FUNDING INFORMATION _Strategies For Collaboration: Funding And Legal Considerations_ Pat Ourand, MS, CCC-SLP, Rehab Networking Consultant, 23 Kirwin Court, Baltimore, MD 21234. Phone: 410-661-8894, Fax: 410-665-1460 The process of funding Assistive Technology services and devices must be approached with organized, yet often simple, strategies. To accomplish such a task a collaborative team must be assembled to guarantee that a individual receives appropriate devices and service recommendations. This team may include the consumer, parents or other family members, educator, rehabilitation counselor and/or technologist, speech/language pathologist, occupational therapist, physician and many other service providers and pro fessionals. This is a critical first step. Once the team has been established, each member contributes knowledge of the individual and expertise in funding streams. Together, the combined skills of all team members will enable successful identification of, and access to the most appropriate funding source. The team must seek collaboration between funding sources, where appropriate. Many times, more than one funding source is available to share in the responsibility of providing the recommended device and services. Such a strategy allows the consumer access to the most appropriate AT device and/or service, while allowing the funder(s) to serve an increased number of consumers. Without collaboration, many funding alternatives will begin to deplete funds as a result of the enormity of fiscal responsibilities. Additionally, before funding for AT devices and services can be identified, specific questions must be examined to provide answers to identify the most appropriate, versus most promising, funding source. These questions will enable consumers, professionals and other advocates to analyze all possible funding options. These considerations must question not only the availability of resources, but also the legal responsibility of one or more funding alternatives. Although it may seem as if funding for AT is limited and difficulty to identify and subsequently attain, such may not be the phenomenon. If a recommendation for AT services and devices is provided with sufficient documentation and justification, funding is generally available. In some cases, precedents exist and funding is uncompounded. In other situations, background information and history must be provided so as to clarify the appropriateness of the funding request. In still other cases, appeals must be pursued to confirm funding through the most approp riate funding source. When consideration for funding of an AT device is initiated, all pertinent services must also be identified to insure provision of the most appropriate equipment configuration. Additionally, this will help to limit underuse and abandonment. Finally, such an approach insures that the funder will not be asked to provide additional services and devices to prematurely replace those previously provided. This process can only be successful with the implementation of a team approach. Numerous programs are currently available for funding of AT services and administering agencies at the state and local level must work from the same regulations. Therefore it is a good idea for consumers and professionals to be aware of, and to compare access in other communities and states to determine the current and possible scope of these program dollars. If federal funds are being used in one jurisdiction in a manner not available in another community, questions must be posed. Frequently, the response will be that the policy does not support such an expenditure. This rebuttal does not mean that the expenditure can not be made, only that is has not be made. The possibility of having such a policy rewritten does exist and should be pursued instantaneously. Don Coyhis, Founder of White Bison, Inc. noted "a mind stretched by a new idea will never return to its original position." The following is a brief description of numerous funding resources currently available for coverage of AT services and devices. An investigation into any one or more of these programs may provide for an appropriate funding source. --Medical Assistance (Medicaid) -- Medicaid is a program funded by both the federal government and the states and has been referred to as one example of Ocooperative federalismO. With this program the federal and state (or federal, state and local) govern- ments share responsibilities for providing medical benefits to adults and children with limited income and resources. It is a Ovendor paymentO program which means that it reimburses service providers directly, and does not give people cash to pay for covered services. The Federal administrating agency, the Health Care Financing Administration (HCFA), mandates that each state must develop a plan that identifies specific services offered within the state Medicaid program. The services identified are a combination of required and optional services, chosen from federal guidelines. Since each state has the option of choosing specific services, each state offers a different Medicaid program. Given this design, some constants do exist for AT services and devices. MA services for children are covered by a program known as Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). This is not a separate program but is the children's component of Medicaid, as mandated by the Omnibus Reconciliation Act of 1989 (OBRA T89). This Act mandates that as of April 1, 1990, states must provide Otreatment for which federal reimbursement is available, whether or not such services are covered under the State planO (42 USC Section 1396d(r)(5)). This statement requires all states to offer all treatment, including AT services and devices, for MA eligible recipients