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I think we're going to go ahead and get started. I'm going to start the record for this
conference and I'll be back in just a couple seconds.


This is Jim Sheldon. For those that are muting your phones, do get periodic breaks for
questions, you'll have to unmute. I didn't take notes for that because I didn't think I'd
mute myself during the call.

Star six to mute and star seven to unmute.

Thank you Steve.

Conference record has joined the conference. Good afternoon. Today we have Jim
Sheldon from neighborhood legal servicese who will be leading a discussion on how
students with disabilities can fund a ring of assistive technology as they finish their last
years of high school, move to higher education and plan to enter the work force.
Hopefully you had a chance to look at the materials that was sent out that was attached
to the invitation. We'll be using these today. Jim will be going through a case scenario of
the case of Sharon, to facilitated today's discussion on how Sharon will be able to access
several sources, which includes -- funding sources. All of these can be used to a I quire
a wide range of AT.

Before we get started, just ask anyone if you can mute your for.

We did ask folks to register with my secretary after the presentation today, Julie is going
to be sending out an evaluation and attendance form. We're going to need that in order
to get the CLE. If, for any reason, somebody is seeking CLE and did not register, Julie's
email address is J cube man CUSHMAN@NLS for neighborhood legal
Just a brief commercial for our technical assistance project and an upcoming conference
we'll be doing in October. We provide assistance training an other services to a primary
customer base of the protection and advocacy assistive technologies and to the PNAs in
general. Certainly that technical assistance is available to anybody else on the phone as
well. That technical assistance can be a wide range of issues regarding a wide range of
funding sources. Certainly, anything that's discussed during today's presentation, would
be fair game to call me, Diana from our prosector the special educations Ron hay cigar
who left us two years ago to join the national disabilities network in Washington. We do
a number of publications. The article that you've got as a hand out is just an example of
one of them. We do a newsletter that's know targeted three times a year. AT advocate.
Issues relevant to the discussion as we go along. More recently, we've started to do a
series of frequently asked questions and there's already two of those on our website.
The big thing I wanted to mention is the bridges to advocacy convention is going to be
held this year in October, October 21-23, 2009 in Austin, Texas. I'm hoping within a
week to start doing publicity primarily through LISTSERVs and anyone who attended
this call will probably get an email to let you know about this conference. Stay tuned on
that. Now you should have before you, or at least been sent to you three different hand
outs. One is the case scenario of Sharon. One is a Power Point. It's actually 36 slides.
There's two page threes, the second page three is actually page four. Page 39 for some
reason follows 35. That's actually page 36. So you're not missing any slides an you're
not going crazy. There's two page threes. If for some reason you don't have those hand
outs and want to email Julia immediately .

-- this was published in tune in a lab collation we had with Cornell University and again
in 2004 as part of this technical assistance project. The 2008 version that you've got in
front of you, was edited by myself -- didn't quite finish it. We're okay with using it as a
hand out for presentations, but now that we're in to 2009, not only do we have to finish
what we didn't last year but make 2009 changes as well. For the most part, everything
is still accurate in there. I'll try to point out one instance where there's an update.

Okay. In a moment we're get started with the Sharon scenario and explain her
experience for the AT she may be looking for in the next couple years. As Lisa
mentioned we'll go through five funding sources, special education, VR, Medicaid,
Medicare, SSI's plan for achieving self support. Ron and I had originally been prepared
to cover up to a dozen different funding sources, things like private insurance. Make it
less useful if we got too scattered on it. I know we have some people on the phone from
the alternative financing projects, the AT loan programs. We're not going to mention in
any specific way the availability of low interest loans or special loans to cover any of the
equipment we're going to talk about, but that would be anotherral turn tiff funding source.
If you -- alternative funding source. If you need more information on those programs,
probably the best place to go is to resina's website, RE .

We will open up for questions at the end of the presentation. I'll ask you to identify
yourself, where you're from. What's your question. Depending on how many questions
there are, I may cut them off to we can move along. If the question is too complicated or
beyond my expertise, we may have a need to follow up. I may ask you to email more
specifically or inquiry my email address is certainly on the materials. It's on the longer
article, anyway.

We're scheduled to end at 4:45. I'll certainly end the formal presentation by that time.
We need to go at least 90pins of presentation -- minutes of presentation to qualify for the
CLE credit. Question may go for ten minutes beyond that. I'll let you know that I'm
going start going through the Power Point slides, but I will read the case of Sharon in
full, at the same time. Slides one and two are really still in there from the presentation
that Steve Elliot of Texas and I did back in March. Anybody who is looking forward to
hearing Steve present with me, he's not going to join with me today. If you look onto
slide 3 or the first 3 since there's two of them, the purpose of the session is to take a
look at transition. Transition is a term that's used in special education laws and the law
and ranks that govern vocation agencies. We're going to look at transition specifically
from high school to college. The hypothetical Sharon is college-bound. At least talk
about what Sharon may need for the transitions to work. We're going be looking at
expected AT needs in six different categories that maybe she can begin to plan for
through a number of different funding sources over the past two, three, four years or

 Cornell had the national contract to provide training for those working for benefits
planning assistance and benefits outreach programs that since have been renamed,
work incentive plans an assistance programs, funded by the Social Security
administration. Also for those from the PNA network, people that work on protection an
advocacy -- Social Security programs. The idea was to equip benefits counselors
information that goes beyond just the usual Social Security and SSI primarily deal with.
When Ron and I edited the article, updated it for 2004 as one of our national AT
publications, we were really looking at extending this whole notion of benefits planning
to planning AT-related needs. We could easily be having a broader conversation about
individuals that need AT for Independent Living. Of course, Sharon [ Indiscernible ]
Around her transition from high school to college and to work.

Let's start with Sharon. Let's consider Sharon, who's 17 years old and has cerebral
palsy, a diagnosis she has had since birth. She's completing her Junior year in high
school. Has above average grades and plans to attend college to become an attorney.
Sharon's 18th birthday will occur in December of her senior year in high school. The
18th year is critical to the planning. She received support services from a special Ed
indication teacher in a classroom occupational therapy and fiscal therapy services from
the educational department. OT and PT as they're referred to. Sharon resides with her
mother, stepfather an a 12-year-old brother that does not have a disability. Her father
died when she was young. She collected Social Security survivor benefits. $60,000
income, which makes her ineligible for SSI at this point because both the parents and
stepparents income is considered available to Sharon. You'll see as we go along why
SSI eligible becomes critical in the planning for funding of AT devices and services.
Sharon has already visited the school of industrial an labor relations at Cornell
University and hopes to attend graduate school there. Her grades and SAT scores
should ensure her acceptance to the school. Public transportation is not available for
this travel. Sharon plans to continue Liking at home and commute to the campus. --
living at home and commuting to the campus.

