If You Have Insurance through a Private Insurance Company:

You have a contract with that company that defines your rights. A contract can be enforced.

You Don’t Have to Do It Alone

If you have been rejected by a funding agency, call us at Iowa COMPASS for help.

Iowa COMPASS can:

• Send fact sheets.
• Provide you with a referral that will get you a free legal advocate.
• Refer you to peer advocates who have been in a similar situation and who can help you through the paperwork.
• Give you the names of advocacy groups that maybe able to help you.

Find Out Why

Once you understand why your application has been rejected, you’ll know more about how to appeal the rejection and apply to other funding sources.

If an agency denies your request for funding, it’s usually for one of four reasons:

1. You are not eligible for the program -- you don’t fit the definition of the population served by the agency.
2. The particular service or device you are requesting is not covered by the program or agency.
3. Your request does not met the criteria for coverage of the particular service or device, e.g., medically necessary.
4. You need to establish prior rejection by other agencies to qualify for the program.

How to Be Prepared for an Appeal: What You Can Do

To be prepared to appeal a negative decision, you need to keep records pertaining to your case. In a file or notebook, keep track of all paper work and phone conversations. Take notes and write down phone calls and meetings. You should also try to speak to the same contact person each time you call or visit a funding agency.

Remember, persistence often pays off when seeking AT. This means:

1. You should apply in writing. Nothing can happen if you don’t first formally apply to an agency for funding. You have the right to submit a written application or prescription.
2. You need to be aware of deadlines. In applying for assistive technology or appealing a decision, it’s important to pay attention to deadlines. You usually need to pursue your case within a certain limited time frame.
3. You need to be sure you get reliable information. If you are uncertain about your eligibility for receiving AT from any funding source, call Iowa COMPASS for more information.

There are many laws that give eligible individuals legal rights to assistive technology. Some of the more important of these are described in this brochure. Each law defines certain rights and gives consumers the power to challenge decisions if their rights are wrongfully denied.

For information on the various funding agencies and programs described below, or to receive help on an appeal, call Iowa COMPASS 1-800-779-2001 (voice) or 877-686-0032 (TTY).

MEDICAID (also known as Title XIX)

Medicaid is a government program that provides funding for health services. It’s administered through the Iowa Department of Human Services (DHS).

There are many ways to get on Medicaid. You may be on Medicaid through:

• the Supplemental Security Income Program (SSI),
• the Family Investment Program (FIP) {formerly AFDC},
• a Waiver Program, or
• the Medically Needy Spend Down Program.

If you are on any Medicaid program, you are entitled to AT if the AT meets the program’s specifications. The Medicaid program pays for durable medical equipment, prosthetic devices, augmentative communication devices, and medical supplies. Many types of AT can be covered under these categories if the AT is medically necessary.

If your request for AT from Medicaid is rejected, you have the right to appeal to the DHS and to the courts.

MEDICARE

If you are eligible for Medicare, you qualify for AT if it is medically necessary.

Medicare is divided into two parts:

Part A deals with hospital insurance and care.

Part B deals with doctor’s fees, durable medical equipment, including many items of assistive technology, and other aspects of outpatient care. You must pay a small monthly premium to enroll in Part B and receive funding for AT. If you are also eligible for Medicaid, there is a program that will cover the cost of your part B premium.

Medicare will pay for certain items of AT as durable medical equipment. Under Medicare, durable medical equipment is defined as equipment that:

• can withstand repeated use,
• is primarily and customarily used to serve a medical purpose,
• generally is not useful to you in the absence of an illness or injury, and
• is appropriate for use in your home.

If you are denied assistive technology under Medicare, the appeal process can begin with an informal review of your application and advance to a court hearing if necessary.

Vocational Rehabilition

If you are eligible for Vocational Rehabilitation the state is required to provide you with AT if you are otherwise employable and such services enable you to be employed.

A counselor in your local Vocational Rehabilitation office will determine your need and eligibility.

Services are provided according to an individualized plan. You have the right to participate in devising and approving your individualized plan.

If you are denied AT under Vocational Rehabilitation, you can appeal.

