The other day, I was on the phone with a young man who had acquired a spinal cord injury four years ago from a motor vehicle accident. While I was talking with him about the process of acquiring a stander, he seemed to be having a hard time listening to what I was saying. He finally told me he was very frustrated with everything and everyone that day. He couldn’t get an appointment with his doctor in the time frame he needed, his therapist hadn’t returned his calls, and his DME Supplier wasn’t able to provide the equipment he needed. He told me all doctors, therapists, suppliers, manufactures and insurance companies are “in it” for the money; that no one cared about him as a person. His one “bad day” gave him a narrow view of those who could help. His “bad day” was causing this young man to view all those who could help him with a cynical eye.

As manufacturers, clinicians, case managers, suppliers, and payers, we shouldn’t assume what we see or find with one client is how each of our clients will act or behave. We must treat each person as a person, on an individual basis, as we would want to be treated. Consumers need to know that actions or non actions can affect both themselves and others in negative ways. It’s important to follow through with all treatments and technologies prescribed.

Throughout our day, let’s not forget our obligation to treat others as we would want to be treated. Remember someday you could be in the other person’s shoes!

Photo courtesy of charles chan

Have you experienced a similar situation to the examples above? Please share.

But who will be “lucky” enough to get funding for a standing frame? I use the word lucky lightly because it is not so much luck that is needed, but hard work and persistence. One of my favorite quotes from Thomas Jefferson is, “I’m a great believer in luck, and I find that the harder I work, the more I have of it.”

So let’s go back to the three very different consumers. Who do you think was lucky enough to get their stander covered by insurance? Well, they all got their stander covered by insurance, but each had to take a different path. One had to take additional steps and the one that most thought would have the least resistance (the youngest of the group) had to appeal three times!  Let’s meet these consumers:

•Vicki, Cerebral Palsy, Age 16. Private insurance paid on first submission.
•Jeff, T7 Paraplegic, 40+ years post SCI. Insurance paid after one appeal.
•Max, Metabolic Disorder, Age 7. Private insurance denied. Medicaid paid after two appeals.

After reading these stories in my article titled “Making You Own Luck” that was published in Vol. 2, 2011 issue of NRRTS Directions, you will come to find that “luck” had nothing to do with their success in funding standers. These success stories were fueled by customer determination, supportive medical team, and supplier/therapist advocacy.

Read more funding articles and blog posts. 

Have you created your own luck? What steps did you, or will you take to get funding for a standing frame?

“There are always two choices, two paths to take. One is easy and it’s only reward is that it’s easy”. ~Author unknown

On a daily basis, I speak to consumers with disabilities who are looking to purchase Complex Rehab Technology (CRT).  Some are attempting to decide what they should do with the denial they just received from their insurance company. They thought they had all their ducks (paper work) in a row. They thought their clinicians had explained their need for a stander very completely. Yet, they have received a denial for the stander in the mail. Now the question, is what should they do?

As a consumer, it is your right and responsibility to decide your next action. The physician, clinician, supplier nor manufacturer can make that decision for you. You need to decide how important this device is to your life. You may decide that you don’t have any “fight” left in you for the device. Or you may say the stander is of vital importance to your every day functioning. Which ever decision you make, it must be right for you.

If you choose to fight, you do have resources available to you. Remember your medical team, Doctor, PT, OT and Supplier who helped you decide on the correct standing device? They are usually more than happy to help send addendum or additional information to your payer to complete your picture of need.

There are other helpful resources such as:
Funding Guide to Standing Technology on the EasyStand Website
PAAT Directory
AT Projects
Support Organizations

Ultimately which ever choice you make, it is yours to make.

Below is a sample letter of medical necessity for an EasyStand Glider (youth/medium size), graciously shared to us by Lauren Rosen, PT, MPT, MSMS, ATP/SMS. It is also available to download as a PDF.

(Clients Specs – See PDF for more detail)
To Whom It May Concern:

History: D.L. is a 7-year-old with a diagnosis of quadriplegia.  Due to an unknown cause, he has a gap in his spinal cord from C5 to T1.  He is incontinent of bowel and bladder.  His hearing and vision are both intact.

D.L. has decreased trunk strength.  Without trunk support, he is unable to sit.  He can actively move his upper extremities.  He has no active movement of his lower extremities.  Bilaterally, he has ankle clonus and Ashworth 1-2 spasticity.