Start on slide five as we begin to go through the AT that she needs. Sharon and her
parents have identified the following AT or assistive technology, which is needed
presentedly or is expected to be needed over the next three to five years.

Remember, we're talking about transition planning. I think one of the things that we
rarely see the school DOS a great job -- schools do a great job with transition and
planning. I'm not I ware that schools do any kind of job to help people identify the type of
AT they may need as they leave the public schools an get into the late teens, twenties
and look to accomplish Independent Living and perhaps success in college or the work
First thing Sharon needs is apower wheelchair. Her existing wheelchair ising the up to
200 feet. If she attends college at Cornell, the university and the village are extremely
hilly, as anybody knows. She will not be capability of independent mobility without a
power wheelchair. Even in flat areas, keep in mind the buildings on this campus and
most campuses are spaced far enough apart that she cannot propel her manual
wheelchair between classes. I'm going to assume that that wheelchair is going to cost
$10,000 so we can track the kind of price tag for these items. She's going to need
augmentedtive or -- AAC device. Communication device or more recently by some
forces speech generating device. Sharon's speech is understandable to familiar
listeners. She has a 7-year-old device that allows her to speak by electronic moons.
This device is constantly in for repairs. I'm going to assume that's going to cost about
$8000. Next, she needs a laptop computer with adaptive keyboard an voice input
software. Sharon has extreme difficulty in writing and currently has a note taker through
school funded by the special education program. She uses her family's 6-year-old
personal computer with adaptive keyboard to do her assignments. A local universities
evaluation recommends the latest in software technology to allow her to dictate notes
and assignments into the computer. Accept that as a given obviously, that could be a
controversial issue. The evaluators tell Sharon that the software program will be able to
pick up her speech patterns an capture what she says up to 90% accuracy. Sharon's
speech pathologist combination lap tot AAC device that with meet the speech input and
personal computer functions as a fraction of the cost so that the two devices are
combined. The free standing laptop is going to cost 1000 bucks. Could be more or
less. Ceiling track lift. If you are following along ton slide, we're up to slide 8 now. The
ceiling track lift, use a traditional Hoyer lift, the high controllic model that you pump up
with your hand to get her into and out of bed an meet her needs in the bathroom. Her
stepfather's business requires frequent out of town trips. The more expensive state of
the art ceiling track lift would allow Sharon to safely and -- meet her needs. Assume
that that lift could easily be operated without a second person in most cases. I'm going
to assume the price tag on the ceiling lift is about $6000.

On the slide nine, an access ramp at the home, currently Sharon and her wheelchair
must go up and downstairs to enter or exit the home. This next sentence is reminiscent
of cases I've been aware of. The family uses a make-shift method with two long planks
to allow her to move up an down the stairs. She also needs two persons to guide the
wheelchair up or down. A ramp will allow Sharon to come and go without a second
person to help her. When Sharon uses the heavier powered wheelchair. Neighborhood
legal services has had some cases where she eventually got Medicaid to fund portable
ramps of the cost of about 500 a piece. Moving onto slide ten and the last AT that we'll
talk about, in a real case she might need more than that. A van specifically modified for
a wheelchair user. Based on a recent driver evaluation Sharon was found capable of
driving a van that allows her to drive from her while chair. High controllic lift, wheelchair
lock down. If she can obtain the van while she is in college she'll avoid the expense of a
wheelchair van service to take her to college. Travel to work after she leaves college.
Now I'm going to assume the van itself is probably going to cost about 23,000 an the
modifications about 25,000. Many will tell you, I'm sure people on this call could tell us
that 25,000 could be a modest estimate of what that van modifications may cost in
particular cases.

Based on my math that brings us to about $75,500 and we didn't talk about tuition,
books, transportation to and from college. She probably needs some kind of special van
transport. Van insurance when she eventually purchases the van and we can probably
think of many others.

So let's move in to our first funding source. Special education.

As you have questions, you might want to jot them down. I'll make every attempt to
entertain at least a few questions at the end of each session. Bare with me as I take a
drink of water. I don't have a copresenter to share with.

Move along Jim. You're too slow.
  Thanks for the sarcasm.

As we move into special education for each of these funding sources, what we're going
to be talking about first is eligibility for the program itself. How one qualifies for AT, or at
least what we're going to call AT in general. Then how our hypothetical Sharon would
qualify for AT.

The special education programs and you're going to find them in every part of the
country, are authorized through something called the individuals with disabilities
education act. Most of the areas I'm going to cover, there's much broader publications
that may be available. One is a publication that Ron hagger an Diane from May,
formally Diane Smith formally from NDRN put together most recently back in 2003 and
in the process of updating that. Send me an email if you want me to provide you links for
where you can find some of that stuff on our website. If it's available on somebody
else's website.

On slide 11 year. To qualify for special education services, you have to have a child
with a disability who requires special education services to benefit from their educational
program. Now, anybody that sat through one of these presentations, special education
before, knows that Ron or others will point out that all special education services must
be free. So right off the bat it's of no moment that Sharon's parents make 60,000 a year.
They could make three times that much and Sharon would still be eligible for special
education services without any cost to her or her parents.

Now in terms of the national IDEA, individuals with disabilities education act. If you do
the research on this, that some of the AT devices, AT services, someone may need may
be found with related services. You have to be at least be receiving some special
education services. New York is an exception to that federal requirement. I think in most
states, that's going to be the case. Then any services that you get -- this would include
assistive technology -- need to appear in writing on what's in the IEP or the
individualized educational plan. Again, services must be needed to ensure an
educational benefit. That can become a point of contention in a lot of cases. Education
must be made available in the least restrictive environment. We can have some
discussion on that as we talk about Sharon since there may be runs why she's going to
need a little bit of help to participate in a regular program. The least restrictive
environment stuff is discussed on page six of the much larger article.

Onto slide 12, you've got both AT devices and AT services that are defined in IDEA.
They use the same definitions that you would find in the assistive technology act. I think
most recently amended or updated in 2004. You'll see those definitions on page 2 of the
larger article. I'm not going to go into those specifically. The key questions as you're
looking at any students right to a particular AT device or AT service is -- this is what I
call the Rowley dating back to 1982 is the AT device or services needed for some type
of reasonable educational progress? But you know, even if it's not, you still may have an
argument for the AT if it's something that's needed to allow the child to remain in the
least restrictive setting. An example like this -- an example might be someone who
needs adaptive seating. Maybe a specially designed desk in order to participate in
regular classes. Or the third thing, do they need it to prepare for adult life? You're going
to see as we discuss some of the issues for Sharon, that she may need certain things to
adequately prepare her for the transition to college.

Okay. Moving onto slide 13. Sharon's eligibility for these various AT devices
themselves. Now the AAC device can be funded. We've certainly seen them funded
through special education programs. In Sharon's case we'd want to argue that they're
needed so she can adequately communicate with teachers and peers so she can fully
benefit her education Alex per yens.

