What We Do

Ability Unlimited is proud to be an Assistive Technology and Durable Medical Equipment provider in Virginia.

Assistive Technology

Assistive Technology (AT) is a very broad term. It involves many professional disciplines, such as Speech and Language Pathologists (SLP), Occupational Therapists (OT), Board-Certified Behavior Analysts (BCBA), and Physical Therapists (PT), in order to determine which discipline will be effective in ensuring a successful outcome to obtain AT. An interdisciplinary team approach, with multiple professional perspectives, works best. Each individual is different, and the evaluation can determine which form of AT will best suit their specific needs. It is important to get a well-rounded evaluation for the individual’s needs. Professional assessments can address the following:

  • Communication Needs (SLP), such as augmentative and alternative communication devices/apps and audiology (hearing aids/cochlear implants).
    • Low-tech solutions that provide modified communication strategies.
      • Examples: Picture communication boards.
    • High-tech systems that provide speech output with a range of alternative access methods.
      • Examples: Switch-scanning, a head mouse, or eye-gaze technology.
  • Environmental Needs (BCBA), such as safety monitoring products.
    • Examples: GPS tracking and sleep safe beds.
  • Mobility Needs (PT), such as adaptive mobility products.
    • Examples: Adaptive bicycles/standers/trams.
  • Sensory Needs (OT), such as sensory friendly products and adaptive products for fine-motor skills.
    • Examples: Adaptive keyboards, mice, touchscreens, switch-scanning, computer apps, or text-to-speech programs.

Durable Medical Equipment

Durable Medical Equipment (DME) is available under Virginia Medicaid, as well as private insurance health plans. DME is available to eligible individuals: all items and supplies must meet the DME coverage criteria.

Coverage Criteria

Medical Necessity: Only supplies, equipment, and appliances determined as medically necessary may be covered. All DME and supplies must be medically necessary to treat a health condition.

The following criteria must be satisfied:

  • Ordered by a Medicaid provider such as Ability Unlimited.
  • Be a reasonable and medically necessary part of the individual’s treatment plan.
  • Be consistent with the individual’s diagnosis and medical condition.
    • Functional limitations and other symptoms as exhibited by the individual.
  • Not furnished for the safety or restraint of the individual.
  • Not furnished for the convenience of the family or providers.
  • Be consistent with generally accepted professional medical standards.
    • Not experimental or investigational.
  • Be provided at a safe, functional, and cost-effective level.
  • Be suitable for use in the individual’s environment (home/community).

DME through EPSDT

In addition, the Department of Medical Assistance Services (DMAS) may cover DME services when the individual is under age 21 and could be covered under Virginia Medicaid through the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT).

EPSDT is a federally mandated program that provides screening and treatment for Medicaid individuals who are under the age of 21. Some DME not otherwise available to Medicaid individuals may be available for this age group through the EPSDT program, if medically necessary. NOTE: Children who are eligible for Medicaid/FAMIS Plus may be eligible for DME. Most FAMIS benefits are administered through DMAS contracted MCOs.

FAMIS enrollees who are not enrolled with a DMAS contracted MCO receive services directly through DMAS as a fee for service (FFS) benefit. FAMIS MCO and FAMIS FFS individuals are eligible for DME benefits.

EPSDT is not a separate Medicaid program; it is available to all children under the age of 21 who are recipients of Medicaid. The criteria requires that the service/item ordered is medically necessary to correct, improve, or maintain the individual’s condition. For example, when a child needs a piece of equipment to function in the home environment, the request may be covered under the general DME program. However, a child who needs a piece of equipment for transportation (e.g., a car seat), or a child who is able to move about in the home but requires a wheelchair for the school environment, may request coverage under EPSDT.

Resources

Table of Contents

Testimonials

Translate »
Scroll to Top