AT3: AT Reuse & Medicaid Questions and Answers for AT Act Programs (Q&A)

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Questions to Consider

  1. Have you talked with your Medicaid Program about Reuse?
  2. Who is pursuing this partnership? (Agency, Legislative, Advocates, AT Act Program)
  3. Do you currently have an AT Reuse Program?
  4. Ownership of DME?
  • What else?

(Include Questions from Stan> Sara S.)

Budget Considerations

Q1. What startup costs will be incurred?

  • A1. That depends on whether the contract is with an existing program with staff and facilities in place. The program will require an administrator and some staff with supporting facilities and equipment (space, utilities and computers.) In addition to an expense budget for repairs and refurbishing, an inventory management system for tracking equipment and recipients (in the event of product alerts or recalls) is essential. Transportation resources will be needed for pick-up of donations and delivery of equipment. Other expenses include education for staff and device recipients and expenses for marketing and public awareness.

Q2. What is the budget for a reutilization program?

  • A2.That depends on the structure of the reuse program: physical size of the state (transportation consideration), population, scope of reuse operation, and whether repairs and refurbishing are subcontracted to commercial providers or performed in a fixed location with separate resources.

Q3. Are Medicaid funds (with federal match) used for the refurbishment of equipment supplied to Medicaid patients?

  • A3.In Kansas, Medicaid reimburses the cost of equipment refurbished for beneficiaries. More than 70 percent of that equipment comes from public donations. Equipment provided to non-Medicaid beneficiaries is refurbished with funds from other sources.

Q4. What items should we recover and reutilize?

  • A4.That depends on extent of devices currently purchased by Medicaid, the priorities of the program and the needs of the populations served. The program may want to recover the most frequently needed devices (mobility equipment), or it may consider targeting expensive equipment (e.g., bariatric equipment and CPAP machines.)

Q5. What level of savings can be expected from the reuse program?

  • A5.To be conservative, assume that the program is cost neutral in Year One, and then use the experience of recently started programs (e.g., Oklahoma) to project savings.

Q6. Do any programs rent equipment?

  • A6.None have been identified, but it is possible. That would be categorized as device loan, which is a reuse activity.

Q7. Do any programs charge fees to the customer? Some reuse programs charge a modest application or service fee.

Q8. How many FTE's are estimated for the reuse program? That depends on the program model, who performs specific activities, and the size and nature of the state to be served.

Building Positive Partnerships

Q9. How can commercial DME providers be encouraged to support the reuse program? Emphasize the commitment to involve providers in the program. Kansas relies on certified DME vendors to ensure that donated equipment is refurbished to high standards and is in good working condition when the consumer receives it. Refurbishment costs are reimbursed on a per item basis. Authorization requests detailing the proposed work and cost for parts must be approved prior to the start of the repair. The coordinator reviews the proposal and works with the DME provider if there are any questions. The request is then submitted to the program director for approval. Total approval process generally is completed within 24 hours. Vendors receive payment within two to four weeks of completing the work.

Q10. What other parties should be included as stakeholders in building a statewide network? Potential partners include: State AT Act Program and the AT Resource Centers, other existing reuse programs, Vocational Rehabilitation, Centers for Independent Living, Goodwill Industries, nonprofit organizations that serve people with disabilities (local chapters of Easter Seals, United Cerebral Palsy, Multiple Sclerosis Society, ALS Society, Muscular Dystrophy Association), rehabilitation centers or hospitals, AgrAbility, Area Agencies on Aging

Contracting Reutilization Operations

Q11. How does Medicaid contract this process? After defining the conditions, Medicaid may issue a Request for Proposal to permit interested parties to apply.

Q12. What are the criteria for contractors? Contractors to administer the reuse program should have experience in DME reutilization, have demonstrated financial and organizational stability and sustainability, the ability to provide timely delivery and a plan for covering the entire state.

Q13. How long will the planning take prior to implementation? Assuming that no legal barriers exist and that full use is made of lessons learned from both longstanding and recently started programs, comprehensive planning could be accomplished in 12 to 18 months.

Q14. What type of interest should Medicaid expect from bidders? This will vary by state. The most likely bidders are existing providers of DME services or DME reutilization services. If reuse programs exist in the state, they are the most likely bidders. One might expect a lead agency or provider to bid to administer the program but include others, whether commercial or nonprofit, to perform some of the services such as refurbishing equipment or providing transportation.

Education and Public Awareness

Q15. How are service providers educated about reutilization? Pass It On Center has extensive information available about reutilization and appropriate practices in its Knowledge Base and Webinar Archive. This includes resources about where to find third-party training for program staff. Q16. How are recipients of refurbished equipment educated? The program will need a website and printed collateral explaining how the program works and the practices employed to make reuse a safe option. Training in the use of devices assigned to the recipient should be provided prior to or at the time of delivery.