-- educational experience.

Training. Training of both Sharon and both staff would be done as an AT service. That
would meet that definition. Any specialized software for the device could also be
funded as an AT service. If she needs to take the AT device home and why shouldn't
she? There's some good policy on how home use must be allowed if the student needs
the device to benefit from their education. Moving to the laptop computer, again, the test
should be -- is Sharon going to need that so she can adequately benefit from her
education? Arguably she has more homework demands those last years in high school,
she has advanced placement courses, that laptop is going to be needed to keep up with
those demands and I think she can make a pretty good argument that she's going to
need that laptop in college and she needs to start preparing right now to be able to use
it. The real problem that last thing on slide 13 is the whole issue of ownership. What
happens when she graduates? Does she get to take the device with her? Most school
districts around the country that I've heard of, the school retains ownership and it's going
to be a real challenge to transfer ownership to her. In the perfect world, what you might
have is the state vocation rehabilitation agency collaborating with the special education
program perhaps to split the cost of it. Great in theory, in fact the law would support in
doing something like that, doesn't happen too often in practice. For both of these items,
the AAC device and the laptop computer, maybe the good thing to do would be to look
to Medicaid as the funding source so that when she gets these items she would own
them. We'll talk in a few moments about when she's going to become else listeningable
for -- eligible for Medicaid. I assume she's not yet unless she's in a waiver program.
Whether that's going to be timely enough to get these devices when she needs them.

Slide 14 talking about the ceiling track lift and the power wheelchair. See if we have any

The ceiling track lift, modified van, very hard to connect those in any way to her ability to
benefit from education. I suppose you could say if she doesn't get out of the house she
doesn't go to school. It's probably not going to work in the IDEA context. No direct
connection to education, not needed specifically to prepare her for college. What about
the power wheelchair? If you looked at the much longer publication that Ron and Diane
did, you'll see that there are some policy letters out of the U.S. Department of Education
that would support the purchase of mobility type of equipment in some cases. Let's face
it, Sharon is going to wanted to be able to take that power wheelchair with her when she
goes to college. We're assuming she's going to go to Cornell. So I think we're probably
going to want to look at Medicaid as the funding source for that. If you look at page 8 of
the longer article here, there's a reference -- 33 to one of the policy letters when it talks
about the purchase of mobility equipment.

That's the end of the first section. Do we have any questions out there? If you do unmute
your phone. Let us know who you are and where you're from and what your question is.

Unmute your phone press pound six.

It's Lou.

Hi Lou. In the discussion of the three foundations for need educational progress and [
Indiscernible ] Prepare for adult life, is there a basis for the last one as being

Yeah. It would be the transition requirements Lou an I'm not going be able to reference
something right off the top of my head without looking it up. But I know that as we were
preparing this many years ago and Ron and I did a lot of training around these issues,
that the transition requirements, which have been bolstered a little bit over the years, I
think are fairly reasonable foundation for this. I don't know if anybody wanted to
comment on that.

Okay. Thanks.

Feel free to send me an email an I can forward this issue onto Ron who can give you
chapter and verse on this.

Other questions about the special ed issues so far?
I hear somebody talking, but I don't think they're talking to me.

Okay. Let me move o , if there's no questions. We can come back to special education
as we go along if you think of your question.

Moving in to the next topic vocational rehabilitation --

Excuse me. I have one special education question. Could you explore a little bit more
about the collaboration between voch rehab and IDEA. You said that it's possible that
they could collaborate on purchasing the wheelchair and that in an ideal world that
would work but it doesn't happen very often. I know we run into this all the time where
voch rehab is supposed to be involved in kid's special education starting no later at 16 or
starting at 16, yet they aren't. If you were to get a transition coordinator involved in this,
how would you proceed to get -- it's each contributed half of it, I can still see the school
saying they want to keep it.

Who's speaking?

I'm sorry. This is Alex wander Volker disability rights Montana.

I'm going to give you the New York specifics on this. It says in both IDEA and Title I of
the rehab act that governs agencies that they're supposed to collaborate uncommon
indicate with each other. In New York, the reality is that our VR agency they're called [
Inaudible ] Rarely gets involved before the last semester of the careen your year. --
senior year. What we do have in New York is legislation that allows a school district to
sell equipment that a student has been using without having to go through an elaborate
process. I'm not aware that that's used very often. I think this is the delimb that what
you're going to -- dilemma that you're going to face, there's a lot of state and local laws
that may mandate how property is transferred from a school district to say the family, the
student, or to the VR agency F they were going to purchase it -- if they were going to
purchase it and own it for some time. I do know -- not in the special Ed context but in
the Medicaid context -- our formal director of the VR agency was instrumental in working
with Marge from our office and having [ Indiscernible ] And Medicaid or in one case VR
agency an a private insurance company split the costs of a various components of a
wheelchair so the vendor could recover the whole purchase price. Tricky stuff. I'll
encourage you if you want to follow up on this, I'll try to bring Ron into the conversation
because he really knows this stuff much more back wards an forward than I do. I know
the foundation is there for this. It's practical issues in terms of scale. When planning we
want to favor one funding source rather than another.

I'm going to move into VR now.

Okay. I'm assuming that's not for me. Every state is going to have a state VR agency -
- [ Audio interfering with actual speaker. ]

We're hearing a side conversation there.
Every state is going have a VR agency and about maybe two-thirds of the state there's a
separate agency for the blind as bell. That's -- blind as well. There's certainly true in
New York as well. Sharon is not blind based on our hypothetical. So they'd be dealing
with the primary VR agency. In order to meet the basic eligibility criteria, the individuals
going to have an disability that interferes with the ability to work. This does haven't to be
nearly as severe that one needs to qualify for Social Security or SSI. Second, they're
going to need VR services to prepare for, secure, or retain, or regain employment. Any
one of those three things. All services must be connected to the work goal. I know some
people say if it's Medicaid it's medical necessaricy, if it's special Ed, it's educational
necessity if it's VR it's vocational necessity. It's probably not a bad thing to keep those
concepts in mind. As we look at those various items, you're letters of justification for the
item might be worded quite differently if it were to go to the special ed agency, the VR
agency, or as many of us are familiar with to the Medicaid agency. The services or
equipment that somebody is looking for must maximize employment. That language is
found in both rehab act itself as well as the regulations and one of the very good policy
directives. The only thing I'll caution you is that the court haves not been as kind as the
language in the statute and the regs themselves. Ron wrote our origin Alex tensive --
original extensive regulation -- certainly it's been Diane's experience as she looked
through a lot of the case law that maybe it's a case of bad facts making bad law but the
courts have not been great on interpreting max myization but the language is there.
With VR agencies, I talked about the IEP for special education. It's the IPE for
vocational rehabilitation individual plan of employment. For anybody that's been around
for a while or if you are looking at some of the older publications, that term used to be
IWRP or individualized written rehabilitation plan.

