Neighborhood Legal Services, Inc.

Newsletter of the
Assistive Technology Project
 Providing supportive services for Assistive Technology advocacy in New York State

Supported by NYS Office Advocate for Persons with Disabilities, TRAID Project, a Project
Funded by The National Institute on Disability and Rehabilitation Research, U.S. Department of Education.
Copyright 1995-2001, Neighborhood Legal Services, Inc.

IMPACT

To move to an Issue click on the Volume and Issue line

Volume X Summer 2007 - Winter 2007

Volume X, Issue 2 (Fall 2007)

CONSUMER RIGHTS IN THE MEDICAID PROGRAM

The Due Process Protections Available to Recipients in the Prior Approval and Appeals Processes for Durable Medical Equipment

Background: What is Due Process?
The Item Must Meet the Definition of DME
The Requested DME Must be Medically Necessary
De-mystifying the Prior Approval Process
The Requested DME Must be the Least Costly, Equally Effective Alternative
Obligations and Responsibilities of the Medicaid Agency
The Medicaid Agency’s Prior Approval Determination
The Administrative Fair Hearing
Possible Due Process Violations
SPECIAL FEATURES
Using Medicaid Coverage Categories Other Than DME to Fund Specialized Equipment
Our AT Advocacy Project Has Successfully Appealed More Than Twenty Unfavorable Hearing Decisions
Due Process Violations Are Often Cited In Fair Hearing Decision

Volume X, Issue 1 (Summer 2007)

The Department of Veterans Affairs As a Funding Source for Assistive Technology

What is the VA?
Who Qualifies for VA Services?
AT as a Medical Service for Qualified Veterans
Definition of Needed “Care”
Specific Items of Available AT
I. Durable Medical Equipment and Prosthetic and Similar Appliances, In General
II. Specific Devices
III. Training in the Use of Appliances
IV. Acquisition of Housing with Special Features or Adaptations to Current Residence
\V. Home Improvements and Structural Alterations (HISA)
VI. Clothing Allowance
VII. AT and Vocational Rehabilitation
The Right to Appeal a VA Decision
Re-Opening Claims and Requests for Revision
SPECIAL FEATURES
Bridges to Better Advocacy Handouts Available
Veterans’ Benefits Guidebooks and Other References for the VA Advocate
Veterans’ Service Organizations
VA Civilian, Health and Medical Program (CHAMPVA)
TRICARE: AT-Related Benefits for Some Active Duty Personnel, Retirees, and Family Members

 

Volume IX: Winter 2005

Volume IX, Issue 1 (Winter 2005)

PREPARING LETTERS OF MEDICAL JUSTIFICATION

Who Will Review the Letter or Report?
Establishing the Professional Appearance of the Report
Getting Started: Five Key Principles for Writing Letters of Medical Justification
Consider the Funding Source and the Criteria It Will Follow
Using Medicaid Coverage Categories
Other Than DME to Fund Specialized Equipment
Drafting the Report
SPECIAL FEATURES
What if your Patient Only Has Private Insurance?
How does Medicare’s Definition of DME Differ Compared to Medicaid?
Protection and Advocacy for Beneficiaries of Social Security Benefits
Section 1619(b) - Continued Medicaid for Wage Earners
Sample Letter of Medical Justification

To view in PDF format  Click Here


Volume VIII: Fall 2005

Volume VIII, Issue 1 (Fall 2005)

USING MEDICAID TO FUND ASSISTIVE TECHNOLOGY

ADMINISTRATION OF MEDICAID
SSI AND WELFARE RECIPIENTS QUALIFY FOR MEDICAID AUTOMATICALLY
  ALL OTHERS MUST SUBMIT A MEDICAID APPLICATION
THE MEDICAID BUY-IN FOR WORKING PEOPLE WITH DISABILITIESMEDICAID FUNDING OF DURABLE MEDICAL EQUIPMENT
THE PRIOR APPROVAL PROCESS
WHAT IF A MEDICAID APPLICATION OR A REQUEST FOR DME IS DENIED?
OTHER FEATURES:
IMPACT IS BACK!
FAIR HEARING DECISIONS OPEN DOOR FOR MEDICAID FUNDING OF THERAPEUTIC
TRICYCLES, POWER ASSIST WHEELS, AND STOCKTON BEDS
AT COURT WATCH

To view in PDF format  Click Here


Volume VII: Spring 2002 - Winter 2002

Volume VII, Issue 1 (Spring/Summer 2002)