Currently, D.L. does not have any spinal or pelvic deformities.  His lower extremity passive motion is within normal limits.

Standing has been shown to delay the appearance of contractures and improve those that already exist (1).  Because he lacks the strength to stand, the standing frame will help to keep him in a good position to stretch these muscles for extended periods.  This stretch will maintain and improve his lower extremity range of motion.

D.L. has spasticity throughout his lower extremities.  Standing has been shown to decreased spasticity (2).  Decreasing his spasticity will assist in maintaining range of motion and improving his overall level of function.

Children without disabilities stand between 8-10 months of age.  This standing helps with the forming of the acetabulum (3).  It is very important in children with disabilities to get them standing at a young age.  Because of D.L.’s diagnosis and his spasticity, he is already at increased risk of developing hip subluxation as he grows.  Standing will increase the depth of his acetabulum and decrease his risk of subluxation.

D.L. will benefit from a standing frame that can position him properly in standing. Standing also facilitates better emptying of his bladder, which can decrease his risk of developing urinary tract infections (4)

D.L. is at increased risk of developing osteoporosis due his inability to stand independently (5, 6).  Gudjonsdottir, and Mercer studied the effects of dynamic versus static standing on bone mineral density in children with cerebral palsy. All subjects were non-ambulatory. Half the subjects underwent dynamic standing, the other half static standing. All but one of the subjects showed an increase in bone mineral density in the lumbar spine, proximal femur and distal femur (7).  Additionally, Goemaere et al.9 compared SCI individuals who conducted standing 1 hour, 3 times per week with those that did not. It was found that bone mineral densities were significantly higher in the long leg bones of the standing group (8).

This standing frame will allow D.L. to bear weight through his lower extremities.  Because it is easy to move the frame from a seated to a standing position and it is a dynamic stander, his parents will be able to change his position frequently.  Lanyon and Rubin compared static versus dynamic loads and their influence on bone remodeling in animal models (9). They found that static loads did not have an effect on remodeling where as a similar load that was applied intermittently in a dynamic manner was associated with a substantial increase in bone mass. The dynamically loaded group instead of bone loss demonstrated a mean increase in bone cross-sectional area.

Kawashima, Nakazawa, and Akai performed a study to see if passive leg movement in standing was sufficient to improve the oxygenation of lower limb muscles in populations with SCI (10). They compared SCI patients to neurologically normal controls. Passive movements were performed at different frequencies for 3 minutes each and then EMG activity and oxy and deoxy hemoglobin were measured. They discovered that passive leg movements did induce not only EMG activities but also an increased oxygen perfusion to the muscle in SCI populations whereas the controls showed no changes. This study demonstrates a significant benefit to individuals like D.L. for dynamic standing.

With the glider, he will get dynamic loading of his bones rather than just static loading.  Research has shown that more dynamic weight bearing results in less of a loss in bone mineral density (11).  This will provide him with the maximal benefits from standing.

The other benefits of standing are well established.  In addition maintaining his lower extremity range of motion, which is important for him, a standing frame has many benefits.  Standing has been shown to improve circulatory, gastrointestinal, bowel and bladder, and respiratory functions (3,4).   Walter et al. sent questionnaires to individuals with SCI who had purchased standing frames from two different companies (12). The data was analyzed for perceived benefits. These included improved quality of life, decreased urinary tract infections, and decreased spasticity among others. Those that stood greater then half an hour per day and a statistically significant improvement in secondary complication rates. They also quoted a study by Warren et al. that showed that compliance for standing with frames or tilt tables is greater than compliance for standing with KAFO’s in the home environment.

D.L. cannot move himself independently to shift his weight.  This puts him at an increased risk of developing decubitus ulcers (4).  People who stand for at least 30 minutes a day have less pressure sores than those who do not stand (12).

Current Program and Standers Considered:

At this time, D.L. has an EasyStand Magician stander.  He uses the stander daily. Because of the good trunk support, he uses it while he works on different reaching activities, such as turning pages in books and playing with toys.

His mother transfers him independently at home and she continues to need a standing frame that can be operated by only one person.  It would be unsafe and impractical to try to lift and position him into a prone or supine standing frame.

