AT3: AT Reuse & Medicaid Guidance for AT Act Programs

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===Introduction=== The Senate Labor Health, Human Services, Education and Related Activities Subcommittee of the Senate Appropriations Committee issued report language regarding Assistive Technology Act Programs Reutilization Programs:

"The Committee is encouraged that several State Medicaid Programs have developed assistive technology and durable medical equipment reuse programs. These programs retrieve and refurbish devices that were purchased with Medicaid funds, but are no longer being used by Medicaid recipients or other sources. Refurbished equipment may be reassigned to Medicaid members as a priority or to other eligible individuals who are disabled or elderly. CMS should encourage State Medicaid programs to partner with State Assistive Technology Act Programs to develop and implement reutilization programs with a goal of containing Medicaid costs."

Durable Medical Equipment (DME) is a high cost component of Medicaid Health Services. In 1990, CMS reported DME expenditure levels at $4.1 billion. In 2009, CMS reported DME expenditure levels at $34.9 billion. Clearly, managing growth in DME expenditures and engaging in activities that continue to support the DME needs of Medicaid beneficiaries is important. Several Assistive Technology (AT) Programs have partnered with their state Medicaid program in an attempt to manage DME costs. Since the purpose of an AT Program’s device reutilization service is to support the reuse of AT and/or DME that is no longer needed or used by its original owner, it made sense to forge such collaborations. DME needs that may be temporary in nature are ideally suited to the type of a program. Through reuse recipients obtain equipment at significantly lower cost or no cost, and states see DME costs are better managed. Assistive Technology device reutilization programs, which encompass Durable Medical Equipment, are one of four core activities the 56 federally-funded Assistive Technology (AT) Act Programs provide. The 2004 reauthorization of the AT Act required a common set of activities to be provided by all AT Act programs. Required state-level activities include AT device demonstration programs, AT device short-term loan programs, state financing activities and AT device reutilization programs. Here’s how the partnership works: The AT Program tracks the Medicaid purchases of specific DME items and recovers the equipment that is no longer being used. DME items no longer being used, purchased through other funding sources, are also retrieved. The AT Program works with local DME providers and/or trained staff to refurbish the equipment, restoring it to nearly new condition. Then this DME can be reassigned to another Medicaid member or any citizen in need. Considerable health care savings have occurred in the states where this arrangement exists.

Benefits of Medicaid partnerships with AT Act Programs Additional benefits of a Medicaid partnership with AT program reutilization activities include: 1. Reusing DME helps manage Medicaid costs while also meeting the needs of persons with disabilities and the increasing aging population. 2. Access to needed technology improves the health and safety of persons with disabling and health conditions. 3. Access to technology helps keep individuals in less restrictive, less expensive environments. 4. The AT Programs providing reutilization programs are effective, efficient programs that receive high marks from the individuals receiving the lightly used equipment. 5. Reuse of quality equipment reduces consumption of natural resources and reduces use of landfills. Years of experience with different models and the pursuit of improved standards of practice through the Indicators of Quality for Assistive Technology Reuse (IQ-ATR) make the AT Act Programs exceptional partners for Medicaid for safe, effective and appropriate reuse programs. AT Act Reuse Programs in Partnerships with Medicaid Summaries

Models of AT Act Reuse Programs KANSAS DURABLE MEDICAL EQUIPMENT REUSE PROG RAM, 2003

Program Name: The Kansas Equipment Exchange (KEE) Program Director: Dr. Sara Sack, Kansas University, Assistive Technology for Kansans Kansas has operated a durable medical equipment (DME) reuse partnership between the AT Act program and Medicaid successfully for over a decade. The Kansas Equipment Exchange (KEE) conducts a statewide equipment recovery campaign and accepts donations of lightly used DME obtained through public and private sources. All DME requests for Medicaid beneficiaries are first evaluated for new equipment, in the case that Medicaid coverage requirements are not met, the requested DME may be accessed from the reuse program. DME needs that may be temporary in nature are met by equipment accessed through the KEE program. Since 2003, the KEE program has received more than $10 million of durable medical equipment from private donors, and has refurbished and reassigned more than $8 million of used equipment. More than $1 million of equipment purchased by Medicaid has been recovered through the program, refurbished and reassigned to Kansans.

OKLAHOMA DURABLE MEDICAL EQUIPMENT REUSE PROG RAM, 2012

Program Name: Oklahoma Durable Medical Equipment Reuse Program (OKDMERP) Program Director: Linda Jaco, Oklahoma State University, Oklahoma ABLE Tech Oklahoma’s reuse program, Oklahoma Durable Equipment Reuse Program (OKDMERP) in partnership with the Oklahoma Health Care Authority (Oklahoma Medicaid), began operations in 2012. DME is appropriately matched, reassigned and delivered to an Oklahoma resident in need. Priority is given to SoonerCare members, but other Oklahoma residents are eligible. Since 2012, the OKDMERP has resulted in nearly $3.5 million in healthcare savings to agencies and individuals. Over the period, 5,237 DME devices were reassigned including 2,503 devices to SoonerCare (Oklahoma Medicaid) members resulting in $1,055,581 in Medicaid savings.