Q17. How does a new program gain acceptance with Medicaid beneficiaries? Acceptance begins with the involvement of consumers in the design and development of the reuse program. It is reinforced by a commitment to high standards that result in safe, effective and appropriate reutilization. Acceptance may be diminished if a reused device is the first and only option. Choice is an important component of gaining consumer acceptance.

Operational Issues

Q18. Are recipients of equipment required to be Medicaid beneficiaries? The program determines eligibility. Some programs serve beneficiaries and those eligible to become beneficiaries. The program may serve Medicaid beneficiaries and the general public and have different eligibility requirements and funding sources

Q19. How are liability concerns mitigated? The reuse program must demonstrate compliance with all applicable laws and regulations. It must institute operational policies and procedures consistent with the Indicators of Quality for AT-Reuse to ensure safe, appropriate and effective reuse. This includes the use of appropriately trained individuals to perform sanitization and repair services and to match customers to appropriate devices. Devices often come with limited warranties or commitment to make needed repairs within a specified period. Recipients are given appropriate training in the use of the device(s) and often asked to sign releases from liability. Most programs have a follow-up protocol (usually telephone calls) to ensure that the device is being used and that the user has not encountered problems.

Q20. How is the need to return equipment communicated to the user? This is usually explained in a program brochure, at the time of application for equipment, when the equipment is assigned and in the delivery agreement. Many programs have providers attach permanent stickers to the devices with messages (e.g., “When this equipment is no longer needed, call 1-800-999-9999.”)

Q21. What is process for returning equipment when no longer needed? The customer may call a specified number to indicate that the device is no longer needed and can be retrieved. The customer or family member may return the device to the designated location or arrange for pickup.

Q22. Who will clean the devices? Standards are specified in the Indicators of Quality for AT Reuse for cleaning and handling. Donated devices should be sanitized at the refurbishing program following protocols specified by the manufacturers and Centers for Disease Control and Prevention (CDC). These protocols may be device-specific and may be found in Pass It On Center Knowledge Base, Webinar Archives. Sanitization may employ automated cleaning or hand cleaning or a combination of the two.

Q23. Can publicly-donated devices be placed on hold for Medicaid? In a partnership with Medicaid, the program may provide for Medicaid to have priority for devices or to place holds or requests under specified conditions (a specific period of time or specific devices.) Kansas and Oklahoma maintain a real-time inventory system.

Q24. Who makes the decision to dispose of the items and on what basis? The party responsible for repair and refurbishing devices must be qualified to determine when a device has no more useful life. That decision will be based on age, condition and functionality. No device should be added to inventory that is not completely safe for reuse. In some cases, devices may be cannibalized for spare parts. In others, the entire device must be disposed. The program should have contracts in place with certified recycling resources to dispose of devices or parts in a manner consistent with environmental safety and all prevailing regulations. Sometimes recycling may result in some financial return to the program for reclaimed materials.

Q25. What quality controls will be in place to ensure quality work and appropriate equipment? Policies and procedures must be implemented and consistently followed to ensure safe, effective and appropriate reuse. This includes proper training of staff, use of professionals where needed (e.g., matching or setup, depending on the device).

Q26. What type of monthly reports will be provided regarding pickup, delivery, repair, etc.? The program should have a database or inventory system capable of tracking these activities and generating monthly reports. The nature of the reports should be specified in the contract.

Q27. How can the Medicaid program monitor the reuse activities? The program may have access to the real-time inventory and reporting system. Medicaid can require regular reporting. It can assign an individual responsibility for monitoring the activities through visits to service providers and contact with device recipients. These activities may be formulated into a protocol of regular visits and specific numbers of contacts. It can create a point of contact in Medicaid for beneficiaries to report problems with reutilized equipment.

Q28. Are there special issues regarding emergency preparedness? Program contractors should be expected to have an emergency response process defined that includes continuity of operations planning (COOP). As an additional service, it is helpful if the program provides emergency preparedness guidance to customers. Templates for such publications are available in the Pass It On Center Knowledge Base and from other reuse programs.

Pass It On Center has an ongoing initiative for Emergency Management and AT Reuse. Summits have been held in FEMA Regions III, IV and VI (all of the Gulf Coast, Southeast and Mid-Atlantic) to share ideas and plan to disasters. If a reuse program or part of its service area experiences a disaster affecting people and their access to assistive technology, reuse programs in other states will assist in the response to needs. The program may trigger the request for aid by creating a spreadsheet of specific information about the needed devices and instructions for an accessible delivery location. When this spreadsheet is forwarded to Pass It On Center, it is shared with all major reuse programs to assist in locating the needed equipment. One of the largest reuse programs, Friends of Disabled Adults and Children (FODAC) in Georgia has been a leader in disaster response but many others have also helped. FODAC usually involves commercial providers, who have been very generous in providing free equipment for disaster response.