Americans with Disabilities Act and Section 504 of the Rehabilitation Act

Both of these federal laws help guarantee your rights to AT. They prohibit discrimination on the basis of disability. This means they require certain entities to offer reasonable accommodations.

Employers are required to make "reasonable accommodations" for employees or applicants with disabilities. These accommodations may include AT. These federal laws also require that persons with disabilities have access to public programs such as public colleges. Persons are entitled to reasonable accommodations to make these programs accessible. These accommodations may include AT.

If you believe you have been discriminated against because of a disability, you can file a complaint with agencies charges with enforcing these laws.

Private Insurance

If you have private insurance-either through an employer or on your own-and meet the specified criteria in the insurance contract, you are legally entitled to at.

There are two important things to remember about private health insurance.

1. The insurance company has a contract with you to pay for certain items and is legally obligated to follow the contract.
2. Private insurance companies are also regulated by law.

If you have insurance under your employer...

The employee Retirement Income Security Act (ERISA) is a federal law that regulates employee benefit plans. Under this law employees are entitled to information about what is covered under an employer health plan. You also have the right to ask for a review of any denial of benefits and appeal to the courts.

If you have insurance on your own...

If you have obtained your insurance on your own (not through an employer), the State Insurance Commission might be helpful. Otherwise, you can ask the courts to enforce the insurance contract.

Help Is Available 

Remember, when you are seeking funding for AT, don’t be discouraged by rejection. You may be pursuing something that you are entitled to under the law. Call Iowa COMPASS for information about how to get assistance to appeal a funding decision and about your other funding options.

Legal Rights to Assistive Technology
for Older Adults

Did you know that whether you receive assistive technology is not a matter of charity, it’s a matter of rights?

You may have a right to the assistive technology you need. Many funding sources-whether they are government programs or private insurers -- must make their decisions based on whether you meet certain conditions.

Assistive technology (AT) is a device or service that makes certain tasks easier for people with disabilities or the elderly. This includes communication devices, adaptive wheelchairs, stair lifts, computers, van conversions and many other items. AT also includes home modifications and adaptations such as ramps and grab bars in a hallway or bathroom.

In the past, those who were wrongfully denied AT often didn’t have the help or resources to appeal the decision. Now, help is available through Iowa COMPASS.

We have designed this brochure to explain how Iowa COMPASS, an IPAT (Iowa Program for Assistive Technology) program, can help if your request for AT is rejected.

Because assistive technology can be a right, you have a recourse if your request for funding is turned down.

All government programs and most private insurance contracts have an appeal or review process that you can turn to if you are denied benefits. An appeal begins with a written explanation of why your application for assistance should be accepted. The information relevant to your application is then reviewed by someone not involved in the initial decision.

If you are seeking AT, you need to know your rights:

If You Are Seeking AT through a Government Program:

1. You have a right to apply for funding.
2. If you are turned down, you have a right to a written explanation of why your request was denied.
3. You have the right to appeal. This means you have the right to a review by a person not involved with the initial decision.

If You Have Insurance through a Private Insurance Company:

You have a contract with that company that defines your rights. A contract can be enforced.

You Don’t Have to Do It Alone

If you have been rejected by a funding agency, call us at Iowa COMPASS for help.

Iowa COMPASS can:

• Send fact sheets.
• Provide you with a referral that will get you a free legal advocate.
• Refer you to peer advocates who have been in a similar situation and who can help you through the paperwork.
• Give you the names of advocacy groups that may be able to help you.

Find Out Why

Once you understand why your application has been rejected, you’ll know more about how to appeal the rejection and apply to other funding sources.

If an agency denies your request for funding, it’s usually for one of four reasons:

1. You are not eligible for the program -- you don’t fit the definition of the population served by the agency.
2. The particular service or device you are requesting is not covered by the program or agency.
3. Your request does not meet the criteria for coverage of the particular service or device, e.g., medically necessary.
4. You need to establish prior rejection by other agencies to qualify for the program.

How to Be Prepared for an Appeal: What You Can Do

To be prepared to appeal a negative decision, you need to keep records pertaining to your case. In a file or notebook, keep track of all paper work and phone conversations. Take notes and write down contact names and the date and time of phone calls and meetings. You should also try to speak to the same contact person each time you call or visit a funding agency.

