Assistive Technology. Overview and Process: A Vendor s Perspective.

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Beverly Washington
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1 Assistive Technology Overview and Process: A Vendor s Perspective

2 Overview: Definitions & Abbreviations: Assistive technology (AT) is defined as any item, piece of equipment, or product, whether acquired commercially, off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities. (P.L , The Technology Related Assistance Act of 1988). An Assistive technology device (ATD) means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of children with disabilities. (10 NYCRR (I) (2)(i)). Assistive Technology Service is a service that directly assists a child with a disability in the selection, acquisition or use of an assistive technology device. E.g. installing, customizing or adapting equipment; assisting children benefiting from these devices, and training of parents and other caregivers (including child care providers) in using assistive technology devices to improve children's functional capabilities. 2

3 Definitions & Abbreviations Continued: Assistive Technology Coordinator (ATC) a member of the State Fiscal Agent charged with managing the AT process from service authorization to final payment. Assistive Technology Device (ATD) Vendor is a contracted provider of Assistive Technology Device Assistive Technology Device (ATD) Vendor Claim is a request for payment of services delivered as authorized by a Service Authorization. EI Billing is a secure, web based portal, maintained by the State Fiscal Agent that provides easy access for users and updated functionality including features such as online claim correction and access to provider and child enrollment information. It is designed to allow the Provider agencies the capability of submitting claims in the HIPAA compliant 837 file format. EIP is the Early Intervention Program 3

4 Definitions & Abbreviations Continued: Escrow is a fund established by the Municipality from which the State Fiscal Agent pays approved EI claims. Municipality a county outside of the City of New York, or the City of New York in the case of a county contained within the city of New York. Municipality, here, also means the Municipality in which the Vendor renders evaluations, service coordination or early intervention services to children residing in such Municipality. Purchase Authorization is the authorization given by the ATC to the vendor once the service authorization has been issued. Service Authorization is the approval granted by the municipality as evidenced on the Individual Family Service Plan (IFSP) that authorizes the assigned provider of record to deliver a specific service. Service Coordinator (SC) is the professional case manager assigned by the early intervention official upon receipt of a referral of a child thought to be eligible for early intervention services, who participates in the formulation of the Individualized Family Service Plan (10 NYCRR [y]) and coordinates services. SFA is the State Fiscal Agent 4

5 Getting Started: Assistive Technology Vendor Agreement Highlights ATD Vendors intending to receive authorizations for the purchase and delivery of early intervention assistive technology devices must complete and comply with this agreement which sets forth the terms and conditions for such authorizations and payment. ATD procurement decisions are determined by several factors, including but not limited to vendor s third party insurance participation, devices technical specifications, final price, needed services (fitting, adjustments, etc.), proximity to family/child, and delivery terms. For children with third party insurance, preference will be given to vendors who participate with the child s commercial insurance and/or Medicaid plan(s). ATD Vendors are to collaborate and communicate with the IFSP team, including the recommending therapist to ensure that the ATD accessories selected are appropriate to the meet the child s unique needs and the IFSP functional outcomes. 5

6 Key Responsibilities ATD Vendors should be very familiar with the terms outlined in the Assistive Technology Vendor Agreement. A summary of certain key Vendor Responsibilities follows: Vendor agrees to deliver products and/or provide requested services as soon as possible after receipt of an order. See Vendor Agreement for specific timelines. Vendor agrees to be responsible for delivery of assistive technology devices and must, when requested, instruct beneficiaries on the use of the device, and maintain proof of delivery and beneficiary instruction. Vendor agrees to provide, at no additional cost, product technical support, via telephone or remote support, for at least six months from the date of delivery of any product. Vendor agrees that whenever the manufacturer of a product sold by the vendor offers a warranty, the vendor will maintain adequate warranty records and provide assistance in arranging warranty support from the manufacturer. See Vendor Agreement for additional guidelines and timelines. Vendor agrees and understands that the vendor is prohibited from direct solicitation to early intervention families and agrees and understands that the Vendor must not bill or collect payment from the family directly for EI services nor require the family to pay additional costs. Vendor agrees and understands that the Vendor must not initiate repossession or otherwise take back a delivered assistive technology product rather the vendor will work with the Department, municipality and the SFA to resolve any payment dispute. 6

7 Additional Terms: Read in detail the Vendor Agreement for specific information required of state vendors, including: Liability Insurance Coverage Personnel Requirements Confidentiality Record Keeping 7