Just talking about Sharon very quickly, in addition to any of if AT that she may need that
we'll discuss in a couple minutes here, she's going to need tuition, books, transportation,
maybe some other things as well. although the focus of the presentation is on AT as
we're looking at students like Sharon who are in the third or fourth years of high school
or maybe earlier than that, there's just a whole bunch of things that they're going need
that's going to cost money. Now, looking onto slide 16, eligibility for AT. AT must be
necessary to achieve the work goal or benefit from other VR services. When you look at
the regulations and anybody that's going to do VR work, the regulations are very
comprehensive. AT falls within a much broader category of rehabilitation technology.
The definition of AT service, AT device and AT service are exactly the same as those in
the AT act. Exactly the same as those in IDEA. Broad range of AT devices available,
just giving you some sampling of the kind of things that might be available. Prosthetic
devices, specialized transportation -- what happens a lot in New York since our VR
agency will not pay for vehicles, provide what I refer to as a wheelchair van service to
take a student like Sharon the 30-mile commute from her home to the university and
back. That would cost a fortune if the family had to pay for it out of their packet. Vehicle
modifications. Adaptive computer equipment. Just a little footnote on the computer
equipment. I know there was an exchange on the pad's list serve some time ago to get
computer equipment. There was some commentary that suggested notten less the
computer equipment that was specially attaptive. A Deaf student that doesn't need any
particular modifications, if they can show that that's necessary to benefit from their
college program, that can be provided through VR agency funding.

If a student needs a ramp at the house, to benefit from the college program they're
enrolled in, maybe that's what needs to be provided by the VR agency. When I say
provided, the VR agency is a source of dollars an not equipment itself though. Some
agencies may choose to have a repository of equipment. That may be a little more likely
for an agency that serves the blind.

Okay. Moving onto slide 17, vocational rehabilitation the financial need criteria. In title
1 of the rehab act, it's a state option on whether to have a financial needs test. I don't
think I've ever talked to anybody from any state who claims their VR agency did not
have a financial needs test. Most of the key services are going to be subject to financial
need. There's a few exceptions to that. Items that are exempt from financial need.
Diagnostic services. You'll notice that it cede Sharon's already had a driver evaluation.
That's going to be critical if you're doing transition planning for a student who's a
wheelchair user and has some limitations with the use of their hands. They can do
marvels with assistive technology. One of my former clients told me about three years
ago, he's driving with technology that didn't exist ten years ago. He wouldn't have driven
ten years ago but he drives today. So the diagnostic services, I would think that would
include the driver evaluation, it's a critical item, or the school that to pay for the driver
evaluation as part of the transition. Okay? I never really thought about that until just

Counseling and job placement are not needs base services. Personal assistance,
interpreter and reader services, not AT, but I know when we did some training in Texas,
I was amazed at just how many VR dollars in Texas was spent on personal assistant
services. Put a star by this next one. SSDI and SSI recipient is automatically meets the
financial needs criteria. This is -- I believe part of the 2001 amendment if I'm not
mistaken. It's fairly recent that the state VR regulations now make it clear that if an
individual is in receipt of Social Security benefits -- they automatically meet the financial
need criteria. That's important for transitioning students because typically, a VR agency,
this would certainly be true in New York, would look at the income and resources of
Sharon's parents. Perhaps might determine that Sharon doesn't meet the financial need

Now let's look at Sharon's eligibility for AT. The very first thing we're going to look at is
to transition into it, the financial needs test. Sharon is going to become eligible for SSDI
Social Security disability insurance and SSI at age 18. Let me elaborate on that. The
facts say that Sharon is going to turn 18 in December 2009. At age 18, the SSI program
will no longer look at the income and resources of mom and step dad. So she's going to
be eligible based on her income and resources alone. What's her income? The $420 of
Social Security survivor's benefits. We'll go through the budgetary stuff a little bit more
when we get to SSI's plan for achieving self-support. But if she were in a state that pays
the 2009 federal benefit rate for SSI with no supplement she'd be eligible for $274. But
importantly for this AT discussion, she's going to become automatically eligible for
Medicaid at that point in 39 states and the District of Columbia. So most of the people
that are on this call, the person from Alaska, I know [ Indiscernible ] From Florida, Lou,
Steve from New York and California. In your states, Sharon is going to become
automatically eligible for Social Security. As long as the SSI supplement is at least a
dollar she'll qualify automatically. I think Minnesota if I'm not mistaken is a 209B state, so
that's not going to be automatic. You would have to look at your on criteria.

Sharon's going to be eligible for SSDI when her Social Security survivor's benefits end.
That's typically going to be at age 18 or 19 if she's still in school. I'm going to guess in
Sharon's case she's going to graduate depending on what part of the country she's in,
May or June of 2010. At that point she'd transfer from the survivor's part of Social
Security to what's known as disabled adult childs or Social Security more often called
child disability benefits now. She'll be able to keep those disability benefits as she leaves
school an moves into college.

The power wheelchair and the AAC device, we're still on slide 18, technically both of
those can be funded by a VR agency. I'm aware of at least one case where we had a
real battle with Medicaid and our VR agency stepped up an paid for a power wheelchair.
I mentioned those couple other cases where our VR agency was a cofunder with
Medicaid or insurance plan for an expensive and fairly sophisticated power wheelchair.
The practical issue is that Medicaid -- I say Medicare but Medicare is going to be
potentially a problem for the power wheelchair, at least nor mar Ron. Medicare -- for
Sharon. May make just as much sense to go to Medicaid even though technically,
you're not forced to do that under the unique circumstances of this qualifying as AT. I
think we're probably going to look at Medicaid as the funding source for those two
devices. If there's questions, hang on just a second. I have one more slide on the VR.

On slide 19, the laptop with accessories and the ramp, I think those are very appropriate
items for VR agency funding. Most individuals who attend college are going to need
computers. In fact, a lot of them are going to be told they have to have a laptop to
attend college. You can probably build a very good case as to why the laptop is needed
for Sharon. Access ramp is something the VA agency can pay for. Ceiling track lift is a
little more tricky. As we've done training together Ron and I often had a counter point on
whether this is something that the VR agency would pay for. Typically, you think of a
ceiling track lift to allow somebody to get in and out of bed, get in the bathroom, take
care of their hygiene, but if it's necessary to prepare her to get out of the home, you
certainly do have a good argument for VR agency funding. It certainly, in many ways,
the mechanical equivalent of personal assistance services which the VR agency can pay
for but that's in a gray area.