D.L. has outgrown this stander.  Without a new stander, he will not be able to continue his standing program.  As a sit-to-stand stander remains the most appropriate type of stander for him, this is the least costly and most medically appropriate device to allow him to continue to stand and to get the most medical benefits from standing.

Equipment Trial

EasyStand Evolv Glider: D.L. used this unit on numerous trial occasions with excellent results.  Video can be provided if necessary.  His mother was able to set up the system and complete transfer and positioning help as needed.

Recommended Equipment: D.L. is currently at the shortest height range for the recommended stander once the conversion is made so he has maximal growth capability with this stander and it will last him a longer amount of time.

Standing challenges the cardiovascular system by requiring the heart to pump the blood flow against gravity in an upright position. The EasyStand Evolv Glider also provides and upper body strengthening that D.L. is able to complete while he is standing further conditioning the cardiovascular system.  The increase in cardiovascular function further decreases skin breakdown risk due to increased oxygenation to the tissues.

As discussed above, D.L. is at high risk for long term osteoporosis due to lack of weight bearing and muscle stress on long bones. The increase in calcium can contribute to renal stones, which can lead to significant debilitation and increased cost of care.  Normalizing weight bearing and stress on the long bones as provided by the Glider may assist in reducing these medical complications.

After a full examination by the rehabilitation team and D.L.’s family, the following equipment is deemed medically necessary:

1. EasyStand Evolv Youth Glider that comes standard with includes chest pad, glide handles, adjustable resistance cylinders, flip-up kneepads, and adjustable footplates.

Additional Glider options necessary to maximize D.L.’s function:

1.       Quad Grip Handle Extension: Given D.L.’s decreased ability to grip the actuator to raise or lower himself, this grip extension is necessary so that he can hold onto the actuator.  Without this, he will not be able to hold the actuator and he will be completely dependent to raise or lower the system.

2.       Secure Foot Straps: With D.L.’s spasticity, it is difficult to keep his feet positioned properly.  The foot straps will assure that his feet stay on the footplates so that he gets the necessary benefits of standing.  With the glider feature, it is especially important that his feet remain properly positioned to prevent injury from falling out of the system.

3.       Hip Supports-Medium: With D.L.’s decreased trunk control, he needs lateral hip support to maintain upright standing in the stander.  These will work with the lateral supports to properly position him and allow him to remain in the stander for extended times.

4.       Glide Handle Extensions: Given D.L.’s height and size, he requires the extension so he can reach the handles to use the glider function on the stander.  Without these, he will not be able to use the dynamic feature of the stander.

5.       Contoured Back 19”: This is the contoured back support is similar to the contoured back on his wheelchair.  It is needed to provide him with the necessary postural support.  Without this option, he will have no support behind his back, which will make using the stander unsafe and impossible for him.

6.       Velcro Positioning Belt: This basic positioning belt will keep him properly positioned in the stander.  This is an important safety device.  Without it, he will be at increased risk of falling out of the stander.

7.       Lateral Supports 9”-15” W: With D.L.’s decreased trunk control, he needs lateral trunk support to maintain upright standing in the stander.  These will work with the hip supports to properly position him and allow him to remain in the stander for extended times.  With the glider, he especially needs the trunk supports to prevent him from falling out as he moves his upper extremities.

Thank you for your assistance in maximizing D.L.’s function.

Sincerely,

_____________PT______                                                               ______________Physician__

(List References – See PDF for more details)

A special thank you again, to Lauren Rosen, PT, MPT, MSMS, ATP/SMS for sharing this successful letter of medical necessity with us.

Jeff told his DME (Durable Medical Equipment)/CRT (Complex Rehab Technology) supplier,  “That’s crap! I will not accept a denial from my insurance company for the stander. I’ve got to have the stander at home to keep my leg range of motion. What can I do to fight their decision?”

What is self advocacy?

Self advocacy can be described as people with disabilities speaking up for themselves.

Even though a person with a disability may call upon the support of others, the individual is entitled to be in control of their own resources and how they are directed.

As medical care becomes more complex, along with shrinking healthcare dollars and problems with payer coverage, patients have had to become stronger self-advocates for their own care and for the insurance coverage due them. Every time a person speaks for themselves to resolve a problem, they are practicing self advocacy. At the doctor’s office, or before a medical procedure, the patient must read and sign a consent form stating that they understand the reason for the procedure or visit. If there are questions about the procedure or visit, it is the patient’s responsibility to ask questions and get answers before moving forward. This action of “asking questions” and “understanding the answers” is the act of self advocacy.