SSI'S PLAN FOR ACHIEVING SELF SUPPORT

WHAT IS SSI?
WHAT IS A PASS? HOW DOES IT WORK?
CRITERIA FOR PASS APPROVAL
WHAT ITEMS CAN BE FUNDED WITH A PASS?
TIME LIMITS FOR THE PASS
AN APPROVED PASS CAN BE AMENDED
USING THE PASS TO GAIN ACCESS TO 1619(b) MEDICAID
LAWS, REGULATIONS AND POLICIES GOVERNING THE PASS
Other FEATURES:
AT COURT WATCH
New York Court Orders Medicaid to Pay for a Standing Power Wheelchair
Medicaid Agency Agrees, in Settling Lawsuit, to Allow Fair Hearings to Challenge Agency’s Decision That Equipment Falls Under an MRA CodE
SSA’S PASS CADRES
PASS Specialists in Buffalo and New York City Are Responsible for All PASS Proposals
THE PASS AND MEDICAID
THE PASS AND CHILDREN UNDER 18

Volume VI: Spring 2001 - Winter 2001

Volume VI, Issue 4 (Winter 2001)

Individuals with disabilities can retain Medicaid or Medicare while working

Retaining Medicaid While Working
What Is Medicaid?
Former SSI Beneficiaries Can
Retain Medicaid Through the 1619(b) Program
Work and the Medicaid Spend Down Program
The Medicaid Buy-In Program: Available in April 2003
Former SSDI Beneficiaries can Retain Medicare While Working
What is Medicare?
The Extended Medicare Provision
The State Work Incentives Support Center
AT COURT WATCH
ADMINISTRATIVE HEARINGS
Protection and Advocacy for Beneficiaries of Social Security Benefits
Benefits Planning, Assistance & Outreach Projects in New York

Volume VI, Issue 3 (Fall 2001)

VESID AND THE COMMISSION FOR THE BLIND:
Using our State's Vocational Rehabilitation Agencies to Fund Assistive Technology

VESID and the Commission for the Blind
Basic Eligibility Criteria
The Individidualized Plan for Employment
Available Services
Financial Need Criteria
Maximization of Employment
Comparable Services Requirement
Appeal and Hearing Rights
Client Assistance Program
Law and Policy Governing VESID and CBVH
Medicaid Buy-In; a Reality for 2003
Benefits Planning Assistance & Outreach Centers in New York

Volume VI, Issue 2 (Summer 2001)

MEDICARE POLICY CHANGE WILL ALLOW FUNDING
OF AAC DEVICES

MEDICARE: THE BASICS
ELIGIBILITY FOR AT THROUGH MEDICARE
THE HISTORICAL BARRIER TO AAC DEVICE COVERAGE: NCD 60-9
POLICY CHANGES ISSUED BY HCFA AND THE DMERCs
    Approval Criteria Under NCD 60-23 and the DMERCs’ Policy
    Medicare Drops The Computer-Based Device Exclusion
APPEALING MEDICARE DECISIONS
Special Features
A NAME CHANGE FOR HCFA
2001 MEDICARE PREMIUMS AND DEDUCTIBLES
THE RERC WEBSITE
CHANGES IN MEDICARE LAW AND POLICY WILL BENEFIT PERSONS WITH ALS

Volume VI, Issue 1 (Spring 2001)

MEDICAID PART II: PRIOR APPROVAL OF ASSISTIVE TECHNOLOGY, FAIR HEARINGS AND COURT APPEALS

MEDICAID COVERAGE OF DME:
A THREE-PART TEST
MEETING THE DEFINITION OF DME
THE MEDICAL NECESSITY TEST
ESTABLISHING "LEAST COSTLY ALTERNATIVE"
THE PRIOR APPROVAL PROCESS
THE FAIR HEARING
WHAT IF YOU LOSE A HEARING?
AT COURT WATCH
2001 MEDCAID INCOME AND RESOURCES LIMITS FOR PERSONS WITH DISABILITIES
FAIR HEARING DECISIONS OPEN DOOR FOR MEDICAID
FUNDING OF POWER SCOOTERS

Volume V: Summer 1999 - Summer 2000

Volume V, Issue 1 (Summer 1999)

SSI AND THE FAMILY LAW ATTORNEY

SSI: a source of cash benefits;
A way to qualify for medicaid
Application of ssi rules to money received as alimony, Child support, or a property settlement
SSI income rules
SSI resource rules
Famiy law issues
Child support payments and the child support standards act of 1989
Alimony or maintenance for the adult spouse
division of property
Options for settlement for child with disabiity
Options for settlement for adult with disability

