From left: Mark Schultz, Frank Lloyd, and Mary Jo Iwan.

Reimbursement. for many providers, this is the most difficult and frustrating part of their business, particularly when dealing with a government program. But this need not be the case. Nebraska’s Assistive Technology Partnership is a model of how reimbursement—both private and government—should work.

“The only thing better that I’ve ever dealt with in a situation like that is a cash paying customer,” says Jon Novak, a sales representative for Brown’s Home Health Supply of Omaha, Neb. “[The AT Partnership] is a little bit less on the profit, but you know you’re going to get paid, and you get paid fairly quick.” In most cases, reimbursement takes only 3 to 4 weeks.

The partnership, whose goal is to keep disabled Nebraskans independent and out of nursing homes by getting them jobs, believes it is not enough to simply set disabled people up with jobs. They also work with independent companies, such as Brown’s, to get people the ramps, lifts, and other products they need to get out of their homes and to jobs.

The Assistive Technology Program is the lead agency in the partnership that was formed with Nebraska’s Vocational Rehabilitation Department and Department of Health and Human Services (HHS) in 1997. Prior to forming the partnership, HHS had been doing assistive technology modifications on its own, with less than satisfactory results. “Because we lacked the expertise that we thought was needed, we know we spent a lot of money on various equipment and modifications that might not have been done the best way or in the best interests of the client,” says Mary Jo Iwan, Aging and Disability Administrator for HHS. “We had experiences where there were problems with the work done, and so a couple of years ago, when we were looking at our long-term plan for the state, we examined what were the services people really needed. Instead of the typical approach of just putting services into somebody’s home, we tried to make somebody more independent and less dependent on all these services—and that’s where assistive technology (AT) and home modifications come into the picture. We wanted to be able to change the life of that person and enable that person to do a lot of things for him or herself.”

Assessment Is Step One
The process of helping a client begins with an on-site assessment. The AT team then comes up with a solution, hires a contractor to do the modifications or provide the equipment, and then monitors the project to make sure the case is resolved satisfactorily.

Unlike many government programs, the AT Partnership does not arbitrarily set a standard, but goes to the experts—the providers—to help find the best solution for the client. “They called me up...and said, ‘What do you feel is the best piece of equipment for a stairway lift?’” Novak says. “Obviously, what I said made sense because they made that the standard unit....I told them it wasn’t the least expensive, but it was best to spend the extra money up front instead of on the back end worrying about repairs and service.”

Saving money in the long run is key to the program’s survival. Originally, it was completely federally funded, but now the state of Nebraska contributes 21% of funding. The federal funds are scheduled to run out this year. “If we lose those funds, it creates a challenge for us to model these services to other programs that aren’t currently in the partnership,” says Mark Schultz, director of the AT Partnership. “And we lose our ability to create more awareness about assistive technology for the general public. The other challenge we have is within these programs...the need and demand for assistive technology right now are greater than the dollars we have to support staff.”

Because the budget is tight, the partnership always aims to use its funds for the best, most cost-effective solutions. “For example, in situations in which...the property is a rental and the person is elderly, instead of building a wooden ramp, we have purchased the aluminum modular ramps,” Schultz says. “Although the aluminum ramps are more expensive initially...they are easily recyclable and we can remove them and put them on another location.”

This is how the partnership is able to maximize its resources. “A benefit of this partnership [is that] while the equipment may have been purchased by one system, as it comes back in as a piece of recycled equipment, it can go out to any one of those systems under which an individual falls and has a need,” Schultz says. “It’s really increased the cost benefits for all those programs.” The recycling program has saved the state $105,000.

Who Benefits?
Clients are recruited throughout the Nebraska social services departments and private sources, including the mental health system, developmental disability system, schools, and physical therapy practices. The partnership also does targeted marketing to the general public.

In addition, having Schultz’s team as the lead agency helps the other agencies to find more people to assist. “With Schultz’s program, he not only provides services for a lot of the people we work with, he also is a feeder for our program because he’s out working in the community...and he’ll refer people to us,” says Frank Lloyd, director of Vocational Rehabilitation. “It is like a giant web. You get all these programs that operate independently, but they are aware of the resources of the other programs and can be very fluid in how they partner.”

The AT Partnership’s success can be measured in several different ways. From a taxpayer’s perspective, it has leveraged more than $8 million for its programs. Each technology request averages $2,500, half of the yearly per person HHS cap, and home modifications are at a little more than $4,000 per request. HHS has estimated that the AT Partnership has saved the state $3 million over the last year.

For Brown’s Home Health Supply, the program has helped its bottom line both directly and indirectly by creating a whole new group of customers, Novak says. “There was a lady who worked at the Marriott Hotel—[AT Partnership] got her a job there and then she came back to me with insurance through Marriott,” he says. “It was 4 or 5 years later and her insurance company buys her a scooter, instead of having to go back and stay on the program.”

The partnership—with its goal of keeping people independent—has been a good investment. “The cost of assistive technology and home modification can be recaptured in 2 months by preventing institutionalization,” Iwan says. In Nebraska, nursing home costs average $56 per day or more than $20,000 per year.

A testament to the success of Nebraska’s AT Partnership is that Iwan and her colleagues were asked to make a presentation about it at the National Medicaid Conference. And though Iwan says that any state can make this happen, she admits that there were other challenges that needed to be faced. “For Health and Human Services, it really has been a cultural change,” she says. “In the past we have just been putting services in people’s homes and now we are shifting to trying to make them more independent.”

What makes the program work is its market-based approach, Novak says. “It is the only way that I see where the government can efficiently help the most people and still maintain a relationship with vendors that allows us to make a profit and gets them the best possible pricing,” he says. “It is the best face you can put on a government-funded program.”

C.A. Wolski is associate editor of Dealer/ Provider.