Self-advocacy can also include any verbal or written action which describes a problem that the individual is having. This action is then intended to create interest and action by another person to assist the person in resolving the specific problem. Thus, a person might be self-advocating to an individual (such as an OT or PT), or to a company or organized body (such as an insurance company or a State/Federal agency.)

How does self advocacy help Jeff get his stander?

The simple act of Jeff telling this CRT supplier that a denial is not acceptable is self advocacy. Jeff is creating interest and hopefully action on the part of his CRT Supplier.

Assuming the stander documentation is medically appropriate and complete, the next action by the supplier should be, “Have you considered an appeal?” Now it is Jeff’s responsibility to read and understand what the appeal process is for his insurance. If the supplier sees that Jeff is having a difficult time understanding how to proceed with the appeal process, or has questions on how he can fight against his large insurance company or public payer, the supplier should refer Jeff to the local PAAT (Protection Advocacy for Assistive Technology) group.

PAAT (Protection Advocacy for Assistive Technology) attorneys and advocates are a free resource available to assist people with disabilities and their families as they seek funding for Assistive Technology (AT). PAAT locations throughout the US offer support, resources and guidance through the appeals process. Click here for a link to your state PAAT directory.

As a consumer, are you self advocating, or expecting that someone else will take care of you? As a CRT Supplier, do you know about the PAAT resource to help your customers self advocate?

What is Complex Rehab Technology (CRT)?
Complex power wheelchairs, highly configurable manual wheelchairs, adaptive seating and positioning systems and other specialized equipment (such as standing frames and gait trainers) are considered “Complex Rehab Technology” or CRT.

What can I do to help change the access issues that are ever expanding?
You can get involved. Yeah, I know, your very busy, there are only 24 hours in a day, you already do so much for your job, or as a consumer you can barely finish your daily living tasks, etc. If you and I don’t get involved who will? Where will this access spiral end?

How do I get involved?

• Stay informed, go to NCART (The National Coalition for Assistive and Rehab Technology) website
• Contact your local Senator and Representative’s office and help the staff understand the issues and the fix.
• Attend local seminars and conferences and spread the word about the need for a separate benefit category for CRT.
• Attending a national meeting like CELA

What is CELA?
One of the ways that I get involved is by attending the CELA (Continuing Education and Legislative Advocacy) 2011 Conference in Washington DC. The education part of the conference was great, but my reason for attending was to be involved in a fix for the access issues we continue to face everyday.

Here is a brief look at CELA 2011:

Part of the Minnesota CELA delegation (Laurie, Marsha, and Pat) waiting outside Senator Klobuchar's office.

Wednesday February 16^th
Attendees assembled by state. We heard a key note speaker discuss CRT in Health Care Reform; next we had an update on Users First Alliance. Finally on to the Capitol Hill orientation and state delegations’ meeting. Half of the Minnesota delegation had been to CELA and the Hill before, the other half were new to this experience. We discussed our plan for the next day, the role each of us would play in the brief time we had with each congressional staff.

Thursday, February, 17^th
This was was our day on the Hill.  Each attendee (Supplier, Clinician, Manufacturer, and most importantly, the Consumer) went to visit our member of congress or their staff. It was our day to explain the need for a separate benefit category for complex rehabs technology (CRT).

We discussed what CRT is (see definition above).  We described the people with complex disabilities such as Cerebral Palsy, Muscular Dystrophy, Multiple Sclerosis, Spinal Cord Injury, etc. who use CRT. We also explained that these products are not the kind you see advertised on TV, but instead are the type of products similar to that used by the late Christopher Reeve.

Next we explained the entire Team process involved in the assessment and provision for CRT. From the team of clinicians involved in assessment and documentation, to the CRT supplier staff that is trained and credentialed and how the process is labor intensive with high operating costs and many more steps than standard DME.

Our final request was for Congressional support or sponsorship of legislation to create a Separate Benefit Category for CRT, similar to the one that exists for O & P (Orthotics and Prosthetics) under the Medicare DME benefit. We explained that this category must be established so that access to this critical technology can be assured. The basic Medicare durable medical equipment (DME) benefit does not meet the complex needs of individuals who require assistive rehab technology.

