Funding Assistive Technology

Once the appropriate assistive technology device has been determined, the child’s Birth to Three program is responsible for putting funding options in place for obtaining the AT, including accessing third-party reimbursement as appropriate. If the device costs less than $250, the program can pay for the device or can attempt to access third-party reimbursement. If the device costs $250 or more, the program should pursue funding as well as submit the “Assistive Technology Device Request Form” Form 3-11 (appendix 5) to the Birth to Three System. The service provider should submit this request form concurrent with the pursuit of third-party reimbursement.

Payer of Last Resort

The Birth to Three System funds assistive technology devices and services as the payer of last resort. This means that it is the responsibility of the family, program, and vendor to pursue all other funding options. Potential sources of AT or funding for AT include:

• the New England Assistive Tech (NEAT) Resource & Education Center, which also serves as a gateway to vendors; 
• commercial health insurance; 
• Medicaid as part of the EPSDT Screening (Early and Periodic Screening, Diagnosis and Treatment); 
• Children and Youth with Special Health Care Needs; and 
• Board of Education and Services for the Blind.

Obtaining Assistive Technology through the NEAT Center

The Birth to Three System contracts with an AT center in Connecticut (currently the NEAT Resource and Education Center) that helps Birth to Three programs obtain AT and training. This center maintains a database of assistive technology devices that the Birth to Three system owns and has available for loan to children enrolled in the system. In addition, the center maintains a database of equipment available for resale. Once it has been determined that a child needs assistive technology to accomplish an outcome, the provider should contact the AT center to borrow or purchase the appropriate assistive technology. 

If parents are concerned about the use of reconditioned devices, the service provider should inform them that it is Birth to Three’s legal obligation to provide assistive technology devices, not necessarily new devices. The NEAT center will assist the provider in finding an appropriate vendor who will assist with insurance paperwork, for both used and new equipment, through the family’s health insurance, including Medicaid. 

Accessing Third Party Reimbursement for Assistive Technology

It is the responsibility of the local Birth to Three program to initiate and participate in the process to bill commercial insurance or Medicaid for AT for those children whose parents have given permission to bill their medical insurance. This process can occur in collaboration with the NEAT Center. Typically, the billing process necessitates engaging a vendor of durable medical equipment who is an approved provider with the family’s health insurance, including Medicaid.

Insurance and Medicaid customarily fund equipment that fits under the category of durable medical equipment. Examples may include, but are not limited to aids for daily living and personal care, mobility aids, standing and walking aids, wheeled mobility aids, seating and positioning systems, prosthetics and orthotics, augmentative communication aids, and hearing aids. They are less likely to cover learning and developmental aids such as computers, play equipment, and switch-adapted toys. If commercial insurance pays for all or some of the cost of a device, that amount may be applied against the annual and lifetime caps for durable medical equipment benefits in the child’s health insurance plan. 

Insurance Requirements

If the program is working with a vendor of DME, the vendor will likely take responsibility for the insurance billing. To access insurance (for a device costing any amount) or Medicaid funding (for devices over $250), the program and vendor must provide with the insurance claim:

1. A physician’s detailed prescription for the devices. To assist, the vendor often provides the specific device and accessories to the primary medical provider. 
2. A “Letter of Medical Necessity” (LMN) the Birth to Three provider prepares. 
3. Each insurer defines the term “medical necessity” in a different manner. It may be helpful to request the definition from the insurance company or from the vendor participating in the procurement process in order to customize the letter. This letter must be personal, meaningful, and show that the purchase is a worthwhile investment for the payer. 

Refer to appendix 6 for a sample letter of medical necessity.