The vehicle purchase and modification. If you looked at the regulations, I believe we
discussed this in the larger article, the regulations would support, I believe, VR
purchase. One can question whether it mac dates it. As a practical matter, I don't think
there's more than five or six states whether the VR agency has any history of purchasing
vehicles. I think California is one of them. I know some years back had a discussion
with Mike cluck from the California PNA about this. Clearly though, your state VR
agency can pay for modifications. I know in New York, I know the VR agency fairly well,
they would routinely pay for modifications for a young person or older adult who needs a
van in order to have transportation from the wheelchair. I suggested in our hypothetical,
we'd price it out for 25,000. We easily could be talking 40-$50,000 or more.

Okay. Let me come up for air here. See if there's any questions that relate to VR
agency funding before we go into Medicaid. Any questions? You have to unmute your
phone first and let us know who you are and where you're from.

After course I have no idea of knowing whether you have hung up your phones or are
playing solitary.

[ Indiscernible: Speaker/Audio faint and unclear]

They give you a receipt?

We've got a person conversation about a receipt. I take it that's not a VR question. Any
questions relate today VR?

This is January freedman.

-- Jan.

You're giving us price tags on [ Audio feedback breaking into speaker's conversation. ]

Is there some kind of VR cap in most states?

No. No. By no means.

I was wondering what the significance was.

I'm doing it to be able to point out that these things can cost thousands of dollars. I think
it's a great question to ask. Certainly with VR, I'd say this is true with special
education, Medicaid, the only issue would be whether the price is reasonable based on
the need. For example, I said $10,000 for a power wheelchair, well depending on the
circumstances, it might be $20,000.
    It might be less. The ramp to get in and out of the house I priced 2500, Diane has
had cases where portable ramps have gone for $500, but gosh, depending on the
configuration of the things, number of steps, or some type of portable elevator device
could be much more expensive. You are going to find in your state policies probably,
they have some kind of caps or price lists. I think there's almost always an argument to
get around that as an barrier to a more expensive device.

Other VR questions before I move in to Medicaid?
Can you hear me?

I sure can.

One of the things that our VR agency did is they went with some kind of priority list for
certain kinds of things that they would pay for. Kinds of things they wouldn't pay for. I'm
thinking specifically the cost of self-employment. They were able to cap it. I'm not real
clear how they did that. But there's some authorization to allow them to go to some listing
priority of what they're going to spend their money on. Does that make any sense?

Yeah. Let me tell you the only thing they can prioritize. A state can lawfully have an
order of selection. A state can decide that it's only going to serve the severely disabled
folks and only go to the next lower categories of what they classify as less severe
disabilities after they serve the most severely disabled. I belief three quarters of the
states is what's in what's known as order of selection. However; once everybody gets
through the eligibility door. They're not blocked out through order of selection, they're
entitled to all reasonably necessary services in order to meet their approved vocational
goal. I don't think you're going to find anything in the federal law of regulations that
would support a state having a priority list on the types of things they'll fund or an
absolute cap on how much they'll pay for things. Again, I can expect there to be price
guidelines. In New York, there are certain services that have limits of what you can get
without a waiver, which means it goes to central office for approval. I think what you're
describing is not a lawful change by your VR agency. Maybe I'll take one more question
if there's one out there before we move to the next topic.



 This is Jim [ Indiscernible ] Georgia. VR related question regarding purchasing
equipment from a VR agency -- [ Indiscernible: Speaker/Audio faint and unclear] the
Americans with Disabilities Act, there's -- a lot of times there's a conflict because an
employer is not willing to purchase something. What's the standard resolution for that
sort of thing?

That's an excellent question Jim. I'm not sure I'm going be able to give you a di fintive
answer on that. I will say the ADA is a very fluid statute in terms of its enforceability. I'll
tell you what I mean by that. If a person needed let's say -- looking at my own office
here -- if a person needed a $50 modification to their desk, maybe it had to be Jacked
up a little bit. I don't think that would be a question of the employers obligation. It's
theem -- reasonable modification. It's a $50,000 change? Much tougher argument
because the ADA would have you look at the individual circumstances of the employer to
the courtroom whether it's reason -- to determine whether it's reasonable. I don't recall
seeing anything in the research about the interaction between the ADA and Title I of the
rehab act on these issues. Again, the problem is -- I think we can be fairly definitive of
what's available through VR agency funding, whereas, the ADA you can't say without
looking at the individual employer circumstances what's a reasonable accommodation
and what's not. If you want to follow up Jim with maybe an individual email, that might
highlight a particular case that you may be dealing with or have dealt with, we'd be happy
to follow up on that.

Okay. Yeah. I would. I may very well do that. I'm thinking specifically of people who
are blind or vision impaired or they may need additional computer equipment or
something like that that could be in to 1 to $5000 and it might very well be that a
company could possibly afford it. It would not be an undue burden as you find in the
ADA. If you push the company to that point by the VR agency, I think the [ Indiscernible:
Speaker/Audio faint and unclear. ]

Diana from my office wants to jump in with a comment.

The VR cases, I did notice a couple that showed an interplay between ADA or 504 as
applied against a university an what the university's obligation was to provide something
like interpreter services, etc. as opposed to the VR agency. If you want to email me, I can
find those cases. Maybe you can use those to either analogize what they would do
against an employer or find cases that deals specifically with the employer. The only
ones I can remember off the top of my sed deals with the -- colleges obligation to
provide services separate from the VR agency.

Great questions. Depending on how difficult your questions are, we may bring our
friends from the national disabilities rights network into the discussion. There are some
folks there that know the ADA and section 504 a little bit better than we do.

Let me now move into Medicaid for -- roughly on schedule here to what we could get
accomplished in this timeframe. I'm going to start by saying in general, Medicaid the
ends to be the most important funder of what we think of -- tends to be the most
important funder of assistive devices. That may not be true in a case like Sharons. Let
me start on page 20 by talking about eligibility. We could easily spend the whole day on
Medicaid. Certainly bare with me as we try to condense it for our purposes into maybe
15 minute discussion. In terms of eligibility as I mentioned before, for SSI recipients
Medicaid is going to be automatic in 39 states, District of Columbia and the knot earn
Mariannas -- northern Mariannas as well.

