Team Process Approach

Finding and obtaining the funding for assistive technology and rehab equipment, such as a standing frame can be a challenging task. Knowing what your options are and who to turn to throughout the process provides for a more positive experience. For the greatest success in getting rehab equipment paid by your funding source, utilize the Team Process approach. While those involved vary from case to case, the team is often comprised of the Durable Medical Equipment Supplier, Clinician(s), the Enduser, and often the Caregiver or Family.

Rehab Technology Supplier
Your Rehab or Durable Medical Equipment Supplier (ATS, ATP, CRTS) specializes in rehab technology, helping you to find the most appropriate standing technology to meet your needs. They may also be a member of one or more of these organizations: NRRTS, RESNA, TXRPC, NEMED, NCART, AAHomecare, or other regional associations.

The role and/or responsibilities of a DME or Rehab Supplier can include:

• Providing trial rehab equipment or scheduling to trial rehab equipment with a local manufacturer's rep.
• Having expertise on standing equipment and the options that are available.
• Acquiring prior authorization with insurance company or your payer source.
• Providing assembly, delivery and adjustments to individual fit.
• Assisting with the insurance appeal process if necessary.
• Being a valuable resource for a wealth of rehab equipment information.

Clinician
Clinicians on your team can consist of one or more of the following members that may have an emphasis in Assistive Technology (AT): Physician, Physical Therapist (PT), Occupational Therapist (OT) Assistive Technology Practitioner (ATP) Speech Therapist, Special Education Teacher, Physician, etc.

Their role and/or responsibilities can include:

• Physician must approve that it is medically safe for you to stand.
• PT/OT may recommend weight bearing/standing device and program.
• PT/OT may review standing equipment options and make recommendations.
• PT/OT usually writes the letter of medical necessity including trial process.
• Physician usually co-signs the therapist's letter of medical necessity or writes an additional prescription.
• PT/OT usually attends and assists in the final fit and adjustment of the standing equipment.
• If payer source denies standing device, PT/OT may write addendum or new letter of medical necessity and/or attend appeals hearing (via teleconference, in person, or recorded testimony).
• PT/OT may monitor the client's ongoing standing program.

Consumer
The consumer is the person who could benefit from a standing/weight bearing program. The benefits of such a program start with early intervention and continue through to the senior years, taking into account a variety of disabilities. It is the consumer or their legal guardian that is truly the leader of the funding process.

Their role and/or responsibilities can include:

• As the leader, they need to follow up on progress of the funding process through its conclusion.
• Choosing their rehab technology supplier.
• Being aware of their medical need to stand.
• Researching the benefits of standing.
• Specifying wants and needs in standing equipment.
• Trialing and determining the standing equipment.
• Being present for the final fit.
• f an insurance appeal is necessary, the consumer or legal guardian must start the appeals process (often they are the only person who can start the appeals process).
• Once equipment is received and fitted, the consumer must follow through on their standing program to receive the outcomes expected.

Caregiver/Family
The parent, legal guardian, or caregiver of the consumer may be the leader of the funding process if the consumer is unable.

• Handling the role of the consumer if they are unable or under 21.
• Providing support and feedback to the team on transfer techniques and activities of daily living.

Links
Families USA Medicaid Action Center – Be active & vocal!
“Taking a Stand: Evaluation, Justification, and documentation for standers.”