Step 3: Document why you need the device or service
Documentation is very important in securing funding for assistive technology device. You have to prove your need to the funding organization or agency. You can document in form of a written evaluation, a medical prescription or any other way to justify why you need the device. The extent, detail and scope of the document determines you successfully getting the device you need.
Make sure you obtain the assistance of a professional to develop the documentation of need. A good documentation should include input from some combination of professionals; a doctor, a teacher, a speech therapist, a physical therapist, occupational therapist, an assistive technology specialist, case worker, and so on.
Documentation can be one or combination of the following;
- Physician’s prescription for the assistive technology (device and/or service) that you need. The prescription will be duly signed. For Medicare, Medicaid and some other sources, there must be a “determination of medical necessity” in order to receive authorization for assistive technology.
- Medical diagnosis by the professionals involved in your case, this may provide specific medical information regarding your needs.
- Physician letter describing the medical necessity for assistive technology device.
- Letter of medical necessity describing the medical necessity for assistive technology device.
Letters of Medical Necessity
A letter of medical necessity is a very important document when requesting funding for assistive technology. Almost all funding sources, whether it is Medical Assistance, private insurance, or a waiver service program, will require a letter of medical necessity. A letter of medical necessity is written by a health care professional to explain the reasons the assistive technology is needed. The letter should convince the reader that the requested assistive technology is necessary to meet the person’s medical needs.
The letter should be written by a medical professional who is familiar with the person’s medical condition. The letter can be written by a doctor, a nurse, a physical or occupational therapist, or another medical professional. If you have an evaluation for the assistive technology with someone like a physical or occupational therapist, that person may write an evaluation report. The evaluation report is the same as a letter of medical necessity. In addition to a letter of medical necessity, most funding sources will require a prescription from your doctor.
An important note: The person reviewing your request may not be a doctor or medical professional. Therefore, a well-written letter of medical necessity is one that can be understood by a lay person. It should not use a lot of medical terminology or abbreviations that are not familiar to the average reader. If a medical term or abbreviation is used, it should be explained in a way that can be understood by a lay reader.
Elements of a Letter of Medical Necessity
Element 1: Disability Description
The letter should begin with a detailed description of the person’s diagnosis and disability. This description should explain how the person’s disability affects the person’s functioning. For example, if a person is diagnosed with a spinal cord injury, the letter should explain what effect the injury has had on the person’s ability to walk, talk, and use their arms and hands.
Element 2: Assistive Technology Description
The letter should describe the assistive technology in detail. If the technology is new, customized, or not frequently recommended, the description should be even more thorough, because the reviewer may not be familiar with new or less common devices.
Element 3: Medical Need for Assistive Technology
The letter should explain how the assistive technology will meet the person’s medical needs or functional limitations. Sometimes assistive technology is needed for medical treatment, but, in most cases, it is needed to compensate for a function that is limited as a result of a disability. For example, a person has a medical need for a wheelchair to compensate for lost function in their ability to walk and to have a functional means of mobility. A tilt feature on the wheelchair helps a person reposition their body (a function) and also provides treatment by helping to prevent pressure sores.
Element 4: Other Alternatives are not Appropriate
Where there are alternatives, especially less expensive alternatives, the letter should explain why those alternatives are not appropriate for the person. The letter should also describe any special features that make the requested device necessary and appropriate compared to other devices that do not have those features.
Element 5: Ability to Use Technology
The letter should detail the person’s ability to use the assistive technology. This is especially important when the technology is motorized, electronic, or particularly sophisticated. If there was a trial with the requested device, the letter should summarize the results of the trial. For example, when the request is for a power wheelchair, the letter should describe the person’s ability to safely operate the power wheelchair within the person’s home and community, which could include school or where the person works.
Element 6: Community Standard
One part of showing that assistive technology is medically necessary is to show it meets the community standard of practice by the medical professional’s peer group. This means that the medical professional should explain that it is the standard practice or current practice in their profession to provide the requested assistive technology to persons with the same disability or functional limitations as the person requesting the device.
Sample letter of medical necessity
IMPORTANT: Be sure to keep a file with a copy of all the information related to the assistive technology and your request for funding. Later in the process you may find that you will have to come back to this step and provide further documentation.