Optional needy spend down program for people with disabilities. That's available in about
two-thirds of the states. At my last count and this is another part of what I do here, the
Social Security SSI work incentives related work. The Medicaid buy in for people with
disabilities is now a program in 43 states. It's a way of becoming eligible for Medicaid if
it's with income that's -- not going to be able to talk about in any concrete way, can be a
potential source of eligibility and expanded eligibility for assistive technology in any
number of states for populations. In your last Medicaid slide there's a reference to a
newsletter we wrote on Medicaid waiver programs. Moving onto eligibility for AT. Let me
start by saying, no place in any of the Federal law or in any of the state Medicaid
regulations or policies that I know of, anyway, is the term assistive technology used.
There's any number of categories that Medicaid pays for that we think of as assistive
technology. The very first issue after eligibility is the item you are seeking has to fit
within a covered service. Mandatory services, optional services. Not going to try to
distinguish them for the purpose of this short discussion so much as to just give you
some examples. Durable medical equipment you're going to find in every state. There is
some debate about whether it's mandatory or optional. Arguments are very good that
it's a mandatory service. Seems to exist in every state. Maybe that's not critical. These
optional categories, physical therapy, occupational therapy, speech. They're entitled to
any necessary equipment. Prosthetic devices [ Indiscernible ] Some examples where
people have managed to convince Medicaidagencies to provide services.

Mandatory category of Medicaid if you will, for kids under the age of 21. We do have a
newsletter on this that Diana offered called Medicaid AT and kids. EPSDT mandates
that states cover all of the optional categories for kids. Keep in mind, that Sharon is
under 21, so as she gets into the Medicaid program atage 18, she will be EPSDT else
listeningable. -- eligible.

You've established someone is eligible an the device they're seeking fits within a covered
service, it has to be medically necessary. No federal definition of medical necessity,
you're going to have to look at state definitions of this. They might have variance from
state to state. From the federal statute, we know that services are supposed to be
available to help "attain or retain" the capacity or self-care. Distinguishes Medicaid from
Medicare that does not have the term independence in it. When we shift over to
EPSDT, arguably the standard gets more liberal because for kids under 21 they're
entitle to correct or ameal rate whatever their con -- ameliorate. Moving onto slide 23. I
apologize we're going through this so quick. This is as much about possibilities as what
in a very general sort of way goes in to planning for kids as they're coming out of public
schools. Sharon's ability for AT -- slide 23, we know that --

We know at age 18 Sharon is going be else listeningable for Medicaid in her -- eligibility
for Medicaid in her hypothetical state, which is New York. That's going be true for most
states as well. The power wheelchair an AAC device -- and ACC device should be a no-
brainer in terms of the potential availability in each state. The battles are probably going
to be in her case, is the power wheelchair the least costly alternative, could she get by
with a manual wheelchair? I don't think so given the scenario of her having to leave the
house to have to go to a university and so forth. AAC device, the battle could be
replacement rather than repair. I think under the facts given it's a 7-year-old device
constantly breaking down, hard to get parts. Seems to me she's going to win that battle.
But just be aware that on any of these items, there would be an individual battle with the
funding source. Now look specifically at some of the other AT Sharon is looking for on
slide 24. The ceiling track lift. I think it's fairly clear when you look at most state
definitions of durable medical equipment it's going to meet those definitions. Is there
aless costly equally effective alternative available? Often, the battleground for this
argument is can they get by with the cheaper high controllic lift or can -- high controllic
lift -- have done these battlings on individual cases and hearings. Moreen from the
souther disability center, now at a hearing where she's battling the state over coverage
of ceiling track lifts. I think she should be able to get it if she can show that in the long
run, it's both safer and probably eliminate for the personal care aid to help operate the
manual lift because her parent who's there all the time might not be able to operate it
without injury.

Again these are always going to be fact specific. The point is it should be available if the
facts are right. The access ramp. This is always a challenge to fund under most state
Medicaid programs. I don't know that it should be. When we've looked an measured
ramps against New York's durable medical equipment and other states are going to
have common definitions, it sure seems to meet the definition. Unless you can assume
there's no reason for a person to ever leave the house, remember the Medicaid statute
has the words end opinion dense in it -- independence in it, I would think we should be
breaking ground here on getting more and more ramps approved by Medicaid. Diana
has managed only very taking cases to court an settling to get boardable ramps
approved. The easier course of action is to find out whether your state has a Medicaid
waiver that your individual client or consumer might qualify for. Always look for the
closest port in the storm so to speak.

Moving onto slide 25. The laptop computer, if you are simply looking at a personal
computer type laptop, it's hard to make a medical connection to that. Most states are
going to have as part of their DME definition, it has to be something that's not generally
useful in the abseasons of illness or -- absence of illness or injury. Everybody seems to
have a computer these days. Dual device laptop could be the solution. I think that if
you're talking about traditional Medicaid you're probably going to have to show that dual
purpose device is no more expensive than the dedicated device. I'll bring up the
Medicaid waiver again. You might be able to get a laptop or a more expensive dual
purpose device through one of the Medicaid waiver programs if the right one exists in
your state. The van and the van modifications, I think that's pretty hard to get through
Medicaid. We had a case several years ago our client died before we could pursue what
we at least talked about as a potential case. Arguably, since transportation is a category
of service -- I think it's an optional category of service in the Medicaid program. If
transportation is available through Medicaid an they would ordinarily transport to and
from doctors, you might have an argument. I think you have a pretty rough road. I'll
leave to your reading the stuff on Medicaid waivers so that we can plow through things.

I'm going to open it up for any Medicaid-related questions now.

Remember again, you'll have to unmute your phone if it's muted.

  okay. I'm going to -- this is an area where we get frequent calls an emails for technical
assistance. I'm going to encourage you, if you have individual issues, that probably go
beyond the ability to answer them during this call anyway, to contact myself or Diane.
Her email is DSTRAUBE@NLS.ORG.
Now moving into Medicare. I'm on slide 27. You're going to see that Medicare is a bit
different from Medicaid.

In terms of eligibility, typically we associate it with persons 65 or holder, but for the type
of work we do, usually the common thread for eligibility is that the individual is receiving
Social Security disability insurance or SSDI. A 24 month waiting period if you are else
listeningable for your SSDI check. That 24 month period is waived in the case of
somebody with ALS. Persons receiving railroad retirement disability benefits also are
eligible for Medicare. Persons with end stage renal disease are eligible for Medicare
without any connection to the Social Security program. Keep in mind that I'm projecting
here that Sharon is going to be eligible for the SSDI program upon her graduation from
high school next June, June 2010. We could project that she would be eligible for
Medicare 24 months later in 2012, in June. Eligibility for AT. Like Medicaid you are not
going to see the words assistive technology in the Medicare act. It's regulations or
policies. Certainly many of the items that Medicare funds are things we might think of as
AT. Primary funding category for AT-like devices under Medicare is durable medical
equipmentment four part definition. That four part definition an I think we summarized it
in the article, what has driven the DME definitions? A lot of privaten shun policies and in
a lot of state Medicaid programs, but certainly in New York's definition is a little different.
Some items are going to be specifically excluded by statute or policy. Part B which
pays for durable medical equipment is optional an subject to a 96 dollars 46 cents
premium. It can be higher for people in cases with a fair amount of money. There's
typically going to be a 20% copayment when part B pays for manage. There is a --
something. There is a payment for the part B premiums if the person has limited enough
income. Medicare savings programs. QMB which is mentioned, qualified Medicare
beneficiaries program. I believe Sharon should be eligible for that when she gets on
Medicare because Federally, I believe the criteria for eligibility is set at 100% of the
federal poverty level which is 900 bucks around this year. Again, that's something that
the person who's assisting Sharon would have to help identify and figure out if she's
eligible for.
    Moving onto slide 29 and 30, we'll talk about what Medicare can do for her in terms of
the items of AT that we have identified. Power wheelchair. Clearly, power wheelchairs
are covered under the Medicare program. The problem is for anybody that's been
involved in this at all, statutorily, there is what we referred to as suitable for use in the
patient's home. I don't know if I quoted that directly. A couple of years ago, the federal
agency CMS enacted policy, the national coverage decision governing funding for what
they call mobility-related equipment. I forget the actual thing -- I don't have it here in my
notes. The real bug a buy with Medicare and wheelchairs, if you can qualify for one you
can use it in home an out of the home. In order to qualify for a power wheelchair under
Medicare, it has to be needed in the home itself. There's certainly a movement affront
either get the feds to change their policy or take the case into court. As we sit here today,
there's a real barrier for funding a power wheelchair for Sharon if she's able to move
around in her manual wheelchair.