After five meetings with Senate and Representative legislative staff, we were tired, yet fueled from being involved in a solution to continued CRT  access.

If you are reading this blog you are in some way part of CRT, either as consumer, clinician, supplier or manufacturer. Please do more, be involved in a solution to access. Can you think of other ways to be involved?

A special thank you to all who work so hard to put together CELA 2011 and more importantly the CRT~ Separate Benefit Category Proposal.

Think for a moment about one of your dearest family members. Imagine if you will, that they were unfortunately, suddenly in grave need for a wheelchair, standing frame or other equipment. They would be unable to be independent, healthy or social without this equipment. Due to lack of sensation your loved one develops pressure ulcers where the bones in their tailbone break through the skin. They are in desperate need of a custom molded seating system and pressure mapping. (Lets keep in mind that pressure mapping is not reimbursable to a vendor. The cost for a system is $12,000). You are concerned about the ability for a new wheelchair to fit into the various rooms of the house for baths etc.

Competitive bidding happens. You call your clinical facility. You live in Boston. A winning bidder in Seattle contracts another company an hour away in Methuen, MA. to come and do your wheelchair. The person that shows up tells you that you can only have a basic chair because the cost is prohibitive. No mold is done as it costs more to do the mold than the company is reimbursed. You have problems after the sale and are directed to call Seattle office. Seattle office tells you to call the Methuen office. You take a day off from work to wait for the technician to come repair your chair. They never show. Meanwhile your loved one is trapped in bed until the chair is fixed.

While I am a firm believer in free enterprise, competitive bidding simply isn’t competitive. If it were, there would not be a cap.

Now you could have called the company 10 miles away that has an excellent reputation in the industry. They have qualified, trained ATP’s on staff. They have always been an above board Medicare provider. But you can’t call them for your new chair because they didn’t bid low enough in a bidding process that attempts to drive reimbursements to a price that is lower than what the supplier pays for the equipment.

We all agree that healthcare costs are outpacing our ability to contain them. DME and Rehab represents less than 1% of the total healthcare pie, yet no other arena of the healthcare community has suffered such Draconian measures.

It is my strong belief that competitive bidding will have the following negative results:

1. Ethical small businesses will be driven out of business.
2. Failure of such businesses will have an adverse impact on client choice and client care.
3. Inferior quality of care will result in higher costs for procedures such as myocutaneous skin graft surgeries, ER visits, and hospital and PCP visits. These unseen and increased expenses will far exceed the original savings sought.

As a member of the small business community my job, the life savings of the owners, and the jobs of my peers are at stake if competitive bidding is allowed to be employed. So for the safety, comfort, and care of our patients, please consider ending competitive bidding for good.

How do you feel about competitive bidding?  Do you have similar concerns?

This article was re-posted with revisions from the Complex Rehab Network, an online community and resource for those folks involved in Rehab Seating and Positioning for adult and geriatric markets. Sponsored by Active American Mobility.
photo credit: Valerie Everett

As I expected, NCART (National Coalition for Assistive and Rehab Technology) pulled together an exceptional, fully packed program. Presenters included experienced legal experts that shared their Medicaid knowledge and examples of appeals cases won. Also presenting were complex rehab suppliers, State Association Executive Directors and manufacturers who shared their methods of working with their state Medicaid offices to gain appropriate payment and coverage policies.

The case presentations had a recurring theme – of working together as a team (suppliers/dealers) through your state association.  Together the “team” can be successful in developing a relationship with your Medicaid policy, coverage and payment staffs by sticking to the facts, and using concrete data about the issues you both face.

NCART has decided to share the “Medicaid Summit Attendee Workbook” throughout the industry in order to distribute all the information that was presented. Here is the PDF of the NCART Summit Workbook that you can download or view.

Whether you are an industry veteran or a new face to Complex Rehab Technology, let’s work together as a team, with our State Medicaids and consumers  to ensure appropriate rehab technology access for all.

Photo Credit: Hanan Cohen

On September 26, 2010 auction experts and economists sent a letter to Ways and Means Health Subcommittee Chairman Pete Stark (Democrat from California). The economists noted that due to a “collection” of problems, in time the program will descend to a “race to the bottom”.  This will likely lead to DME suppliers becoming unreliable and the quality of service and products will deteriorate.