Remember, persistence often pays off when seeking AT. This means:

1. You should apply in writing. Nothing can happen if you don’t first formally apply to an agency for funding. You have the right to submit a written application or prescription.
2. You need to be aware of deadlines. In applying for assistive technology or appealing a decision, it’s important to pay attention to deadlines. You usually need to pursue your case within a certain limited time frame.
3. You need to be sure you get reliable information. If you are uncertain about your eligibility for receiving AT from any funding source, call Iowa COMPASS for more information.

There are many laws that give individuals age 65 or older legal rights to assistive technology. Some of the more important of these laws are described in this brochure. Each law defines certain rights and gives consumers the power to challenge decisions if their rights are wrongfully denied.

For information on the various funding agencies and programs described below, or to receive help on an appeal, call Iowa COMPASS 1-800-779-2001 (voice) or 877-686-0032 (TTY).

MEDICARE

If you are eligible to receive Medicare, you may be entitled to receive AT.

Medicare is divided into two parts:

Part A deals with hospital insurance and care.

Part B deals with doctor’s fees, durable medical equipment, including many items of assistive technology, and other aspects of outpatient care. You must pay a small monthly premium to enroll in Part B and receive funding for AT. If you are also eligible for Medicaid, there is a program that will cover the cost of your part B premium.

Medicare pays for AT that is "durable medical equipment" and:

• can withstand repeated use,
• is primarily and customarily used to serve a medical purpose,
• generally is not useful to you in the absence of an illness or injury, and
• is appropriate for use in your home.

If you are denied assistive technology under Medicare, the appeal process can begin with an informal review of your application and advance to a court hearing if necessary.

MEDICAID (also known as Title XIX)

Medicaid is a government program that provides funding for health services. It’s administered through the Iowa Department of Human Services (DHS).

There are many ways to get on Medicaid. You may be on Medicaid through:

• the Supplemental Security Income Program (SSI),
• a Waiver Program, or
• the Medically Needy Spend Down Program.

If you are on any Medicaid program, you are entitled to AT if the AT meets the program’s specifications. The Medicaid program pays for durable medical equipment, prosthetic devices, augmentative communication devices, and medical supplies. Many types of AT can be covered under these categories if the AT is medically necessary.

If you are eligible for Medicaid as well as Medicare, you should check your eligibility for AT under Medicaid. This is important to know because Medicaid coverage is more comprehensive than Medicare coverage.

If your request for AT from Medicaid is rejected, you have the right to appeal to the DHS and to the courts.

Americans with Disabilities Act and Section 504 of the Rehabilitation Act

Both of these federal laws help guarantee your rights to AT because they prohibit discrimination on the basis of disability.

These laws also ensure that persons with disabilities have access to public programs such as community programs or senior centers. Persons with disabilities are entitled to "reasonable accommodations" that will make these programs accessible to them.

Employers are also required to make reasonable accommodations for employees or applicants with disabilities. These accommodations may include AT.

If you have been denied AT required under the ADA or Section 504, you can file complaints with government agencies responsible for insuring these rules are followed.

Private Insurance

If you have private insurance -- either through an employer or on your own -- and meet the specified criteria in the insurance contract, you are legally entitled to AT.

There are two important things to remember about private health insurance.

1. The insurance company has a contract with you to pay for certain items and is legally obligated to follow the contract.
2. Private insurance companies are also regulated by law.

If you have insurance under your employer...

The employee Retirement Income Security Act (ERISA) is a federal law that regulates employee benefit plans. Under this law employees are entitled to information about what is covered under an employer health plan. You also have the right to ask for a review of any denial of benefits and appeal to the courts.

If you have insurance on your own...

If you have obtained your insurance on your own (not through an employer), the State Insurance Commission might be helpful. Otherwise, you can ask the courts to enforce the insurance contract.

Help Is Available

Remember, when you are seeking funding for AT, don’t be discouraged by rejection. You may be pursuing something that you are entitled to under the law. Call Iowa COMPASS for information about how to get assistance to appeal a funding decision and about your other funding options.