AAC device, the good news since 2001 this is now a covered item under Medicare, a
category called speech generating device. The criteria is pretty good. If all Sharon is
looking for and we're projecting forward for and we're to 2012 when he becomes eligible
for Medicare, if all she's looking for is the standard speech generating device without the
dual function, can probably get it. Ceiling track lift. If we're having this conversation
back in 2008 when Ron and I most recently did some edits to the article, it was fairly
clear that all the Medicare contractors that deal with durable medical equipment and is
for them, what we know is local coverage decisions that precluded funding on track lifts,
there has been a change as a result of a case we worked on here out of New York to
the local coverage decision criteria. That's now in place for all the durable medical
equipment Medicare administrative contractors. If you need specific information or links
to where you can find that policy where it covers your state, send me an email after the
    The laptop, certainly standard lap top for personal computer you are not going to get
out of Medicare. It's not primarily and customarily used for a medical purpose. -- speak
to this much more intelligently and extensively than I can here. What the policy provides
is that you're not precluded to getting the device that was manufactured to be a dual
purpose device, but in order to be covered by Medicare and paid for through Medicare,
the personal computing functions must be disabled. That's a separate conversation
about what you can do but essentially you can buy a kit to unlock the personal
computing function. Van modifications we're not looking at Medicare as a place to pay
for those. Those are certainly not items that are going to be used in the home. The
access ramp -- is an access ramp an item for the use in the person's home? Fairly
difficult thing to get. I think it's going to be a real challenge and in Sharon's case, I think
we have some other funding sources based on her unique circumstances so we'll turn
the page on that one.

Let me open it up for maybe one or two questions if you have them about

This is Josh fromman BRS. I had a question about how would she qualify for SSDI?
She doesn't have a work history so would she only be eligible for SSI?

Not all transition students would be eligible for SSDI. It would be claiming off her father's
work record.


It's based on those unique circumstances.

Any other questions? That's a good one because it's going to play nicely into the next

This is Eileen in Delaware. I am wondering if there's any chance that the computer could
be purchased -- if it were being used with an environmental control system?

We're sticking with Medicare?
Yes. But with any but yes in particular.

Probably only after a -- when I say "we" I'm talking about the general A TNETwork. I've
-- AT network. That is certainly a device that I have seen funded under Medicaidware
med ire -- Medicaid waiver programs. There's a durable medical equipment list that's
published by CMS and you -- on that list there's items that are specifically included,
when they're funded. There's items when they are specifically excluded. I don't recall
environmental control devices being specifically addressed within way or the other.

It's a category of exclusion.

Is it Lou?


So it's a category of exclusion. If you thought it really did meet the definition of durable
medical equipment, you could prove it was medically necessary, that's a case that would
either have to involve a complaint to challenge the national coverage decision itself, or
an appeal probably into a court that would have jurisdiction to declare national coverage
decision was invalid.

Just to get a communication device, they all have environmental capability built into

That's what I thought.

Great point Lou. I just wanted to say, a lot of times -- I'm a lawyer, Lou's a lawyer, this is
not about smart lawyering so to speak. It's about looking for creative solutions.

Let me do this because I want people feeling free like they can get off this phone by my
watch in about 12 minutes. I'll stay on for further questions. The lastly talk about SSI's
plan about achieving self-support or PASS. Have a very extensive article on this that I
co-wrote with my colleague at Lopez.
   I have a link for 2003 version. It's not been published yet but it will be on Cornell
university's website. Their employment disability institute. I suspect within the next
month or so.

Just to give you the theoretical context for a PASS plan the SSI program is based on
financial need. In 2009, SSI checks are based on a benefit rate of 674. Some states
will have an optional supplement to that. New York does, for example, Texas doesn't.
California does. Pretty sure Florida doesn't. The example use willed be based on the
federal benefit rate of 674. The SSI regulations contain extensive lists of items that are
not to be counted as income or certain formulas for reducing income. The PASS is just
one of those income and resource exclusion devices if you will, to have income that
would otherwise not count.
   If, in fact, that income is supportable vocational goal, written in the PASS plan and
approved by the Social Security administration. Slide 32, I have a very small list of AT
that's potentially available with a PASS. There's a very comprehensive list on pages 27
and 28 of the longer article of all the things that appear in the SSI policy manual. Even
that is a representative list. [ Noise on the line. ]

Some of the things that might fit into our common understanding of AT might be
modifications to a home or office. A customized desk. A computer, whether or not -- if
it's AT, it height be customize -- it might be customized but it won't have to be. A
specialized keyboard, a hand screen. Software for a computer or other device. Screen
readers. [ Noise on the line. ]

Blindness or low vision. Dictation software. Vehicle modifications. Really just to name a
few. Importantly, a vehicle itself can be funded under a PASS plan. If you look at 33,
we're only going to get a very small snapshot of how this can work and how it can work
for Sharon. This has been one thing we have not been able to fund so far with any of
the sources we've discussed except for the vehicle itself. Like your VR agency,
individual plan for employment, the PASS has to be driven by a vocational goal. Sharon
is already saying she wants to be an torn. Like the rest of -- attorney. I'm not sure if she'll
change her mind before she's finished. What she's put forward to the RV agency an
what' she -- and what she's put forward in the PASS proposal. She wants to take 400 of
her Social Security disability check and save it monthly for the van. You might ask why
not 420, well the first 20 is disregarded by SSI anyway.

