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317:40-5-100. Assistive technology devices and services

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Revised 6-25-09

(a) Applicability. The rules in this Section apply to assistive technology (AT) services and devices authorized by the Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services Division (DDSD) through Home and Community Based Services (HCBS) Waivers.

(b) General information.

(1) AT devices include the purchase, rental, customization, maintenance, and repair of devices, controls, and appliances. AT devices include:

(A) visual alarms;
(B) telecommunication devices (TDDS);
(C) telephone amplifying devices;
(D) other devices for protection of health and safety of members who are deaf or hard of hearing;
(E) tape recorders;
(F) talking calculators;
(G) specialized lamps;
(H) magnifiers;
(I) braille writers;
(J) braille paper;
(K) talking computerized devices;
(L) other devices for protection of health and safety of members who are blind or visually impaired;
(M) augmentative and alternative communication devices including language board and electronic communication devices;
(N) competence based cause and effect systems such as switches;
(O) mobility and positioning devices including:

(i) wheelchairs;
(ii) travel chairs;
(iii) walkers;
(iv) positioning systems;
(v) ramps;
(vi) seating systems;
(vii) standers;
(viii) lifts;
(ix) bathing equipment;
(x) specialized beds;
(xi) specialized chairs; and

(P) orthotic and prosthetic devices, including:

(i) braces;

(ii) prescribed modified shoes;
(iii) splints; and

(Q) environmental controls or devices;
(R) items necessary for life support and devices necessary for the proper functioning of such items, including durable and non-durable medical equipment not available through SoonerCare.

(2) AT services include:

(A) sign language interpreter services for members who are deaf;
(B) reader services;
(C) auxiliary aids;
(D) training the member and provider in the use and maintenance of equipment and auxiliary aids;
(E) repair of AT devices; and
(F) evaluation of the AT needs of a member.

(3) AT devices and services must be included in the member's Individual Plan (IP) and arrangements for this HCBS service must be made through the member's case manager.
(4) AT devices are provided by vendors with a Durable Medical Equipment (DME) contract with the Oklahoma Health Care Authority (OHCA).
(5) AT devices and services are authorized in accordance with requirements of The Oklahoma Central Purchasing Act, other applicable statutory provisions, OAC 580:15 and OKDHS approved purchasing procedures.
(6) AT devices or services may be authorized when the device or service:

(A) has no utility apart from the needs of the person receiving services ;
(B) is not otherwise available through SoonerCare, Department of Rehabilitative Services, or any other third party or known community resource;
(C) has no less expensive equivalent that meets the member's needs ;
(D) is not solely for family or staff convenience or preference;
(E) is based on the assessment and Personal Support Team (Team) consideration of the member's unique needs;
(F) is of direct medical or remedial benefit to the member;

(G) enables the member to maintain, increase, or improve functional capabilities;
(H) is supported by objective documentation included in a professional assessment except as specified per OAC 317:40-5-100;
(I) is within the scope of assistive technology per OAC 317:40-5-100; and
(J) is the most appropriate and cost effective bid if applicable.

(c) Assessments. Assessments for AT devices or services are performed by a licensed professional service provider(s) and reviewed by other providers whose services may be affected by the type of device selected. A licensed professional must:

(1) determine whether the person's identified outcome can be accomplished through the creative use of other resources such as:

(A) household items or toys;
(B) equipment loan programs;
(C) low-technology devices or other less intrusive options; or
(D) a similar, more cost-effective device.

(2) recommend the most appropriate AT based on the member's:

(A) present and future needs, especially for members with degenerative conditions;
(B) history of use of similar AT, and ability to use the device currently and for at least the foreseeable future (no less than 5 years); and
(C) outcomes.

(3) complete an assessment, including a decision making review and device trial that provides supporting documentation for purchase, rental, customization, or fabrication of an AT device. Supporting documentation must include:

(A) review of device considered;
(B) availability of device rental with discussion of advantages and disadvantages;
(C) how frequently and in what situations device will be used in daily activities and routines;
(D) how the member and caregiver(s) will be trained to use the AT device; and
(E) features and specifications of the device that are necessary for the member, including rationale for why other alternatives are not available to meet the member's needs.

(4) provide a current, unedited videotape or pictures of the person member using the device, including the time frames of the trials recorded, upon request by DDSD staff.

(d) Authorization of repairs, or replacement of parts. Repairs to AT devices, or replacement of device parts, do not require a professional assessment or recommendation. DDSD area office resource development staff with assistive technology experience may authorize repairs and replacement of parts for previously recommended assistive technology.

(e) Retrieval of assistive technology devices. When devices are no longer needed by a member, OKDHS/DDSD staff may retrieve the device.

(f) Team decision-making process. The member's Personal Support Team reviews the licensed professional's assessment and decision making review. The Team ensures the recommended AT:

(1) is needed by the member to achieve a specific, identified functional outcome;

(A) A functional outcome, in this Section, means the activity is meaningful to the member, occurs on a frequent basis, and would require assistance from others, if the member could not perform the activity independently, such as self-care, assistance with eating, or transfers.
(B) Functional outcomes must be reasonable and necessary given a member's age the diagnosis and abilities.

(2) allows the member receiving services to:

(A) improve or maintain health and safety;
(B) participate in community life;
(C) express choices; or
(D) participate in vocational training or employment;

(3) will be used frequently or in a variety of situations;
(4) will fit easily into the member's lifestyle and work place;
(5) is specific to the member's unique needs; and
(6) is not authorized solely for family or staff convenience.

