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Assistive Technology & Remote Supports Guidance

Attention

All Providers, County Boards, Business Managers, CEOs, & COG Directors

Message

The Ohio Department of Developmental Disabilities is providing this guidance in response to questions that have been asked within Ohio’s support system for people with developmental disabilities. Many questions have been received regarding recent changes in the Remote Supports and Assistive Technology home and community-based waiver rules which no longer allow for the provision of internet.  Additional guidance is also being offered based on general questions received about the Remote Support and Assistive Technology services. If there are any questions regarding this guidance, please contact Kelly Schuck, Waiver Policy Manager, at Kelly.Schuck@dodd.ohio.gov.

 

Internet Access and General Cellular Data

 

Providers, county boards of developmental disabilities, and the Ohio Department of Developmental Disabilities (DODD) have an obligation to ensure that internet access, general use cellular data, or any other general utility are not covered in the monthly fees or any part of the Assistive Technology or Remote Support waiver services.

 

Many devices require internet access or cellular data plans for use as assistive technology. Several situations may be encountered as teams are working through the approval process. Here are some examples and guidance for these situations (this list of situations, resolutions, and examples is not intended to be comprehensive):

 

  1. Situation:  The reoccurring plan will provide general access to more than the functionality required to fulfill the assistive technology need.

Resolution: The device can be purchased as part of the Assistive Technology service, but the reoccurring plan cannot be covered through an HCBS waiver.

Examples:  iPhones, Cell Phones, iPads, Google Nests, Amazon smart devices, Wizard Watches, etc.

 

  1. Situation:  The reoccurring plan will provide access only to fulfill the need for the Assistive Technology device and is limited to that capacity only.

Resolution:  The device can be purchased as part of the Assistive Technology service which may have the reoccurring plan included. Teams will need to review and ensure that the reoccurring plan is not for general utility. The cost of the reoccurring plan would be part of the reoccurring fees, as noted in the Appendix of the Assistive Technology rule, and may not exceed $75.00 total each month.

Examples: 

AngelSense – the AngelSense device would be covered for the individual with the included monthly cost. This monthly cost includes the package needed to use the device. The device that connects with the AngelSense tracker would not be covered under an HCBS waiver service.

Lively mobile + - The Lively mobile + medical alert device would be covered for the individual with the included monthly cost. This monthly cost includes the package needed to use the device.

MedReady – The MedReady medication dispenser device would be covered for the individual with the included monthly costs for monitoring. This monthly cost includes the package needed to use the device.

 

  1. Situation:  The assistive technology device, equipment, or application has a monthly service charge to utilize the technology.

Resolution:  The reoccurring monthly service fee that is needed to utilize the assistive technology can be covered through the Assistive Technology service if it does not include internet access or access to a cellular data plan for general utility. The reoccurring costs would be part of the reoccurring fees, as noted in the Appendix of the Assistive Technology rule, and may not exceed $75.00 total each month.

Examples: 

Ring Devices with Professional Monitoring – The Ring device would be covered for the individual with the included monthly professional monitoring subscription costs. The monthly cost does not include the internet access/cellular data plan that would be needed to utilize the device. This internet access/cellular data plan would not be covered under HCBS waiver services.

GPS Tracking Applications – The fee for the application would be covered under the Assistive Technology service in addition to the ongoing monthly charge for access. The one-time and/or monthly fee for the application would not include the internet access/cellular data plan that would be needed to access and use the application. This internet access/cellular data plan would not be covered under HCBS waiver services.

Guidance for use of Remote Supports with 2:1 staffing

 

The following criteria would need to be assessed and approved by the county board before Remote Supports and Homemaker/Personal Care (HPC) services could be billed at the same time:

  1. The county board would need to show an assessed and approved need for 2:1 staffing.
  2. The Remote Support would need to be used instead of the second staff.
  3. The backup provider for Remote Supports would need to be an additional person that will provide the support, either paid or unpaid. The backup person cannot be the staff that is already in the home.
  4. Remote Support would need to be the least costly alternative.

Equipment Replacement at 24 Months

 

In 2020, the Remote Support and Assistive Technology services celebrated the two-year mark of implementation in Ohio. The Assistive Technology rule specifies that equipment may be replaced after 2 years. However, the rule does not state that the equipment must be replaced at 2 years. There are several options that exist within the rule: 

  1. A purchase agreement is in place with the cost of the equipment divided over 24 months. The person owns the equipment at the end of the purchase agreement. The equipment does not require replacement in this situation if it is still meeting the needs of the individual.
  2. A lease agreement is in place with the cost of the equipment divided over the 24 months. The provider owns the equipment at the end of the lease agreement. In this situation, the individual and team would need to discuss a new lease or purchase agreement with the provider and the equipment may or may not be replaced.

Drop-in Services

 

In the current billing structure, the service of Remote Support cannot be billed for less than one hour of service. DODD understands that there is a need for drop-in Remote Support that can be billed as units for less than an hour of service. DODD will be amending the rule to address this need within the system. Until the rule is amended, DODD supports, if appropriate, teams building any drop-in services needed into the reoccurring monthly fees which can be up to $75.00 a month. This option is only recommended until the rule can be revised.

Passive Services The number of hours of Remote Support services to be authorized should be identified in the ISP based on the assessed need.  Medicaid does not allow for payment of services for a provider to be on-call or on “standby”.  The provider will bill for the hours of active and engaged services as defined in the current rule and authorized in the ISP.  Remote Support services are defined by rule as supports by staff who are engaged by equipment.
Equipment Usage Assistive Technology is purchased for the use of the person enrolled on the waiver and receiving services.  The person should be wearing the technology and using the technology.  If a person has a unique assessed need that makes it impossible to comply with this, please reach out to DODD TA for assistance prior to authorizing.