Here is a copy of the complete letter sent, and an interview in HME News with Peter Cramton, the University of Maryland economist  who got 167 economists and auction experts to sign the letter.  Please take a moment to read it, as this flawed program will eventually impact you or someone you love, unless action is taken now!

TAKE ACTION, ENSURE ACCESS:
Contact your members of Congress and let them know what you think about Medicare’s Competitive bidding of DME. Use this quick link to help you contact them. You can also help spread the word by viewing the video below, “Jenny Takes on Capitol Hill” and sharing it with your referral sources, clients, friends and families.

Have you thought about your future needs for DME /Complex Rehab Technology recently? If so, what are you doing to ensure access to needed equipment?

1. Public Insurance (Medicaid, State Waiver programs)

2. Private Insurance (i.e. BCBS, HMO, PPO, etc)

3. Worker’s Compensation

4. Disability Insurance

5. Liability Insurance (i.e. car, home, etc.)

Note: Remember, when submitting for a standing frame for insurance your therapist will need to write a detailed letter of medical necessity stating why YOU (specifically) need to stand. if you get denied by an insurance company for medical equipment that will improve your quality of life, APPEAL! You may need to appeal more than once.

6. Vocational Rehab

7. Purchase by Workplace: If a standing frame could help the individual be more productive or efficient during the workday, the employer may purchase the stander for use while at work.

8. Cash Sale

9. Credit Card or Payment Plan Talk to your supplier to see what options are available.

10. Low Cost Loan Specific to Assistive Technology (through your state AT Project)

11. Creative Saving/Budgeting: Get creative! We have had some customers who have asked for cash in lieu of gifts to save up for their stander.

12. Purchase by the school for the school: When standing is part of a child’s IEP, or if the standing frame is purchased for the use of multiple students in a school setting, it could be paid for by the schools capital equipment budget. There may also be funds left from the IDEA Part B school stimulus funds.

13. Purchase by facility for the facility: Often the rehab facilities and clinics who are prescribing standing are also standing their clients. These funds would be available through the rehab clinic/hospital’s capital equipment budget for more or updated standers.

14. Local Charities or Churches: Rotary Clubs, Lions, etc. may donate money to an individual in need of a standing frame.

15. Disability Groups: Organizations such as MDA, MS Society, UCP, etc. may help with the purchase of a standing frame.

16. Grants: Grants for facilities and schools may be available for capital equipment purchases.

17. Fundraisers: Well-organized fundraisers by families and friends for a person in need can often raise enough money for one or more pieces of needed assistive technology.

18. Discounted Demonstration Equipment: Local EasyStand representatives often have demonstration equipment for sale at a discount. Check with your local EasyStand rep or Kevin Markgraf at 800-342-8968 to see what’s for sale in your area.

19. If Denied, Appeal: Always appeal a denial from public and private insurance. Rejection and appeals is often part of the process.

20. PAAT (Protection Advocates for Assistive Technology): Use the services of advocates and attorneys at PAAT for appealing. Their services are free and often invaluable.

21. Buy a Used Standing Frame: Check out the EasyStand Facebook page, the CareCure forum, and you local ebay and Craig’s List to see if there is a used standing frame available for less then the cost of new equipment.

22. Veteran’s Administration: If you are a veteran, talk to the doctors at your local Spinal Cord Injury VA Hospital about getting a standing frame.  Altimate Medical Inc. has a VA Contract #V797P-4469a for the EasyStand Evolv, Evolv Glider, and StrapStand.

For more resources on funding for standers, go to www.easystand.com/funding

How did you get your stander paid for? Do you have any tips or funding sources to add to this resource list?

Photo Credit: Lisa Brewster, Khaleeka, and the National Guard

Here are some of the areas that must be included in the LMN/J:

• Include client name, date of birth, diagnosis, onset, height, weight, primary funding.
• Users level of function
• User’s medical issues and outcomes expected by use of the standing frame.
• Other less costly alternatives were considered i.e. ROM, splints, other methods of weight bearing
• Other medical intervention may be necessary if your client cannot receive a standing frame (i.e. surgeries, bracing, etc.)