Volume V, Issue 2 (Fall 1999)

OUR PRO BONO REFERRAL PROJECT: HELPING US EXPAND SERVICES WITH A LIMITED BUDGET

What is a pro bono project?
Legal services programs; the private attorney involvement mandate
Description of our pro bono project
Medicaid appeals of at-related cases are a natural for pro bono project
Our volunteers: big firms, small firms and invidual practitioners
Marge gustas, our project coordinator
Case evaluation & referral to a pro bono attorney
Technical assistance to attorneys
Extent of volunteer’s committment
Highlights of the pro bono project 95-99
special features
Ticket to work and work incentives improvement act of 1999
Publications available on social security & ssi work incentives

Volume V, Issue 3 (Winter/Spring 2000)

Medicare and Managed Care: the Application and Appeals Process

Managed care options: traditional
Managed care and the new, medicare+choice plans
Medicare’s approval process for at dev ices: easier to negotiate under managed care
Medicare at device claims:
Required documentation
Medicare decision making and appeals process
Step 1: Initial Decision.
Step 2: Reconsideration
Step 3: Administrative Law Judge Hearing
Step 4: Departmental appeal board
Step 5: Judicial review
special features
HCFA decision will make it easier to get medicare approval for aac devices
Decisions of interest

Volume V, Issue 4 (Summer 2000)

Medicaid Part I: Overview of Eligibility Criteria; Special Disability-Related Provisions

Administration of medicaid
SSI and welfare recipients qualify for medicaid
   automatically
All others seeking medicaid must submit an
   application
Categorical eligibility
Financial eligibility
Verification of eligibility is the applicant’s
   responsibility.
Medicaid must provide written notice of its
   determination
Medicaid appeals: the fair hearing process
Special Medicaid rules for persons with disabilities
Automatic Medicaid for former SSI recipients
Special deductions from income and resources
special features
Hearing decision awards medicaid funding for two key
   items

Volume IV: September/October 1998 - March/April 1999

Volume IV, Issue 1 (September/October 1998)

AUGMENTATIVE COMMUNICATION DEVICES: A DISCUSSION OF SEVERAL POTENTIAL FUNDING SOURCES

General guidelines for submitting a funding request
Medicaid
Medicare
Four hearing decisions have approved medicare funding
Medicare appeals should be encouraged
Private insurance
Special education programs
Preschool special education
New York’s early intervention program
The physically handicapped children’s program
Vesid and the commission for the blind
Ssi’s plan for achieving self support
special features
the 1619-b medicaid program
administrative hearings

Volume IV, Issue 2 (November/December 1998)

1998 Rehabilitation Act Amendments:
greater role for VESID and CBVH Consumers


Basic eligibility criteria
The individualized plan for employment
Rehab ‘98 revolutionizes informed choice
Individualilzed plan for employment
Available services
Comparable services requirement
Purchase of AT for special education students in Transition: who pays?
AT for the college student: who pays?
Appeal and hearing rights
Mediation
Impartial hearing
Administrative review
Court appeals
special features
AT court watch

Volume IV, Issue 3 (January/February 1999)

The SSDI and SSI WORK INCENTIVES: FUNDING ASSISTIVE TECHNOLOGY
TO MAKE WORK A REALITY


THE SSDI AND SSI WORK INCENTIVES: FUNDING
ASSISTIVE TECHNOLOGY TO MAKE WORK A REALITY
SSDI and SSI; Medicare and Medicaid : The Basics
SSDI and Medicare WorkIncentives
The $500 Substantial Gainful Activity Rule
Reducing Wages Below $500 Through IRWE’s
Extended Medicare Coverage When A Person Loses SSDI
SSI and Medicaid Work Incentives
SSI Applicants: The Limited Application of the $500 Rule
SSI Applicants: The Use of IRWEs When Calculating Amount of the SSI check
Blind Work Expenses
1619(b) Medicaid
SSI’s Plan for Achieving Self Support
SPECIAL FEATURES:
NYS SSI Benefit Levels
SSA’s Proposed Regulation Would Increase SGA
Work Incentives Improvement Act of 1999
NYS Dept. of Labor Demonstration Project
Reference Materials on SSDI/SSI Work Incentives

Volume IV, Issue 4 (March/April 1999)

