible, e.g. "electric wheelchair with left-handed joystick and reclining back" rather than just "electric wheelchair." A good approach is probably to have the doctor write something like, "electric wheelchair per specifications from physical/occupational therapist," as that should include every possible requirement. Taking this extra precaution will, we hope, minimize the risk of your receiving an AT device that you cannot use because it does not meet the required specifications. Also, the form submitted by your doctor should be as current as possible, preferably less than three months old.

Use Appeals or Grievance Processes to the Fullest Extent Possible. Most of the agencies you will work with-whether nonprofit, for-profit, private or government-will have either an appeals process or a process by which you can file a grievance or complaint with that agency. If an agency has issued a decision to deny your request for AT, find out if and how you can appeal that decision (usually the appeal must be made in writing). Sometimes agencies include information about how to appeal their decision with their letter denying the request, but sometimes they don't. If the agency says they have no appeals process, ask if you can file a grievance with them and how. Usually you must appeal or file your grievance within a certain amount of time, and if you wait too long, you will miss your chance. Don't miss the deadline!

RESOURCE LIST
Below is a list of agencies who can provide some assistance to obtain AT. Each agency in the list has its own rules about who it will serve and what it will provide.

The descriptions following are not comprehensive by any means. They are meant only to give you a general sense of the kinds of assistance these organizations may be able to provide you. If you think that one of the agencies below may be able to help you, we strongly encourage you to call the agency and inquire exactly what kind of assistance they can offer you.

Medicaid. Medicaid is a largely federally-funded program designed to provide health care insurance coverage to clients who have limited incomes. In the state of New Mexico, Medicaid is linked with Supplemental Security Income (SSI) benefits in such a way that if a person receives SSI, then that person automatically receives Medicaid. Persons may also be eligible for Medicaid through the Temporary Assistance to Needy Families (TANF) program or through the New MexiKids program. In some cases, Medicaid will purchase AT devices for its clients. Medicaid may be able to purchase AT devices that are medically necessary for daily living tasks such as mobility, eating, and communicating. All requests for AT through Medicaid must be approved by your doctor. Medicaid in this state is run by the New Mexico Medical Assistance Division.

Medicare. Medicare is a federally-funded program designed to provide health insurance coverage mainly to clients over the age of sixty-five. However, some individuals with disabilities who are younger than sixty-five may be eligible for Medicare through Social Security Disability Insurance (SSDI). Like Medicaid, Medicare will sometimes purchase AT devices for its clients. Medicare may be able to purchase AT devices that are medically necessary for daily living tasks such as mobility, eating, and bathing. All requests for AT through Medicare must be approved by your doctor. Medicare may say that they are the agency of last resort for obtaining AT. Medicare is run by the Health Care Finance Administration (HCFA).

Social Security Administration (SSA). If you receive SSI benefits, then you may be able to take advantage of a Plan to Achieve Self Support (PASS). With the help of your social security worker, you may be able to write a PASS to allow you to regularly set aside another source of income, such as wages or SSDI payments, for the purpose of purchasing an AT device.

Private Insurance. Consult the policy in question to determine what kind of coverage it may include for AT devices. Your insurance carrier should be able to answer any questions.

Division of Vocational Rehabilitation (DVR). DVR serves people with disabilities who need assistance in order to obtain or retain employment due to their disability. In some cases, DVR will rent, purchase, or provide partial payment for AT devices that enable their clients to obtain or retain a job.

New Mexico Technology Assistance Project (NMTAP). This is a special program within DVR, but you do not have to be a DVR client to receive services through NMTAP. NMTAP has a financial loan program through First Security Bank that enables some consumers to obtain a loan with lower interest or for a longer duration. NMTAP also runs the Assistive Bank of Loanable Equipment (ABLE) program through which they maintain a small quantity of AT devices that they can loan to children in public schools or to DVR clients. NMTAP also has a small budget to assist people with low incomes to purchase equipment that costs $500 or less.

Commission for the Blind. The Commission is like DVR, having the same purpose as DVR, except that the Commission's clients all have a visual impairment in addition to other disabilities they may have. Like DVR, the Commission in some cases will rent, purchase, or provide partial payment for AT devices that enable their clients to obtain or retain a job. The Commission may also provide AT for consumers who are receiving independent living services from the Commission.

Independent Living (IL) Centers. There are five IL centers in New Mexico; each one is a separate nonprofit business and has its own service area. IL centers are not able to serve all parts of the state at this time. Each IL center administers a Technical Services Program. This program recycles AT devices among consumers, and can sometimes purchase or partially pay for AT devices. The program gives priority to serving people with disabilities who participate in any income-based state entitlement program (e.g., Medicaid, SSI, and others).

Special Education. Special education serves students with disabilities ages 0-21 years who require specially-designed instruction in school. In some cases, special education will provide a student with an AT device that the student requires in order to receive a free and appropriate public education (FAPE), as mandated by the Individuals with Disabilities in Education Act (IDEA). Special education is administred by local schools and school districts.

Commission for the Deaf and Hard of Hearing. This agency runs the Telecommunications Equipment Distribution Program. Under this program persons who are deaf, hard of hearing, or have a speech impairment and are determined by the Commission to be eligible, can obtain TDD equipment, amplified telephones and/or ring signaling devices to assist in their telecommunications needs. There is no charge to apply or receive equipment from this program. The program is funded through a monthly surcharge on all telephone customers in the state.
Traumatic Brain Injury Services Fund. This fund provides services to clients who have sustained a traumatic brain injury (TBI). In some cases, the Brain Injury Fund can purchase AT devices for its consumers. The Fund is run by the Department of Health, which defines this fund as a source of last resort.
Grants and Scholarships. Visit your public library or school-based career services center to find out about grants or scholarships that could assist you in obtaining AT.

Civic Organizations. Examples include the Elks, the Shriners, the Moose Lodge, and Civitan. These organizations are sometimes willing to assist with obtaining AT devices when all other available resources (such as those listed above) have been exhausted.

WHERE TO GO IF YOU'RE GETTING NOWHERE
If you are trying to get an AT device, have encountered difficulties and don't know where to go next, call us at the Protection and Advocacy System at (505)256-3100 or 1(800)432-4682
(V/TDD). We may be able to assist you, depending on your situation. P&A does do not provide AT. Our role is to give you information and or advocate on your behalf in order to help you obtain the AT you are seeking. We hope the information in this article will get you off to a good start.

Agency Phone List:
Medical Assistance Division (Medicaid):
(505)827-3100
Health Care Finance Administration (Medicare): (800)213-5452
Medicare Ombudsman for Durable Medical Equipment: Eric Carlson, (720)493-5301
Social Security Administration:
(800)772-1213
Division of Vocational Rehabilitation:
(800)224-7005
New Mexico Technology Assistance Project:
(800)866-2253
Commission for the Blind:
(888)513-7968
Commission for the Deaf and Hard of Hearing: (in Santa Fe) (800)489-8536
Independent Living Centers:
Ability Center: (in Las Cruces) (505)526-5016
Choices:(in Roswell) (505)627-6727
San Juan Center for Independence:
(in Farmington) (505)334-5805
New Vistas: (in Santa Fe) (505)471-1001
Independent Living Resource Center:
(in Albuquerque) (505)266-5022
Traumatic Brain Injury Services Fund:
(in Santa Fe) (505)827-2499