By the way, if she's not yet transferred over to Social Security disability insurance, we
can use the 400 survivors benefits that are not tied to disability. If approved a VR
agency will pay for the modifications while the PASS is going to support the purchase of
the van. So look at slide 34 and here is the way the budget's going to work. We're
going to assume that we're submitting this either right around Sharon's 18th birthday or
just afterward. When it gets submitted, she's going to be eligible for an SSI check for
Social Security. Probably automatic Medicaid in most states. Know with an approve --
now with an approved PASS. She looks like a good candidate to have PASS approved,
now in addition to disregarding or not accounting the $20 -- they're going to exclude the
$400 the the new SSI rate is the full federal benefit of 674 or since in this hypothetical
Sharon is from New York and she lives in the community with her folks. She's going to
get the 697 rate for New Yorks living with others category. Also retain that automatic

Now look at what Sharon's accomplished by getting this approved PASS. That's slide 35.
She's going to -- I'll trust you to do the multiplication, but she's going to save 19,000 for
the van over the period of time that she's saving throughout the remainder of her high
school senior year and a few years of college. She's going to leverage, I say 15,000 or
more from VR agency for modifications. I think we can easily make that 25,000 or more
for the modifications. Keep in mind those modifications are no good if she doesn't have
the vehicle. She keeps the same income for living expenses. You do the math, she had
694 or in her case since she's from New York, 717 come beaned before she --
combined before she submitted the PASS. 774 after the PASS is approved. More
money flowing is not continued by any of the federally subsidized housing programs.
This is written in the HUD regulations. Not counted by the food stamp program and
there may be some other needs-based programs as well where you can just discount
what specifically that's in PASS and targeted for these expenditures. I probably have
three or four minutes before we hit the 4:45 p.m. eastern time. Maybe we can entertain a
question or two on the PASS before there's more general questions that people want to

Anybody have a general question on the PAS,is that I didn't cover? While we're waiting
to see if you do, I just want to reference for your reading a second example on pages 29
and 30 on the larger article. I'm not going to attempt to really go through it. Keep in
mind the PASS can be used to set aside anything that would ordinarily count either to
eliminate somebody's eligibility for SSI or maybe [ Indiscernible: Speaker/Audio faint and
unclear] check.

What happens is when kids are less than 18, the parents are considered responsible
relatives. There's a formula, a deeming formula, that in many cases result in some of
that parent's income being counted as unearned income to the kid. That deemed income
could be used in a PASS. The other thing I want to mention is that I suspect most of the
people on the call are probably not going to get involved in writing PASS plans, though I
encourage you to. We can support you with technical assistance if you want to. Every
part of the con try you're going to have a work incentives program assistance project.
You could locate the project in your neck of the woods by going to the web side There's a state by state work directory. What I'm going to do since
we've certainly gotten our 90 minutes of CLE time in is I'm going to open it up to see if
there's any questions on any of these topics or something that you might fiend related --
find related. Certainly the folks that were staying onto get their CLE credit you don't have
to hang around for this part of it. Anybody want to pose any other questions?

This is Mike from Nebraska advocacy.

Hi Mike. I think we've exchanged emails.

Long time ago. I know that it's difficult in terms of getting Medicare to pay for computers,
but have you got any background in regard to Medicare picking up costs of software for
an existing computer?

I do not, Mike, and I think we -- you know what's interesting and I'm going to give you an
example of something. Medicaid might be a better example than Medicare. There's
more wiggle room to get things covered in Medicaid. There's some folks in Iowa who
have invented something that costs I'm going to say 4 or 500-dollars that can be used to
read prescription labels and provide voice output. I think there's an argument that that
could be durable medical equipment covered by Medicaid. I think it's much more difficult
with some of this stuff for Medicare. I use that as an example of really meeting medical
needs from new technology. I still think you're going to have to have a pretty concrete
connection to medical. It's going to have to get through that coverage door before you
get to medical necessity. I don't know. You can think of some software that could do
that, but I think it might be difficult.

Two things I wanted to note. One is that if you get service for I phones, I understand
there's an App. now that does voice sensitizing over the I phone. I think it does it for
icons. But that's a really inexpensive cool way to get a voice synthesizer. The other
thing I had wanted to say is I think your [ Indiscernible ] Standard is too low. We did a
ten day hearing here and the standard we were able to convince the hearing officer to
accept was much higher than that. It says that kids are entitled to all medically
necessary services to maximize -- to reduce their disability to the maximum extent
possible and to -- I'd have to look up the rest of the language. It was to reduce their
disabilities to the maximum extent possible that was so powerful in actually getting some
of the best services in the United States for the kid we were fighting for.

I think that's great. I assume your little acronym, EPSDT.

Certainly if you haven't, if what you're talking about has been reduce today writing, we'd
love to have a copy of it. Diana who left can speak a little bit more intelligently to the
EPSDT stuff but the newsletter stuff does have a case law that's out there. I applaud
you for urging what you just urged, even more liberal interpretation than maybe I was

I can give you the exact language now. It says kids are entitled to other screening
diagnostic screening preventative and rehabilitative services. The maximum reduction of
physical or mental disability of restoration to of the individual to the best possible
functional level. When you've got that kind of language in early periodic screening and
treatment it is one powerful level when people start saying we get to give them
something that's barely adequate or barely works. EPSD TGIFs you one of the highest
standards that I've come across in any statute on determining whether something is
medically necessary or not.

I apologize if I don't know what's in that Medicaid manual, it's great stuff.

We got the hearing officer to accept that. Nothing in there that defines medical
necessity as a term but there are a number of places where you are argue that this is
the definition of medical necessity. It's what's required for medical disability -- functional
level. He bought it.

Okay. Let me see. Couple more minutes. Other questions or feel free to jump in with
the comments since the formal presentation is over.
Okay. I think it's fairly tiring to sit through this kind of thing by telecon presence. I don't
blame people if they want to get off. I'm going to call it quits. I don't know Lisa, if you
have anything else that you wanted to mention?

I just wanted to say thank you for doing this for us. We appreciate it. We shared a lot of
great information.

I do have one question. At the beginning of the presentation you mentioned a
conference in October, bridges to better -- I missed the rest of it.

This is Veronica from Arizona.

For the PNA program.

If you talk to Ed Meyers in your office you can -- it's October 21st-23. Same hotel we've
been going to for a number of years. I'm hoping to have our first early bird registration
materials out on this in a week or so.


So whether or not you're on our list serve, by the way, anybody from the PNA network
can get on our LISTSERV. If you signed up for the CLE, we're going to hit you with our
promotional materials.


Okay. Thank you.

Thank again to RESNA for hosting this and those who need this CLE, Julie is going to
be sending those -- you need to register after the fact here if you need CLE.

All right. Thank you Jim.

Thanks Lisa.

All right. Take care.


Josh says: Thanks for the great event. Good bye.

[ Event Concluded ]

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