8 The Process: At a Glance A ATC receives the request, specifications, physician s orders and medical necessity form ATC obtains preliminary, competitive pricing, location, availability and delivery timelines, selects the ATD vendor & communicates that information to the Municipality/SC ATC contacts the ATD Vendor; ATD vendor will collaborate with therapist and/or child/family for selection/measurements; revise bid if necessary The ATD vendor receives a purchase authorization from the ATC, obtains any third party liability authorizations and orders/fabricates the device. The ATD Vendor and treating therapist will collaborate and coordinate on the delivery date Routine adjustments or questions should be directed to the ATD Vendor by the family in consultation with the treating therapist. Concerns regarding the quality of the device or services should be directed to the SC who will communicate the concerns to the ATC. B 8

The Process: At a Glance B ATD Vendor prepares a billing with payment information, relevant CPT codes and pricing and submits, along with the delivery confirmation and warranty information, to the

9 The Process: At a Glance B ATD Vendor prepares a billing with payment information, relevant CPT codes and pricing and submits, along with the delivery confirmation and warranty information, to the ATC ATC inputs the service/billing information into ElBilling for third-party processing and payment. Once received, the ATD Vendor will forward the EOB to the ATC for entry into ElBilling. Was the product fully covered by a Third Party? NO Was the device partially covered by Third Party? YES ATD Vendor is paid in full by Third Party NO Escrow pays total allowable amount to ATD Vendor YES Escrow pays ATD Vendor remaining allowable balance 9

10 Behind the Scenes: A Look at the Process The PCG Assistive Technology Coordinator (ATC) receives a ATD request from a service coordinator which includes specifications of the device along with the physician s orders and Medical Necessity Justification form. Within two working days of receipt of request, the ATC will seek preliminary, competitive pricing information when needed from vendors having agreements with the State. The ATC will select the ATD Vendor with the technical expertise, best pricing, delivery terms, insurance in-network status, and convenience for the family. The ATD Vendor will collaborate with the treating therapist and child/family to determine the best AT device, accessories and to obtain measurements or castings. A revised bid may need to be submitted after collaboration. The selected ATD Vendor will receive a purchase authorization from the ATC containing the specifications of the device, demographic information and insurance information for the child with the physician s orders and letter of medical necessity. 10

11 Behind the Scenes: A Look at the Process The ATD vendor is responsible for obtaining all necessary third-party preauthorizations; however, the pre-authorization process shall not delay delivery of products and/or provision of requested services. Any difficulties in obtaining preauthorization should be communicated to the ATC. The vendor will communicate to the ATC when the device is ordered or fabrication begins and the estimated delivery/completion date. The ATC will communicate that date to the service coordinator/municipality. The ATC will monitor the transaction until delivery to the child as evidenced by the vendor s delivery confirmation signed by the parent/guardian or designee and will update the service coordinator/municipality of any anticipated delays. The AT Vendor will collaborate with the authorized treating therapist regarding delivery scheduling when appropriate or necessary depending on the nature of the device. When appropriate, the treating therapist should be present when the device is delivered to the child/family to ensure the device is still appropriate and the family is adequately instructed on the operation of the device. 11

12 Behind the Scenes: A Look at the Process Routine adjustments or questions regarding the function of the device should be directed to the ATD Vendor by the parent in consultation with the treating therapist. Parent or therapist concerns regarding the quality of the device or service should be directed to the service coordinator/municipality who in turn will communicate the concerns to the ATC via secure /fax. The ATC will address any concerns with the ATD vendor. The ATD Vendor will prepare a billing with payment information, relevant CPT codes and pricing and submit, along with the delivery confirmation and warranty information, to the ATC. ATC inputs the service/billing information into ElBilling for third-party processing and third-party payment. Third-party payment will be made directly to the vendor. An ATD vendor may choose to use their own billing process to submit claims to third party payors. If that is the case, the two prior steps are not applicable. The ATD billing process will resume with the next step. 12

13 Behind the Scenes: A Look at the Process Once received the ATD Vendor will forward the explanation of benefits (EOB) to the ATC for entry into EIBilling. If the ATD was fully covered by insurance, the ATD Vendor will receive payment in full from the third party payor. If there was a partial third-party payment, the vendor will receive payment of any remaining allowable balance from Escrow If there is no third-party coverage or liability, the vendor will receive payment of the total allowable amount from the Escrow 13

14 Questions? 14

15 Contact Sheet Sherree Sinclair Assistive Technology Coordinator 15

16 Public Consulting Group, Inc. 148 State Street, Tenth Floor, Boston, Massachusetts (617) , 16

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