The customary items within the LMN should include (Goebel, 2009):

• Personal benefit: How does this device increase participation in daily activities related to independence, choice, self-determination, reduced costs for caregivers, and living a full, abundant, and dignified life? 
• Investment: Besides the health and functional benefits of the device, what are the costs of not providing the requested AT? For example, the costs to an insurer of respiratory and gastrointestinal complications, joint malformation, low bone density, etc., far exceed the cost of a suitable standing device for an individual who cannot yet bear weight. 
• Equipment choice: Why is this particular equipment the most appropriate choice to address the needs of the child? What features make this equipment the right choice? Can it adapt to the child’s needs over time (even though it may cost more initially)?

Based on established fee schedules, vendors have information regarding the amounts that Medicaid and the various commercial insurance carriers will pay toward durable medical equipment. The payment may cover the cost of the device(s) completely or partially. When the vendor has paid for the full cost of the device, the program cannot bill Birth to Three for cost above those allowed. The vendor must accept as payment in full the amount Medicaid reimburses. However, if payment is partial by commercial insurance, the program can submit a request for reimbursement of the balance to the Birth to Three System. The Birth to Three System cannot supplement Medicaid payments. 

Accessing Birth to Three Funding

The Birth to Three System is responsible for funding only equipment intended to achieve functional outcomes identified on the IFSP. No new devices or equipment should be requested for children who are 2 years, 9 months of age or older, as equipment requested during this period would not be available long enough to make progress on identified outcomes. An exception will be made for initial hearing aids if the child is newly enrolled in Birth to Three after age 2 years, 9 months. 

The Birth to Three program is advised to submit the Assistive Technology Device Request Form (appendix 5) to the Birth to Three System while third party funding is being pursued. A copy of the current IFSP must accompany this form. 

Requests should reflect all costs for the acquisition of equipment, including shipping and handling, fitting and customization, and extended warranties. The Birth to Three System has an approved dispensing fee for services needed to acquire hearing technology for young children, and Medicaid has its own rate for dispensing fees. 

The Birth to Three central office staff will review the request for AT funding and return a decision to the provider program on Form 3-11 (appendix 5). If approved, Form 3-11 will include the date of approval and the maximum amount of reimbursement allowed. 

If the family’s health insurance denies payment or approves only partial payment for the AT, the program will pay the vendor directly for the amount not covered. After the family receives the device, the program will submit the final invoice for the device along with the pre-approved Request Form 3-11, showing the result of the third party billing, to the Birth to Three fiscal office. Proof of payment (e.g., copy of check showing cancellation or zero balance invoice from vendor) must be included for reimbursement as part of the regular monthly invoice.

If funding has been requested and approved by the Birth to Three System and a third-party payer covers the full cost of the device, the requesting program should notify the Birth to Three fiscal office so that funds are not set aside unnecessarily. 

Maintenance and Repair of Assistive Technology

• The child’s Birth to Three program is responsible for the maintenance and repair of the AT device. If any devices or service are part of a child’s IFSP, then the technology must be available to the child for fulfilling the outcomes and objectives of the IFSP. If a device needs repair or maintenance, the Birth to Three program is responsible for providing alternative access or temporary use of another device or equivalent during the period of time the regularly used device is out of service. 
• The NEAT Center provides minor repair service for AT owned by the Birth to Three System. 
• Whenever possible, the local Birth to Three programs should consider obtaining insurance and/or maintenance contracts when purchasing AT. Parents are also requested to insure the AT devices under their homeowner’s or renter’s insurance policy if possible. 
• If the child continues to use assistive technology after age 3, the Birth to Three System will not assume responsibility for any repair or maintenance.

Ownership of Assistive Technology

The party that paid for a majority of a device owns assistive technology devices purchased for children enrolled in the Birth to Three System. If third-party funding ends up paying more than 50 percent of the purchase price of the device, then the device belongs to the family. If Birth to Three funds pay for 50 percent or more of the device, the Birth to Three System owns that device. 

Programs are responsible for tagging all equipment purchased with Birth to Three funds with inventory tags the Birth to Three fiscal office supplies. The fiscal office notifiesthe AT center of the devices purchased along with the address of the family using the AT. This information is maintained in the center’s data system.