under 21 years of age. Specifically, EPSDT offers the following treatment services which may include CAT services and devices: * Home health services * Inpatient hospital care * Outpatient hospital care * Rehabilitation Services * Speech, language and hearing * Prosthetics * Community supported living arrangements for persons with developmental disabilities * Other diagnostic, screening, preventive, and medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healingarts, for the maximum reduction of a physical or mental disability. Since each state offers a different selection of Medicaid optional services, individuals over age 21 are only covered by the services established in the State plan. Careful review of the State plan may identify the following covered services for provision of AT services and devices: * Home health services (42 USC Section 1396d(a)(7)), * Outpatient Hospital Services, a required service, * Rehabilitative services (42 USC Section 1396d(a)(13) which provide "for maximum reduction of physical or mental disability and restoration of a recipient to is best possible functional level" (42 CFR Section 440.130(d)), ce, as an outpatient,or in your home. Once eligible for Part B benefits, the individual is required to pay an annual deductible, each calendar year. After you meet the deductible, Medicare Part B generally pays 80 percent of the Medicare-approved amount for covered services you receive the rest of the year. The individual or other funding source is responsible for the other 20 percent. Under certain circumstances, other insurers may cover these costs. For example, the Medical Assistance Program (Medicaid) may pay all three types of costs for qualified persons. Major medical insurance policies often cover the co-pay. Note here that Medicare only covers 80% of the "allowable" charge for a piece of equipment. The remaining 20% must be paid by the beneficiary or other insurance. Medicare will only pay for equipment if the prescribing physician can certify in writing that the equipment is needed to help the person reduce or manage problems associated with a diagnosed medical condition. -- Technology-Related Assistance For Individuals With Disabilities Act Of 1988 All 50 states, the District of Columbia, Puerto Rico, American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands each have a Tech Act Grant. As a rule, the Tech Act Projects will not purchase devices for individuals. All States will assist an individual in obtaining devices and/or services through the various funding sources by providing information and guidance on eligibility criteria, how to fill out forms, and how to appeal a decision. Although state project activities vary, examples of services include: information and referral services; national or statewide 800 numbers for information; centers in which individuals can try out devices and equipment; training courses for service providers, individuals with disabilities and/or their family representatives, development of funding guides; equipment exchange and recycling programs; revolving and low interest loan programs; peer support groups; and mobile van outreach services. Contact: RESNA Technology Assistance Project, 1700 N. Moore St., Suite 1540, Arlington, VA 22209-1903. Phone: 703-524-6686 (Voice), FAX: 703-524-6630, TTD: 703-524-6639. -- Social Security Administration Work Incentive Programs -- Most people, including those with disabilities, want to work, but may require specific equipment to accomplish such. It is important for disability beneficiaries to understand that they can still receive benefits while they try to purchase devices and services necessary to work. AT services and devices are a perfect example of such. There are numerous Work Incentive Programs that persons who receive Social Security Administration (SSA) benefits can use. These programs are becoming widely used since they are more flexible and generous than in previous eras. In fact, many of these initiatives have been legislated since 1990. This fact points to the thinking that appears to be developing at the federal level. Ma to which it belongs. For computers, this time frame is typically either five or seven years, depending on the accounting decisions. Though many taxpayers who can do so would prefer to expense their equipment, even individuals with incomes sufficient to fully absorb the deduction in the year of the purchase may on occasion find it advantageous to opt for depreciation instead.O Consideration of such an expenditure under these IRS rulings must be discussed with a tax accountant well versed in the tax law and recent rulings. --Disabled Access Credit (Title 26, Internal Revenue Code, Section 44) -- This credit was enacted November 5, 1990 and is formally known as Expenditures to Provide Access to Disabled Individuals. The purpose of the credit is to allay fears of small businesses with respect to ADA compliance, as well as to provide encouragement for compliance through tax subsidization. This credit is available to "eligible small businesses." A qualifying small business is defined as one that in the preceding year: * had gross receipts of $1 million or less, OR * employed no more than 30 full-time employees. The credit is in the amount of 50 percent of "eligible access expenditures" that exceed $250 but do not exceed $10,250 for a taxable year. A business may take the credit each year that it makes eligible for access expenditure. The Internal Revenue Code defines four major categories of eligible expenses. These include removal of architectural, physical, communication and transportation barriers that prevent access to or use of the business by persons with disabilities; provision of services such as qualified readers, taped texts and other Oappropriate methodsO for making