Of high importance is the inclusion of:

• The types of standing technology that were considered and rejected.
• A description of the standers that were trialed, and why each trial either approved or rejected.
• Provide the user’s history of standing compliance.

Conclude the LMN with this information and stress necessity and importance:

• What type of standing technology is being recommended and why?
• What options/accessories are being recommended and why (i.e. lateral supports to assist with symmetrical alignment of the upper body, ankle straps for L/E alignment and safety, etc.).
• What is the prescribed standing program (i.e. minutes/hours per day, days per week)?
• Supportive research bibliography on standing if citing research
• Include the date and both the Therapist’s and Doctor’s signatures.

Here is a PDF sample of a successful letter of medical necessity for the EasyStand Bantam, that has all the items specified in our checklist above. Many more samples of successful letters of medical necessity for standing frames can be found on the EasyStand website.

For more details on what should be included in the LMN/J documentation click on these links:

http://www.easystand.com/health-benefits/research.cfm

Do you include all these items on your letters of medical necessity for standers? What other tips or advice do you have on how to successfully document a client’s need for standing technology? Please comment below.

The objectives of CELA and our visits to Capitol Hill were to:

1. Create an understanding for future legislation supporting a Separate Benefit in Medicare for Complex Rehab Technology.
2. Thanking our Congress person for signing on to H.R.-3790, or discussed why they needed to sign on to this important legislation. H.R.-3790 amends title XVIII of the Social Security Act to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner.
3. Our last objective was to invite our members of Congress to visit our companies, be it, Suppliers, Rehab facilities, or Manufacturers during their August recess to help them gain actual sight experiences with Complex Rehab Technology and the consumers who use it.

A big thanks to CELA Team Minnesota!

I want to personally thank the Minnesota CELA team of Marcia Margolis PT at Fairview University Hospitals & temporary consumer, Derek Anderson, Brian Crenna and Jackie Semrad dedicated suppliers from Reliable Medical and Mark Schmitt, a consumer and manufacturer for making my CELA 2010 experience inspiring.

Have you thought about inspiring others in Washington D.C.? I strongly encourage those just thinking about CELA 2011, to get off the fence post and just do it!

This is Amy from New Zealand, who we recently met on our EasyStand Facebook page.  New Zealand has a funding system by the government called Enable. When equipment is no longer required, it goes back to Enable into a storeroom to be re-issued, which is how Amy got her EasyStand Evolv!

The American Recovery and Reinvestment Act (ARRA), more commonly known as the Economic Stimulus Package, was signed into law last year and continues through the end of 2010. According to the Council for Exceptional Children, this act more than doubles federal funding for programs such as special education and early intervention.

. . . this act more than doubles federal funding for programs such as special education and early intervention.

The Department of Education released their guidelines on how stimulus funds might be used in ways that aligned with their core reform goals. Topping their list of possible uses for IDEA Part B Funds was to “obtain state-of-the-art assistive technology devices and provide training in their use to enhance access to the general curriculum for students with disabilities”. According to the Dept. of Education, Assistive Technology is defined as “Any item, piece of equipment, or product system… that is used to increase, maintain, or improve functional capabilities of individuals with disabilities…” Standing frames like the EasyStand fit the definition of Assistive Technology.

Topping their list of possible uses for IDEA Part B Funds was to “obtain state-of-the-art assistive technology devices and provide training in their use to enhance access to the general curriculum for students with disabilities”.

The Department of Education goes on to explain that these funds are only available for two to three years, and that any purchases made with stimulus funds must be a short-term investment that has the potential for long-term benefits. An EasyStand standing frame is a one-time investment that has long-term benefits. Its durability allows it to be used in your classroom for many years by multiple students. Including standing on a child’s IEP can help them to achieve simultaneous goals (i.e. the child uses their stander for weight bearing during speech therapy or for inclusion in physical education activities).

Now is the time to speak up about the assistive technology needs in your classroom, before the funds are no longer available.

Learn more about how the economic stimulus plan can help your school:

State/Program Allocation Tables for Recovery Funds at Dept. of Education: Find out how much your state/program will receive for education programs under ARRA.

Education and Recovery Reinvestment Center at Learning Point: Numerous resources, including a Fund Finder , State Resources, district and local services, and more.

Has your school used stimulus funds on assistive technology already? What equipment was purchased?  What advice would you give others who are going through the process?