The Federal Special Education Regulations of 1999 Provision of a Free Appropriate Public Education

When does the right to special education services end
Definition of disability
Scope of special education services
The right to summer school services
A family’s use of private insurance
The choice of educational methodology
Comprehensive system of personnel development
Assistive technology
Least restrictive environment
Individualized education program development
Private school placements
The right to continued services when an appeal is filed
AT in the courts

Volume III: September/October 1997 - July/August 1998

Volume III, Issue 1 (September/October 1997)

SPECIAL EDUCATION AMENDMENTS OF 1997; MORE SERVICES FOR CHILDREN, GREATER ROLE FOR PARENTS AND INCREASED RELIANCE ON AT

Definition of Appropriate Education
IEP Development
Evaluations
IEP Content
Least Restrictive Environment
Assistive Technology
Policy Letters
Private School Placements
Mediation
Attorney's Fees
Student Discipline
SPECIAL FEATURES
Vocational Rehabilitation Update
Administrative Hearings

Volume III, Issue 2 (November/December 1997)

PRIVATE INSURANCE CONTRACTS, PART I

Will Insurance Pay for AT? A 3-Step analysis
Obtain the Actual Insurance Contract
Who is Covered? Rights & Limitations
Waiting periods, preexisting conditions & coverage of adult children
Kennedy-Kassenbaum law of 1997
Right to continued coverage after lay off or job termination
special features
SSA issues new policies governing pass
Administrative Hearings

Volume III, Issue 3 (January/February 1998)

PRIVATE INSURANCE CONTRACTS, PART II

Is the AT device covered by the policy?
Is the AT Device Medically Necessary?
What if the Policy's Language is unclear?
Appeal Rights
Appeals Directly to Insurance Co.
Court Appeals
Filing a Complaint with the State Insurance Department.
The impact of ERISA
The Americans with Disabilities Act
Administrative Hearings
AT and the Courts
New SSI Rates for 1998

Volume III, Issue 4 (March/April 1998) 

REPORT WRITING: JUSTIFYING THE NEED FOR AT

Establishing Integrity of the Report
Five key principles of report writing
Consider the funding source
Drafting the report
Administrative Hearings:
Sometimes a Letter of Justification becomes the Basis for the Decision

Volume III, Issue 5 (May/June 1998)

The Internet as a Tool for AT Advocacy

What is the Internet? A Web Page?
Four Ways of Reaching Web Pages
Typing a Known Web Address
Searching by Key Words or Phrases
Using Bookmarks
Using Links Already Created
Using our Web Page & Links
The VESID Issue
special features
Important WEb Sites
AT Court Watch

Volume III, Issue 6 (July/August 1998)

The NY assistive technology project: where are we after three years?

What we set out to do
Where we are are now
Direct Advocacy
Indirect Advocacy
Clearinghouse for Information
Referral List free legal Assistance:
Our Pro bono referral Project
The impact newsletter
Maximizing Use of Computer Technology
Our Web Page
Where does the at advocacy project go from here
The uncertainty of future funding
Continuation of Core Services
Expanding Pro Bono Referral Proj.
special features
What is assistive technology

Volume II: September/October 1996 - September/October 1997

Volume II, Issue 1 (September/October 1996)

The Dept. of Veterans Affairs as a Funding Source

What is the VA?
Who Qualifies for VA Services?
AT as a Medical Service for Qualified Veterans
Specific Items of AT Available
The Right to Appeal a VA Decision
Law & Regulations Governing VA Actions
Veterans Service Organizations
Guidebooks & Other References
Administrative Hearings
Avoiding Medicaid Fair Hearing Remands
Acknowledgments
New York's Motorized Wheelchair Lemon Law

Volume II, Issue 2 (November/December 1996)

AT through NY's Early Intervention Program

What is the Early Intervention Program
The Application Process Begins with a Referral
The Service Coordinator
Specific Services Available
Assistive Technology
The Evaluation
Devloping the IFSP
The Transition Plan
The Right to Appeal
Mediation
The Impartial Hearing
Attorney's Fees
System Complaints
Law and Regulations
Administrative Hearings

Volume II, Issue 3 (January/February 1997)