materials available to people with sensory impairments; acquisition or modification of equipy of the Red Book on Work Incentives. Contact: Social Security Administration --Internal Revenue Code -- According to Mendelsohn (1993), the Internal Revenue Service supports numerous and varied tax credits and deductions which are available to individuals purchasing AT devices and services. He notes "the deductibsidy. Mendelsohn notes "these provisions are not available to individuals with disabilities, but they are used by businesses to subsidize certain expenses that benefit people with disabilities." --Targeted Jobs Tax Credit (TJTC, Title 26, Internal Revenue Code, Section 51) As illustrated above, this credit may provide an indirect means of funding for AT services and devices by providing an employer with additional income which may subsequently be used to pay for an employees AT needs. Using this program, employers are eligible to receive a tax credit up to 40 percent the first $6,000 of first-year wages of a new employee with a disability. The employee must be referred by state or local vocational rehabilitation agencies, a State Commission on the Blind, or the US Department of Veterans Affairs, and certified by a State Employment Service. In order to access this credit it is critical that the worker belong to one of the targeted populations identified by the law. Mendelsohn (1993) states "two of these populations which encompass most potential employees with disabilities are Supplemental Security Income (SSI) recipients and persons referred by the vocational rehabilitation agency." There is no credit after the first year of employment. For an employer to qualify for the credit, a worker must have completed at least 120 hours of work for the employer. The TJTC is an incentive specifically tailored to hiring and is not available for hiring anyone who has ever worked for the firm before since the purpose of the TJTC is to bring people from underemployed groups into the work force. RS Form 5884 is necessary to claim this credit. --State Sales Tax -- Consumers purchasing AT devices may be able to save a small percentage of the cost of a device by inquiring as to whether sales tax on the product is exempted. Mendelsohn notes Ostates vary enormously in what they exempt from sales tax and in the procedures for obtaining these exemptions.O In some case, devices ordered through the mail allow the buyer to save the cost of sales tax. Mendelsohn (1990) notes that some states do provide exemption(s) of special interest to people with disabilities. If this solution is not currently a possibility in your state, this may be a systems change activity that can be enforced through individual state advocacy and subsequent legislation. --Charitable Contributions -- The Internal Revenue Code allows for a deduction for amounts up to certain limits, that individuals or business contribute to organizations that qualify as a 501(c)3 corporation. In some instances this option can be incorporated when individuals chose to contribute to the purchase of an AT device by taking advantage of the IRS tax deduction for charitable contributions. This strategy can only be accessed in certain situations. Check with a tax accountant before applying this solution. --Impairment-Related Work Expenses (IRWE's) -- This program sounds and functions similar to the program identified as a Social Security Work Incentive. IRWE's were added to the Internal Revenue Code in 1986. The Code defines IRWE as "expenses of a handicapped individual as defined in Section 190 (b)(3) for attendant care services at the individual's place of employment and other expenses in connection with such place of employment which are necessary for such individual to be able to work, and with respect to which a deduction is allowable under Section 162 determined without regard to the section." This deduction allows an individual to take a tax deduction for any and all expenses incurred in order to hold a job as long as they are related to the impairment. Unlike other employee Business Expenses, the IRWE's are not subject to the 2% of adjusted gross income (AGI) limit. This can make the IRWE program one of the most effective and far-reaching of all options. --Summary -- As suggested throughout this document, there are numerous and varied strategies which can be considered when searching for funding for AT services and devices. This process, as defined at the beginning, frequently necessitates creative problem solving and collaboration. In addition to the programs discussed above, there are additional strategies which may be considered. Some of these include fiscal loan programs and other forms of bank financing, equipment recycle programs, equipment short-term and long-term loan programs, manufacturer rebates and many others. The specific strategy to be applied must be considered with regard to the current and future circumstances of the individual. What works for one situation may not be appropriate for another, and what works for one individual may not work for another. --References -- Button. (1993, February) Reauthorization of the Rehabilitation Act Increases Access to Assistive Technology. AT Quarterly, 4 (1) Golinker, L. (1994) Personal Communication Kailes, J. I. (1993). A Guide to Planning Accessible Meetings. Texas; ILRU Research & Training Center on Independent Living at TIRR. Mendelsohn, S. B. (1993). Tax Options and Strategies for People with Disabilities. New York: Demos. Williams. (1990, Summer) Assistive Technology: Making It Work for People on the Job. AT Quarterly, 1 (2) rhaps this strategy should be considered by more individuals. Mendelsohn (1993) further states, Othe number of years over which an item of capital equipment can be depreciated depends on the categor