Assistive Technologies Research: Funding

Assistive technology in medicaid home- and community-based waiver programs.

Kitchener M, Ng T, Lee HY, Harrington C.  Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118, USA.  Gerontologist. 2008 Apr;48(2):181-9.

PURPOSE: As consensus emerges concerning the need to extend publicly funded home- and community-based services that support the independence of seniors, studies have reported the efficacy and cost effectiveness of assistive technology (AT). This article presents the latest available national AT expenditure and participation trends (1999-2002) for Medicaid 1915(c) waivers, the largest Medicaid home- and community-based service program.

DESIGN AND METHODS: We collected annually reported Centers for Medicare and Medicaid Form 372 data from state officials for each waiver providing AT for the period from 1999 to 2002. Descriptive statistics examined trends in national participation and expenditures, interstate variations in participation and expenditures, and differences in provision between elderly persons and persons with developmental disabilities. RESULTS: Although we report a rise in the number of waivers providing AT, there has been much slower participant growth compared with the broader waiver program, and there is wide interstate variation in waiver AT provision. Not only do most waivers with AT serve persons with developmental disabilities, AT spending for that target group is almost twice that for aged or disabled waiver participants.

IMPLICATIONS: This study highlights three policy concerns: first, the large interstate variations in AT provision in Medicaid waivers may signal access problems in some states; second, policy choices in some states may favor Medicaid spending on AT for the developmental disability population over that for the elderly population; and third, data limitations prevent a comparable state-by-state analysis of Medicare AT provision.


Funding, ethics, and assistive technology: should medical necessity be the criterion by which wheeled mobility equipment is justified?

Canning B.  Wheelchair and Seating Clinic, Rehabilitation Institute of Chicago, Chicago, Illinois, USA. Top Stroke Rehabil. 2005 Summer;12(3):77-81.

The article will explore the use of the term medical necessity as it relates to wheeled mobility. Health insurance will cover a wheelchair if it is determined that it is medically necessary for a particular client. There are many different types of health insurance, and no universal definition of medical necessity. This presents a problem for clients and for individuals who are making wheelchair recommendations for clients. Case studies describe how equipment is currently recommended based on the limitations of the client’s insurance coverage. As more equipment becomes available to improve the quality of life for people with disabilities, it will become harder for therapists recommending equipment to determine the limits of medical necessity.


Power mobility device provision: understanding Medicare guidelines and advocating for clients.

Dicianno BE, Tovey E.  Department of Physical Medicine and Rehabilitation Institute for Rehabilitation and Research and Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.  Arch Phys Med Rehabil. 2007 Jun;88(6):807-16.

The Centers for Medicare and Medicaid (CMS) issued a new national coverage determination (NCD) for mobility assistive equipment (MAE) including wheelchairs in May 2005. CMS then issued a Final Rule in April 2006 that outlined significant changes required for documentation for prescribing MAE. Other insurance providers have since adopted and sometimes modified the NCD criteria and have begun to apply these criteria according to their own interpretations because some of the criteria are vague. In this report, we introduce a case example to show the components of the CMS NCD criteria, what was intended but poorly described in the language, how insurance providers may misinterpret or alter the criteria, and how clinicians can act as advocates.


Sources of payment for assistive technology: findings from a national survey of persons with disabilities.

Carlson D, Ehrlich N.  US Department of Education, National Institute on Disability and Rehabilitation Research, Washington, DC 20202-2700, USA.  Assist Technol. 2006 Spring;18(1):77-86.

This article provides an overview of who pays for the most commonly used assistive technology devices, special adaptations, and environmental accommodations by persons with disabilities in the United States. The latest findings from the 2001 survey of Use and Need of Assistive Technology and Information Technology by Persons With Disabilities in the United States conducted by the National Institute on Disability and Rehabilitation Research, Rehabilitation Engineering and Assistive Technology Society of North America, and the University of Michigan will be presented and compared to findings from earlier research and reviews of the literature. A modified discriminant function analysis was performed to determine the interaction between the source of payment for assistive technology used by persons with disabilities. In the sample of 1,414 such persons, 901 were found to use some form of assistive technology in their daily lives. Ten distinct sources of payment were specified. Respondents were able to mention up to three sources of payment for each example of assistive technology used. A total of 1,877 sources were mentioned. Overall, the most mentioned payment source was self or other family member in household, accounting for nearly 40% of all sources mentioned. The variables tested were found to have varying levels of interactive potency. Occupational status, education level, severity of impairment, opinion as to the effectiveness of assistive technology, and personal income were significant, whereas age, family income, opinion as to improvement over the past decade, and race were statistically unrelated to source of payment. From the perspective of relative discrimination on the basis of payment source, Medicare stands as the lone significant discriminant source of payment. The authors offer a summary and conclusion based on an integrated view of all available sources of information about payment.


Wheelchairs, walkers, and canes: what does Medicare pay for, and who benefits?

Wolff JL, Agree EM, Kasper JD. Department of Health Policy and Management and Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, USA.  Health Aff (Millwood). 2005 Jul-Aug;24(4):1140-9.

Medicare’s role in the distribution of mobility-related assistive technology has not been well documented, yet rapid growth and regional variation in spending, and concerns over “in-the-home” coverage criteria, highlight the need for facts. Using the 2001 Medicare Current Beneficiary Survey, we find that 6.2 percent percent of beneficiaries obtained mobility assistive technology under the Medicare durable medical equipment (DME) benefit. These beneficiaries were disproportionately poor, disabled, and users of both acute and postacute services. Average per item spending ranged from $52 for canes to $6,208 for power wheelchairs. Among beneficiaries who acquired such technology through the DME benefit, these devices comprised just 2 percent of overall Medicare spending.