GOVERNMENT OF THE DISTRICT OF COLUMBIA Department on Disability Services. Adaptive Equipment:
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1 GOVERNMENT OF THE DISTRICT OF COLUMBIA Department on Disability Services Adaptive Equipment: Acquisition, Replacement, Modification, Repair
2 Application The Department on Disability Services (DDS) Any individual or provider organization that receives District or Federal funds to serve DDS individuals and are responsible for the acquisition, repair or replacement of adaptive equipment.
3 Purpose of DDS Policy The purpose of this policy is to set guidelines for proper and timely acquisition, replacement, modification, and repair of Adaptive Equipment.
4 Purpose for Provider Policies Promote early identification Obtain repairs or acquisition of equipment expeditiously Continuously assess a person s need Recognition that individual needs may change due to physical status, health conditions, etc.
5 Provider Responsibility for Internal Policies All provider organizations that receive Federal or District funds to provide services for DDS s individuals shall have adaptive equipment policies and procedures. Such policies and procedures shall be consistent with the requirements stated herein and shall be submitted to the Health and Wellness Unit for review and approval.
6 Adaptive Equipment Durable Medical Equipment (DME) Assistive Technology Devices
7 Assistive Technology Devices Assistive Technology Devices includes, but are not limited to: Augmentative Communication Devices Sound Amplifiers TTY Devices Braille Devices Learning Toys Talking Calculators
8 Durable Medical Equipment Durable Medical Equipment includes, but is not limited to: Wheelchairs Hospital Beds Bath/Toilet Aids and Commodes Canes/Walkers Crutches
9 EXPECTATION FROM PROVIDERS
10 Creative Thinking EXAMPLE If Jacob had very good upper body strength and the use of one of his legs, but due to a car accident he lost the other leg, what type of adaptive equipment could staff recommend to ensure Jacob is as independent as possible?
11 Identification of Need An observation by a customer, caregiver, staff person, health care professional, or any person identifying a need for repair, replacement, modification, or acquisition of adaptive equipment.
12 Caregiver ANY individual or provider organization that has the responsibility to care and support people supported by DDS. This may include members of the person s natural support network; or DDS.
13 Expectation For Providers Staff report the need for repairs or replacement in a timely fashion. Staff monitor the use, productivity and effectiveness of adaptive equipment.
14 Timely Assessment Appointments for assessments by the health care professional shall occur as soon as possible, but no later than 30 days from the date of determination of need.
15 Responsibility ICF/MR Intermediate Care Facility QMRP CRF/MR Community Residential Facility DDS Service Coordinator Foster Homes Natural Homes Independent Living DDS Service Coordinator
16 Non-Compliance with Timely Assessment QMRP or DDS Service Coordinator shall provide written notice to the Health and Wellness Unit Notice should document the reasons for the delay and the date of the scheduled appointment with the health care professional.
17 Determination of Need The recommendation for Adaptive Equipment by an appropriate health care professional (Physician, Physical or Occupational Therapist, Dentist, etc.). This determination is noted on the DDS Form 719A.
18 Indicators for Determining Needs Life expectancy and usage of the device Age Changes in the conditions for which the device was prescribed has Damage or poor maintenance Misplacement or theft Improvements in the design or function of the product
19 DDS Form 719 A This form is a modified version of the Medical Necessity Form, required by payment sources such as Medicare and Medicaid for approval of funding for adaptive equipment. This form must be signed by a physician to establish medical necessity.
20 Expectation for Providers QMRP/DDS Service Coordinator schedules assessments for the need, repair or replacement of adaptive equipment in a timely fashion. Individuals adaptive equipment needs are assessed and determined by a licensed healthcare professional in 30 days or less.
