Medicaid and Persons with Disabilities

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Transcript Medicaid and Persons with Disabilities

Funding Work Related Assistive Technology for the Transition-Aged Special Education Student July 23, 2014

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Today’s Presenters

James R. Sheldon, Jr.,

Supervising Attorney National Assistive Technology Advocacy Project Neighborhood Legal Services, Buffalo, NY [email protected]

* 716-847-0650 ext. 262

Ronald M. Hager,

Senior Staff Attorney National Disability Rights Network Washington, D.C.

[email protected]

* 202-253-5252 2

CUEs

The RESNA Catalyst Project offers CEUs for this webinar session. The RESNA Catalyst Project is an approved authorized provider for CEU credits by the International Association for Continuing Education and Training (IACET). You can receive 0.1 CEUs for a sixty to ninety minute webinar. There is a $16 fee to receive credits for each webinar. To learn more about CEUs or to apply for CEUs from an archived webinar, contact Paul Galonsky, [email protected]

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Funding of AT to Support Work Webinar Series

• September 17, 2014 -

State Vocational Rehabilitation Agencies: Using VR Agency to Fund AT to Support a Work Goal

• October 22, 2014 –

Using SSI’s Plan for Achieving Self Support (PASS) to Fund AT to Support a Work Goal

• November 19, 2014 -

A Review of Lesser Known Funding Sources and Funding Strategies for Work Related AT

• December 10, 2014-

Using Traditional Medicaid and Medicaid Waivers to Fund Assistive Technology to Support Work

All sessions 2:00 to 3:15p.m. Eastern & sessions will be archived at http://www.resnaprojects.org/statewide/webedarchive.html

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Services of the National AT Advocacy Project A Technical Assistance and Training Project

• Call or email speakers for technical assistance • Any topic covered in the webinars • Any issue related to funding of AT • We can assist you in thinking through funding issues and appeals

Additional materials available on most topics

• Contact us for copies and/or links.

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Purpose of Webinar Series

Barriers to Funding AT to Support Work

• It can be expensive.

• Individuals and service providers may not be familiar with funding sources and funding criteria.

Will discuss funding sources, funding criteria:

• Most common funders – Medicaid, special education, vocational rehabilitation • Less common funding sources • Special rules within programs that support funding for work, education, training.

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Format for Today’s Session

• Walk through power point (on screen, received via email) • Participants can post questions in question or chat box.

• Will attempt to address questions during presentation.

• Follow up questions can be emailed to presenters.

• Contact presenters for more resources on any of the content.

• Additional resources-This ppt and additional documents will be posted at http://www.resnaprojects.org/statewide/webedarchive.ht

ml – Using Your States General Curriculum Mandates to Fund AT – Funding of AT through Special Education Programs 7

Purpose of this Session

• The IDEA is key AT funding source • What are the criteria for obtaining AT under the IDEA • How can IDEA transition requirements be used – to ensure students with disabilities have the AT they need – to prepare them to enter integrated employment, – either with or without additional education or training.

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Use of AT to Prepare for Work

• The School to Sheltered Workshop Pipeline • Schools tend to use one-size-fits-all approach in transition employment preparation programs • For students with significant disabilities these tend to be segregated • Would AT make integrated programs more viable?

• Webinar-A Brain in the Palm of your Hand: http://www.resnaprojects.org/statewide/webedar chive.html

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Examples of IDEA Funded AT to Support Work

• Speech Generating Devices • Computer/tablet based academic assistance – Text to speech software – Speech to text software – Screen enhancement/adaptation software • Computer Assisted Real-time Captioning (CART) • Tape recorder/MP3 recorder • Smartphone/tablet applications for memory, organization, video recording 10

Special Education Introduction

• Have an enumerated disability and require special education services • Special education and related services • Services pursuant to Individualized Education Plan (IEP) • Services must ensure free appropriate public education(FAPE) • Education in least restrictive environment (LRE) 11

FAPE

• United States Supreme Court: does not mean District required to “maximize” student’s potential or provide best education possible.

Rowley.

• Program must be designed to meet unique, individual needs of student and to enable progress.

• Schools not relieved of FAPE obligation even though student advancing from grade to grade.

• Must also ensure access to general curriculum.

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Functional Performance

• “Adversely affects educational performance” not limited to academic performance.

• IEP Team must consider academic, developmental, and functional needs of child, including – socialization, – independent living, – and orientation and mobility.

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AT Under the IDEA

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General Standard

• AT devices and services must be made available, as required, as: – Special education – Related services – Supplemental aids and services for LRE • Basic standard—needed for FAPE – To receive educational benefit – To participate in the general curriculum – To support transition from school to work 15

AT Device

• Any item, piece of equipment, or product system • Whether acquired commercially off the shelf, modified, or customized • Used to increase, maintain, or improve functional capabilities • Does not include medical device that is surgically implanted, or replacement of such device 16

AT Device

• Definition taken from the AT Act • Legislative history indicates broad range of AT devices contemplated: – Broad definition to provide maximum flexibility to address varying needs – To make clear simple adaptations included as are low and high technology items – Includes software.

