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Indiana Protection & Advocacy Services

IPAS > Assistive and Information Technology > Tools You Can Use Tools You Can Use

Funding Assistive Technology

A skillfully drafted letter of medical necessity is an essential part of a request for funding for Assistive Technology. A letter of medical necessity, whether being submitted to the Department of Human Services, a private insurance company or another funding source, should contain the information needed to convince the reader that the requested Assistive Technology is necessary to meet the medical needs of the person for whom the Assistive Technology is being requested.

The letter of medical necessity should be written by a medical professional familiar with the requesting party's medical condition. The professional should briefly describe his or her credentials and relationship to the requesting party. This professional may be a physician, a nurse, a physical therapist, an occupational therapist or other medical professional. However, note that most funding sources require a physician's prescription as part of the funding request. Therefore, letters of medical necessity not written by a physician should be endorsed by a physician or accompanied by a physician's prescription.

Elements of a Medical Necessity Letter

  1. Disability Description - The letter should contain, usually at the beginning, a thorough description of the requesting party's disability. This description should include an explanation of how the disability affects the requesting party's function. For example, the effects of the disability on the use and function of the requesting party's leg. The disabling condition(s) and/or functional limitation(s) that necessitate the request for the Assistive Technology should also be highlighted.
  2. Assistive Technology Description - The Assistive Technology being requested should be described in detail. A more thorough description is required when the requested technology is new, unique, customized or not frequently requested.
  3. Assistive Technology Relationship to Medical Needs - The letter should explain how the requested Assistive Technology addresses the requesting party's medical needs or functional limitations. Generally in this context, a medical need is not a ;need to receive medical treatment. Rather, it is a need to compensate for a function that is limited as a result of a disability. For example, a requesting party has a medical need for a wheelchair to compensate for lost function in the lower extremities and to have a functional means of mobility.
  4. Inability of Alternatives to Meet Medical Needs - Where there are alternatives, especially less expensive alternatives, available to met the requesting party's medical needs, the letter should explain why these alternatives are not appropriate for the requesting party. Also, the specific features that make the requested technology the necessary and appropriate alternative should be identified.
  5. Ability to Use Technology - the letter should detail the requesting party's ability to use the requested Assistive Technology. This is especially important when the technology is motorized, electronic or particularly sophisticated. For example, when a power wheelchair is being requested, the requesting party's ability to safely operate a power wheelchair should be noted. If there was a trial with the requested device, the results of this trial should be summarized.
  6. Requested Assistive Technology as Community Standard - The letter should justify and explain the requesting party's need for the Assistive Technology. This justification should be in terms of the community standard of practice by the medical professional's peer group. The medical professional should explain that it is the standard practice or current practice in their medical profession to provide the requested Assistive Technology to people with the requesting party's disability.

Example Letter

The letter that follows is a sample letter of medical necessity. The numbers contained in the letter correspond to the numbered elements listed above.

<This fact sheet was produced with funds from the Governor's Advisory Council on Technology for People with Disabilities/STAR Program funded by the National Institute on Disability and Rehabilitation Research under the Technology-Related Assistance for Individuals with Disabilities Act of 18 as amended, P.L. 103-018. This fact sheet may be reproduced with credit to the Minnesota Disability Law Center if reproduced in its entirety.>

The Minnesota Disability Law Center
430 First Ave. N., Suite 300
Minneapolis, MN 55401-1780
Toll Free Number: 1-800-292-4150

January 20, 2008
RE: Ms. Jane Doe
Clinic#: 4124-109
DOB: 5/21/64

To Whom It May Concern:

(1) Ms. Jane Doe is a 30-year-old woman with C5-6 quadriplegia related to a motor vehicle accident in 1985. Despite her significant disabilities, she has been able to achieve independent living with the assistance of a personal care attendant. (1) However, she continues to have difficulties with environmental controls within her home due to her impaired upper extremity function.

(1) Due to Ms. Doe's high level of injury, she is unable to use her upper extremities to control her environment. She is in need of being provided with appropriate technology for permanent use. I recommend that a voice recognition system from Advanced Speech Interface Systems, Inc. be purchased and installed in Ms. Doe's present residence. (2) This company has demonstrated their equipment to us and will be able to provide ongoing service of their product.

(6) This system is medically necessary and I accepted among the medical community because it provides people with C5- quadriplegia (like Ms. Doe) independent living to generate self-care and self-esteem as mandated under federal law. (6) In order to maximize Ms. Doe's functional independence, an environmental control system I medically necessary. (3) She would benefit from a (2) voice-controlled system that allows her the ability to control multiple functions within her home such as opening doors to exit her residence in case of an emergency situation like a fire, (4) since she is currently unable to do so without the assistance of a personal attendant. (2) This system will also allow her to change the room temperature to prevent hypothermia, (3) since a person with C5-6 quadriplegia has difficulty maintaining a normal body temperature. (2) In addition, it will provide her with the means to dial a phone by using voice commands in the event of an emergency. (3) Because of her condition, this system will increase her functional capabilities and decrease her need and use for a personal care attendant.

Ms. Doe needs this system immediately. She is not going to recover nor regain any of her functional ability due to her disabling condition that occurred nine years ago. I recommend that this system be provided by Advanced Speech Interface Systems, Inc. (2) This company has been in this field of expertise for 10 years. They are a recognized medical assistance provider, and they are supported by the medical community. The system provided by Advanced Speech Interface Systems, Inc. will be customized to Ms. Doe's medical needs. (6) Because this system will be specifically catered towards her health needs, it represents an effective and appropriate use of program funds.

If you have any questions or concerns, please contact me.

SIGNED: _____________________

Philip Physician, M.D.

Physical Medicine and Rehabilitation Specialist

How to file a 508 formal complaint

Section 508 uses the federal procurement process to ensure that technology acquired by the federal government is accessible. The law also sets up an administrative process under which individuals with disabilities can file a complaint alleging that a federal agency has not complied with the standards. This process uses the same complaint procedures established under section 504 of the Rehabilitation Act (which covers access to federally-funded programs and services). Individuals may also file a civil action against an agency to seek injunctive relief and attorney's fees (but not compensatory or punitive damages). The enforcement provisions of section 508 are effective as of June 21, 2001.

By statute, the enforcement provisions of section 508 apply only to electronic and information technology “procured on or after the effective date.” As a result, section 508 does not authorize complaints or lawsuits to retrofit technology procured before this date to meet the board's standards. However, even though section 508's enforcement mechanisms apply only to “procurement,” the law does require access to technology “developed, used or maintained” by a federal agency.

"Undue Burden" Exemption

A Federal agency does not have to comply with the technology accessibility standards if it would impose an undue burden to do so. This is consistent with language used in the Americans with Disabilities Act (ADA) and other civil rights legislation, where the term “undue burden” has been defined as "significant difficulty or expense." However, the agency must explain why meeting the standards would pose an undue burden for a given procurement action and must still provide people with disabilities access to the information or data that is affected.

Source: The Access Board: Electronic and Information Technology Standards

  • To build and document your case, be sure to include:
    • Your name, address, telephone/TTY number and e-mail address
    • Name and address of the federal agency
    • A detailed description of the product or service that is inaccessible
    • The date you became aware of the inaccessible product or service
    • A detailed description of the inaccessible feature or functions, including exactly what happens or what does not happen
    • Suggestions for improvement
    • Assistive Technology you use with this product or service, such as the name and version of your screen reading software
  • Contact the 508 Coordinator for the applicable agency and find out where to register a complaint
  • Follow the agency’s specific procedures
    • Under section 508, each agency develops procedures for handling complaints

Source:Information Technology Technical Assistance and Training Center