USING SSI AND ITS INCOME & RESOURCE RULES TO LEVERAGE MONEY FOR AT

What is SSI?
SSI Recipients are Automatically Eligible for Medicaid & for VESID and CBVH Services Tied to Financial Need
Using SSI to Obtain Medicaid
Using SSI to Obtain Eligibility for VESID or CBVH Srvs
Retaining SSI Eligibility
Parental Income & Children under 18
The Generous Relative
The Community Fundraiser
Using SSI's Income & Resource Rules to Leverage Money for AT
Child Support for Children
Matrimonial Settlements for Adults
Impairment Related Work Expenses
Blind Work Expenses
SPECIAL FEATURES:
NYS Benefits Assistance Levels
Parent to Child Deeming Break-Even Points
New Web Page
Regulations

Volume II, Issue 4 (March/April 1997)

Charities- Don't Overlook them as a Funding Source for AT

Final Vocational Rehabilitation Regulations Appear in Federal Register
Tax Tips for Individuals or Families who Must Purchase Assistive Technology
SPECIAL FEATURES:
New Additions to our Web Page
Administrative Hearings
Charity Criteria
AT Court Watch

Volume II, Issue 5 (May/June 1997)

SSI's PASS: Where do Things Stand After 1996 Changes to Policy & Procedure?

What is a PASS? How Does it Work?
Criteria for PASS Approval
What Items Can be Funded with a PASS?
Time Limits for the PASS
An Approved PASS Can be Amended
Summary of Changes in April 1996 POMS
SPECIAL FEATURES:
Law, Regulation, Policy Governing the PASS
Fair Hearings I
VESID's Obligation to Purchase Vehicles underNew Federal Regs: Part II
Fair Hearings II
1996 State Policy Allowing Schools to Transfer AT upon Graduation
Section 1619(b) Medicaid:

Volume II, Issue 6 (July/August 1997)

MEDICARE & AT: A MAJOR FUNDING SOURCE FOR BOTH YOUNG AND OLDER ADULTS

What is Medicare?
Medicare Eligibility
What is Excluded?
What is Covered?
Processing Medicare Claims for AT
New York State DMERC
Medicare Funding of ACDs
Medicare Appeals
Special features:
Conference Announcement
Administrative Hearings I
Administrative Hearings II

Volume I: October 1995 - August 1996

Volume I, Issue 1 (October 1995)

NEIGHBORHOOD LEGAL SERVICES ESTABLISHES ASSISTIVE TECHNOLOGY ADVOCACY PROJECT

Welcome to our Readers
Neighborhood Legal Services Awarded AT Advocacy Grant
What is Assistive Technology?
Services available through the AT grant?
Purpose of Future Newsletters
When to Call the AT Advocacy Project?
What can You do?

Volume I, Issue 5 (February 1996)

SSI's PASS: EXTRA MONEY TO PURCHASE ASSISTIVE TECHNOLOGY

How the PASS Works
Criteria for PASS Approval
What Items can be Funded with a PASS?
An Approved PASS can be Amended
1996 Conferences

Volume I, Issue 6 (March 1996)

VOCATIONAL REHABILITATION AGENCIES:USING VR DOLLAR$ TO FUND ASSISTIVE TECHNOLOGY

Basic Eligibility Criteria
The Individual Written Rehabilitation Plan
Available Services & Financial Need Criteria
The Need to Seek Funding from Other Sources
Appeal and Hearing Rights
Client Assistance Program
Law & Policy Governing V Agencies

Volume I, Issue 7 (April 1996)

OBTAINING ASSISTIVE TECHNOLOGY THROUGH THE PUBLIC SCHOOLS

Special Education Law: The Basics
AT in the Schools _ What Is it?
How to Obtain AT from the Special Education System
Appeals
Section 504 of the Rehabilitation Act
Obtaining AT under Section 504

Volume I, Issue 8 (May 1996)

THE PHYSICALLY HANDICAPPED CHILDREN'S PROGRAM

Administration of the PHCP
Law, Regulation and Policy Governing the PHCP
PHCP Eligibility Criteria
Services & Equipment Available Through the PHCP
PHCP Appeals
The Colson Decision
The Article 78 Court Appeal

Volume I, Issue 9 (June 1996)

ASSISTIVE TECHNOLOGY: NOT JUST WHEELCHAIRS

Introduction
Expand Your Definition of AT
Case Histories

Volume I, Issue 10 (July/August 1996)

WHERE TO FIND AT CASES & ISSUES; THEY MAY BE RIGHT IN FRONT OF YOU

AT Issues: Some May Be Right in Front of You
Where Do Potential Issues Hide?
When Does the Need for AT Become A Legal Issue?
AT in the Courts:
Ralabate v.. Wing
Administrative Hearings
Matter of Helen S.

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