Funding Assistive Technology

Once the appropriate assistive technology device has been determined, the child’s Birth to Three program is responsible for putting funding options in place for obtaining the AT, including accessing third-party reimbursement as appropriate. Specific information on payment for Assistive Technology can be found in the Birth to Three Payment Procedure. 

Payer of Last Resort

The Birth to Three System funds assistive technology devices and services as the payer of last resort. This means that it is the responsibility of the family, program, and vendor to pursue all other funding options. Potential sources of AT or funding for AT include:

• the New England Assistive Technology (NEAT) Resource & Education Center, which contracts with the Birth to Three System to  provide Birth to Three owned AT devices for trial or use:
• commercial health insurance; 
• Medicaid as part of the EPSDT Screening (Early and Periodic Screening, Diagnosis and Treatment); 
• Children and Youth with Special Health Care Needs; and 
• Board of Education and Services for the Blind.

Obtaining Assistive Technology through the NEAT Center

The Birth to Three System contracts with an AT center in Connecticut (currently the NEAT Resource and Education Center) that helps Birth to Three programs obtain AT and training. This center maintains a database of assistive technology devices that the Birth to Three system owns and has available for loan to children enrolled in the system. In addition, the center maintains a database of equipment available for resale. Once it has been determined that a child needs assistive technology to accomplish an outcome, the provider should contact the AT center to acquire the appropriate assistive technology. 

Accessing Third Party Reimbursement for Assistive Technology

It is the responsibility of the local Birth to Three program to initiate and participate in the process to bill commercial insurance or Medicaid for AT for those children whose parents have given permission to bill their medical insurance. Typically, the billing process necessitates engaging a vendor of durable medical equipment who is an approved provider with the family’s health insurance, including Medicaid.

Insurance and Medicaid customarily fund equipment that fits under the category of durable medical equipment. Examples may include, but are not limited to aids for daily living and personal care, mobility aids, standing and walking aids, wheeled mobility aids, seating and positioning systems, prosthetics and orthotics, augmentative communication aids, and hearing aids. They are less likely to cover learning and developmental aids such as computers, play equipment, and switch-adapted toys. If commercial insurance pays for all or some of the cost of a device, that amount may be applied against the annual and lifetime caps for durable medical equipment benefits in the child’s health insurance plan. 

Insurance Requirements

If the program is working with a vendor of DME, the vendor will take responsibility for the insurance billing. To access insurance (for a device costing any amount) or Medicaid funding, the program and vendor must provide with the insurance claim:

1. A physician’s detailed prescription for the devices. To assist, the vendor often provides the specific device and accessories to the primary medical provider. 
2. A “Letter of Medical Necessity” (LMN) the Birth to Three provider prepares. 
3. Each insurer defines the term “medical necessity” in a different manner. It may be helpful to request the definition from the insurance company or from the vendor participating in the procurement process in order to customize the letter. This letter must be personal, meaningful, and show that the purchase is a worthwhile investment for the payer. 

A letter of medical necessity is typically written by the Birth to Three therapist with expertise in the area related to the device, sent to the vendor and signed by the physician.  Information on what should be captured in a letter of medical necessity can be found here: Sample letters of medical necessity (LMNs)

Based on established fee schedules, vendors have information regarding the amounts that Medicaid and the various commercial insurance carriers will pay toward durable medical equipment. The payment may cover the cost of the device(s) completely or partially. When the vendor has been paid for the cost of the device at the Medicaid rates, the program cannot bill Birth to Three for cost above those allowed. The vendor must accept as payment in full the amount Medicaid reimburses. However, if payment is partial by commercial insurance, the program can submit a request for reimbursement of the balance to the Birth to Three System. The Birth to Three System cannot supplement Medicaid payments. Refer to Birth to Three Payment Procedure for details.

Accessing Birth to Three Funding

The Birth to Three System is responsible for funding only equipment intended to achieve functional outcomes identified on the IFSP. No new devices or equipment should be requested for children who are 2 years, 9 months of age or older, as equipment requested during this period would not be available long enough to make progress on identified outcomes. An exception will be made for initial hearing aids if the child is newly enrolled in Birth to Three after age 2 years, 9 months. 

The Birth to Three program is advised to submit the Assistive Technology Prior Authorization/Reimbursement Form 3 – 11. to the Birth to Three System while third party funding is being pursued. Refer to Birth to Three Payment Procedure and Forms on www.Birth23.org.

Maintenance and Repair of Assistive Technology

• The child’s Birth to Three program is responsible for the maintenance and repair of the AT device. If any devices or services are part of a child’s IFSP, then the technology must be available to the child for fulfilling the outcomes and objectives of the IFSP. If a device needs repair or maintenance, the Birth to Three program is responsible for providing alternative access or temporary use of another device or equivalent during the period of time the regularly used device is out of service. 
• The NEAT Center provides minor repair service for AT owned by the Birth to Three System. 
• Whenever possible, the local Birth to Three programs should consider obtaining insurance and/or maintenance contracts when purchasing AT. Parents are also requested to insure the AT devices under their homeowner’s or renter’s insurance policy if possible. 
• If the child continues to use assistive technology after age 3, the Birth to Three System will not assume responsibility for any repair or maintenance.

Ownership of Assistive Technology

The party that paid for a majority of a device owns assistive technology devices purchased for children enrolled in the Birth to Three System. If third-party funding ends up paying more than 50 percent of the purchase price of the device, then the device belongs to the family. If Birth to Three funds pay for 50 percent or more of the device, the Birth to Three System owns that device.