(g) Requirements and standards for AT devices and service providers.

(1) Providers guarantee devices, work, and materials for one year, and supply necessary follow-up evaluation to ensure optimum usability.
(2) Providers ensure a licensed occupational therapist, physical therapist, speech therapist, or rehabilitation engineer evaluate the need for AT and individually customize AT devices as needed.

(h) Services not covered through AT devices and services. Assistive technology devices and services do not include;

(1) trampolines;
(2) hot tubs;
(3) bean bag chairs;
(4) recliners with lift capabilities;
(5) computers except as adapted for individual needs as a primary means of oral communication and approved per OAC 317:40-5-100;
(6) massage tables; and
(7) educational games and toys.

(i) Approval or denial of AT. DDSD approval, conditional approval for pre-determined trial use, or denial of the purchase, rental, or lease/purchase of the AT is determined per OAC 317:40-5-100.

(1) The DDSD case manager sends the AT request to designated DDSD area office resource development staff with AT experience. The request must include:

(A) the licensed professional's assessment and decision making review;
(B) a copy of the Plan of Care;
(C) documentation of current Team consensus, including consideration of issues per OAC 317:40-5-100; and
(D) all additional documentation to support the need for the assistive technology device or service.

(2) The designated area office resource development staff, with AT experience, approves or denies the AT request when there is no fixed rate for the device and the device has a cost less than $2500 based on:

(A) the criteria given in subsection (d) of this Section;
(B) the scope of the program, as explained in subsection (a) of this Section; and
(C) the cost effectiveness of the AT, as explained in subsection (a) of this Section.

(3) Authorization for purchase or a written denial is provided within ten working days of receipt of a complete request.

(A) If the AT is approved, a letter of authorization is issued.
(B) If additional documentation is required by the area office resource development staff with AT experience, to authorize the recommended AT, the request packet is returned to the case manager for completion.
(C) If necessary, the case manager will contact the licensed professional to request the additional documentation and the licensed professional will supply further documentation upon request of the area office resource development staff with AT experience.
(D) The authorization of AT that has no fixed rate and is $2,500 or more is performed as in paragraph (2) of this subsection, except that the area office resource development staff with AT experience:

(i) solicits three bids for the AT;
(ii) submits the AT request, bids, and other relevant information to the DDSD State Office AT programs manager within five working days of receipt of the required bids; and
(iii) the State Office AT programs manager or designee issues a letter of authorization, a written denial, or a request for additional information within five working days of receipt of all required documentation for AT.

(j) Approval of vehicle adaptations. Vehicle adaptations are assessed and approved per OAC 317:40-5-100. In addition, the requirements in this paragraph must be met.

(1) The vehicle to be adapted must be owned or in the process of being purchased by the member receiving services or his or her family.
(2) The AT request must include a certified mechanic's statement that the vehicle and adaptations are mechanically sound.
(3) Vehicle adaptations are limited to one vehicle in a ten year period per member. Authorization for more than one vehicle adaptation in a 10-year period must be approved by the DDSD division administrator or designee.

(k) Denial. Procedures for denial of an AT device or service are described in this paragraph.

(1) The person denying the AT request provides a written denial to the case manager citing the reason for denial per policy.
(2) The case manager sends the Notice of Action, OKDHS form 06MP004E, to the member and his or her family or guardian.
(3) Denial of assistive technology services may be appealed through the OKDHS hearing process per OAC 340:2-5.

(l) Return of an AT device. If, during a trial use

period or rental of a device, the therapist or Team including the licensed professional if available, who recommended the AT, determines the device is not appropriate, the licensed professional sends a brief report describing the reason(s) for the change of device recommendation to the DDSD case manager. The case manager forwards the report to the designated area office resource development staff, who arranges for the return of the equipment to the vendor or manufacturer.

(m) Rental of AT devices. AT devices are rented when the licensed professional or area office resource development staff with AT experience determines rental of the device is more cost effective than purchase of the device or the licensed professional recommends a trail period to determine if the device meets the needs of the member.

(1) The rental period begins on the date the manufacturer or vendor delivers the equipment to the member, unless otherwise stated in advance by the manufacturer or vendor.
(2) Area office resource development staff with AT experience monitor use of equipment during the rental agreement for:

(A) cost effectiveness of the rental time frames;
(B) conditions of renewal; and
(C) the Team's re-evaluation of the member's need for the device per OAC 317:40-5-100.

(3) Rental costs are applied toward the purchase price of the device whenever such option is available from the manufacturer or vendor.
(4) If a device is rented for a trial use period, the Team decides within 90 days whether:

(A) the equipment meets the member's needs; and
(B) to purchase the equipment or return it.

(n) Assistive Technology Committee. The committee reviews equipment requests when deemed necessary by the OKDHS/DDSD state office assistive technology programs manager.

(1) The AT committee is comprised of:

(A) DDSD professional staff members of the appropriate therapy;
(B) DDSD AT state office programs manager;
(C) the DDSD area manager or designee; and
(D) an AT expert not employed by OKDHS.

(2) The AT committee performs a paper review, providing technical guidance, oversight, and consultation.
(3) The AT committee may endorse or recommend denial of a device or service, based on criteria given in this Section. Any endorsement or denial includes a written rationale for the decision and, if necessary, an alternative solution(s), directed to the case manager within 20 working days of receipt of the request. Requests reviewed by the AT committee result in suspension of time frames specified in OAC 317:40-5-100.

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