21 Acquisition Process Process to be followed for the acquisition of adaptive equipment depends on where the customer resides. ICF/MR Intermediate Care Responsibility QMRP Facility Reporting the status of the acquisition of adaptive equipment to DDS. DDS Responsibility 1. Monitor the status of acquisition. 2. Provide technical and referral assistance to ensure timely receipt of equipment. Non-ICF/MR Responsibility DDS
22 Replacement, Modifications, and Repairs In the event that equipment is broken or mishandled by provider staff, due to lack of training on its use, or other reasons, the provider shall be responsible for the replacement or repair of the broken equipment.
23 Timely Acquisition and Repair Acquisition, repair, modification or replacement of adaptive equipment shall occur within sixty (60) days from the date when the Need was Determined.
24 Non-Compliance with Timely Acquisition, Repair, Modification, or Replacement QMRP or Service Coordinator shall provide written notice to the Health and Wellness Unit documenting the reasons for the delay and identifying the interim plan to address the person s needs.
25 Interim Arrangements QMRP will be responsible for ICF/MR residents. DDS Service Coordinator will be responsible for Non- ICF/MR residents.
26 Payment for Adaptive Equipment Purchase, replacement, repair, and modification of adaptive equipment may be paid for by: Personal funds Private health insurance Medicare/Medicaid Government Purchase orders with vendors Combination of these payment arrangements. Evans class members shall not be required to pay for equipment with personal funds.
27 Payment for Adaptive Equipment Personal Funds: In the event that adaptive equipment is to be purchased using person s funds, the need must be listed in the ISP and the funds for the purchase must be identified in the IFP. Private Health Insurance: Claims will be submitted to private health insurance companies based on the coverage and conditions identified in the policies for those having such insurance. Deductibles may be covered through consumer funds in accordance with his or her IFP or through a combination of District funds and personal funds or through District funds for cases where it is documented that there is no other resource for payment.
28 Payment for Adaptive Equipment Medicare/Medicaid: People who have Medicare and/or Medicaid, may submit requisite paperwork to obtain equipment through insurance. People with Medicare only may file claims for adaptive equipment with prior approval by Medicare. If Medicare does not pay the entire cost, the person is responsible for the balance. The District will pay the balance for Evans class members if the person does not also have Medicaid coverage. If the person has Medicaid, Medicaid will pay for the equipment provided that prior approval is given. If the person has both Medicare and Medicaid, Medicaid may pay a portion not covered by Medicare. The claim must be submitted to Medicare first.
29 Payment for Adaptive Equipment DDS Funding - DDS will make determinations of approval for adaptive equipment purchases or repairs funded by the District, using the criteria established by the Medical Assistance Administration. Government Contracts/ Purchase Orders: The government will establish contracts or purchase orders, or human care agreements to acquire, modify, replace, or repair adaptive equipment. Provider Responsibility - In the event that equipment is broken or mishandled by provider staff, the provider shall be responsible for replacement/repair of the broken equipment.
30 Denials for Payment Denials from private insurance companies, Medicaid, or Medicare must be appealed through the appeal process for that entity. Denials by DDS for acquisition, repair, and replacement of equipment funded by District dollars, may be appealed through the grievance resolution process. The person being supported, their family, or guardian shall have all the rights articulated in the Grievance Resolution policy for due process.
31 Documentation Requirements Physician s order. Assessments and/or evaluations by the therapist. Recommendation from the ISP process. Equipment usage and maintenance records. Training documentation (initial and refresher) for the use and maintenance of the adaptive equipment. Name of the person or persons responsible to ensure that the training was completed. Dates of training.
32 Technical Assistance At any time during the process, providers may report delays or other concerns related to the acquisition, repair, modification, or replacement of adaptive equipment to the DDS Service Coordinator and seek technical assistance. The Service Coordinator may then contact the Health and Wellness Unit to report concerns or delays and to seek technical assistance in resolving the concern or delay. DDS will identify resources that can provide technical assistance on the acquisition, repair, modification or replacement of adaptive equipment and will circulate a list of resources at least annually.
33 GOVERNMENT OF THE DISTRICT OF COLUMBIA Department on Disability Services Other Questions?
All requests will be prioritized according to the type of device, its purpose and function.
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