Medicare, Part B
Legislative/ Legal Basis
Title XVIII of the Social Security Act
Eligibility
Persons who are 65 years or older and persons who are under 65, but disabled enough to qualify for Social Security Disability Insurance (SSDI) for at least 25 months.
Payment Policies
Durable Medical Equipment (DME) is equipment which can withstand repeated use, is primarily and customarily used to serve a medical purpose, generally is not useful to a person in the absence of an illness or injury, and is appropriate for use in the home. If considered to be DME, a device is covered, whether purchased or furnished on a rental basis.
Medicaid
Legislative/ Legal Basis
Title XIX of the Social Security Act
Eligibility
Categorically needy persons who are eligible for AFDC or Supplemental Security Income programs. Some states cover medically needy whose income, after medical expenses, fall below income threshold.
Payment Policies
Varies from state to state, but generally follows Medicare policies. Medical necessity is critical factor for payment.
TEFRA
Legislative/ Legal Basis
Tax Equity and Fiscal Responsibility Act of 1982
Eligibility
Birth through 6 Provides coverage for children diagnostically eligible (as established by SSI definition), but would be financially ineligible for SSI due to parent income. Children must meet medically necessity requirements for institutional care
Payment Policies
The intent is to provide the necessary services, including equipment for the child, to remain in the home versus institution.
Private Insurance: Health, Disability Liability, and Self-Insured Employers' Insurance
Legislative/ Legal Basis
Insurance Contract
Eligibility
Persons recognized as beneficiaries/dependents under particular insurance policy
Payment Policies
Depends upon the terms of the contract. In some cases, equipment is specifically excluded, however, often is not explicitly specified in the contract. Payment then depends upon insurers' legal obligations, and the role of the desired equipment in meeting those obligations.
Federal/State Rehab: Title I: VR Services; Title VI: Supported Employment; Title VII: Independent Living; Title VIIC: Independent Living (Elderly Blind)
Legislative/ Legal Basis
Rehabilitation Act of 1973 and Amendments (Title I)
Eligibility
Working age persons who are disabled and have some potential to benefit. Emphasis is on persons with severe disabilities. Other Titles of Rehab. Act stress Independent Living/Support Employment, where vocational potential is not the determining factor.
Payment Policies
Equipment that is justified as expediting goal of vocational placement. Usually purchases reserved for clients who are at least job ready (Title I). In many states, rehab. agency retains ownership to equipment.
Veterans Administration
Legislative/ Legal Basis
Title 38 of the U.S. Code
Eligibility
Veteran's service/financial status -Category A: Service connected veterans or non-service connected, but with income below $15, 000 (single); $18,000 (with dependent). Category B: Veterans not in Category A, but with annual income below $20,000 (single); $25,000 (with dependent). Category C: all other veterans.
Payment Policies
Equipment is paid for when deemed part of overall medical or rehabilitation intervention, which is dependent upon eligibility status. VA pays for equipment, such as mobility and transportation aids, when deemed necessary. Benefits provided to Category B vets on an as-available basis and to Category C vets as available, with some co-payment required.
Workers' Compensation
Legislative/ Legal Basis
Individual state Workers' Compensation Laws
Eligibility
Workers covered under employer's workers' compensation policy, as mandated by state law.
Payment Policies
Many states require physical and vocational rehabilitation benefits as means of helping return injured workers to the workplace. Equipment is often purchased as part of the rehabilitative process when deemed cost-effective
Credit Financing
Legislative/ Legal Basis
Federal Reserve Regulations including anti-discrimination law (Reg. B), and Truth in Lending Law (Reg. Z)
Eligibility
Based upon applicant's credit history, collateral, and other assurance of the likelihood the loan will be repaid
Payment Policies
Some equipment that would be difficult for bank to resell in event of default may need to be secured in other ways, however, borrower basically determines what is to be financed
Last Updated: 3-2-2006