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Personal Devices

• Generally, school not responsible for personal devices, such as eyeglasses or hearing aids, required regardless of whether attending school • However, if IEP Team determines required to receive FAPE, must be provided at no cost • Eyeglasses, hearing aids and wheelchairs have all been mentioned as examples of items that can be funded to ensure FAPE 18

AT Device Example

• Sam is a16 year-old student with TBI • Takes medication and has poor short-term memory, distractibility and organizational problems • Needs reminders for medication, needs a calendar for appointments, needs visualization and reinforcement to learn new tasks • Use of an iPod to meet these needs – Medication reminder apps – Calendar apps for appointments – Alarms for when to switch tasks – Can video record step-by-step directions for new tasks 19

AT Service

• Definition taken from AT Act • Selection, acquisition or use of AT device • Evaluation • Purchasing, leasing or otherwise acquiring • Selecting, designing, customizing, adapting • Maintaining, repairing or replacing • Coordinating and using other services • Training to child, family and those working with child 20

AT Service Example

• Jenny is a 17 year-old student with a spinal cord injury • Uses a wheelchair, but with limited hand mobility cannot use traditional joy stick • Medicaid funded wheel chair with head array, allowing her to operate by moving head to activate pads • Will need extensive training to maneuver smoothly in school and community, including job internships 21

IEP Special Factors

• For child who is blind or visually impaired, provide instruction in Braille and use of Braille • Unless IEP Team determines, after evaluation of child's current and future needs that instruction in Braille or use of Braille is not appropriate 22

IEP Special Factors

• Consider communication needs of child • In case of child who is deaf or hard of hearing, consider – child's language and communication needs – opportunities for direct communications with peers and professional personnel in child's language and communication mode – academic level, and full range of needs, including opportunities for direct instruction in child's language and communication mode 23

IEP Special Factors

• For all students, consider whether student needs AT devices and services • If the school purchases the AT, it is the property of the school, which can have implications for transition • If Medicaid or another funding source purchases the AT, it is the property of the student 24

AT Evaluations

• Providing appropriate AT begins with a good, comprehensive assessment.

• Parent has right to independent AT evaluation, at District expense – if parent disagrees with the evaluation obtained by the District, – and District fails to show that its evaluations were appropriate 25

IEP Implementation

• To support implementation of AT, definition of AT services includes training for student, staff and family • Supreme Court noted schools "cannot limit educational access simply by pointing to the limitations of existing staff.“ • "IDEA requires school districts to hire specially trained personnel to meet disabled student needs."

Cedar Rapids Community Sch. Dist. v. Garret F.

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Home Use

• Schools may be responsible for providing AT in the home, or in other settings, if IEP Team determines student will need the AT in that setting to receive a FAPE.

• Example given by Department of Education was closed circuit TV for student who is blind and needs device at home to complete homework.

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LRE and AT

• LRE requirement--removal from regular education classes occurs only when student cannot be successfully educated in that setting even with supplemental aids and services.

• In 1990 Congress noted that advances in AT have provided new opportunities for students with disabilities to participate in educational programs.

• For many, provision of AT “will redefine an ‘appropriate placement in the least restrictive environment’ and allow greater independence and productivity.

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Transition Overview

• Schools must develop a long range plan to prepare students for life after school • Schools begin to make connections with adult service providers while students still in school • Schools may look to others, such as vocational rehabilitation (VR), to begin providing services • States must develop interagency agreements for transition implementation 29

Transition Services

• Definition: – Coordinated set of activities – Designed within a results-oriented process – Facilitates movement to post-school activities • Live, learn, work and play • Based on student’s needs, preferences and interests • OSEP—LER applies to transition programs, including work preparation 30

Transition Services

• Yankton School District v. Schramm

– Student with orthopedic impairment desiring to attend college – Driver’s education – Self-advocacy – Independent living skills • Cooking • cleaning 31

Developing Transition IEP

• Begins no later than year student turns 16 • May begin earlier where nature of disability may require more time to develop essential skills • May begin earlier for students at risk of dropping out – Consider curricular modifications to reduce risk of dropping out 32

Developing Transition IEP

• Based upon age appropriate transition assessments related to: – Training – Education – Employment – Independent living skills, where appropriate • Develop measurable goals • Identify services to meet goals 33

Developing Transition IEP

• Must invite student • If student does not attend, must take other steps to get student input • Must invite agencies with likely responsibility to provide or pay for transition services • If agency does not attend, must take other steps to obtain agency input 34

Transition and AT

• Sam is a16 year-old student with TBI • Takes medication and has poor short-term memory, distractibility and organizational problems • Needs reminders for medication, needs a calendar for appointments, needs visualization and reinforcement to learn new tasks • Use of an iPod to meet these needs – Medication reminder apps – Calendar apps for appointments – Alarms for when to switch tasks – Can video record step-by-step directions for new tasks 35

Transition and AT

• Can the school fund the device under IDEA?

• Can the school fund the needed services under the IDEA?

• What, if anything, should be the vocational rehabilitation agency’s role?

• Anything different for Jenny’s need for training on using her wheelchair?

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Transition and AT

• VR may and should participate in transition planning meetings with school • If graduating student clearly will need the AT device – for educational, training or employment purposes, – it’s reasonable to have VR agency purchase device in first instance or purchase it from school when student graduates 37

Transition and AT

• The need for the device – would continue to be reflected in the IEP, – with reference to the VR agency as payer (or purchaser upon transfer).

• AT device would also appear in the VR individualized plan for employment (IPE) • Which must be developed by the VR agency before the child finishes school.

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Transition and AT

• U.S. Department of Education indicated – permissible for a school district to transfer AT, costing more than $5,000, to state VR agency if it will no longer need device for other students, – assuming device modified for individual student and, therefore, no longer needed by district when student graduates – for devices costing less than $5,000 district could transfer device to VR whether or not it needed for other students

OSEP Policy Letter to S. Goodman

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Thank you!

Please use your chat box to ask questions

James R. Sheldon, Jr., Supervising Attorney [email protected]

* 716-847-0650 ext. 262 Ronald M. Hager, Senior Staff Attorney National Disability Rights Network [email protected]

* 202-253-5252 40