REPORT WRITING: JUSTIFYING THE
NEED FOR ASSISTIVE TECHNOLOGY

INTRODUCTION

    Previous issues of IMPACT have discussed many different funding sources for AT, including Medicaid, Medicare, private insurance, the special education system, the Veteran’s Administration, the Office of Vocational and Educational Services for Individuals with Disabilities (VESID), the Commission for the Blind and Visually Handicapped (CBVH) and the Supplemental Security Income program’s Plan for Achieving Self Support.

    Each of these funding sources will generally require a report or letter of justification before approving funds for an AT device. This report may come from a doctor, a physical therapist, an occupational therapist, a speech pathologist, a special education teacher, a vocational rehabilitation counselor or any number of other professionals. In this issue of IMPACT, we will discuss report writing as one means of justifying an AT request.

    The writer must impress upon the reader that his or her report is worthy of value and respect -- i.e., that is was written by a professional. This starts with the physical appearance of the document. The following should be a starting point of every report:

• If the writer is a professional or works for an organization, the report should be written on appropriate letterhead.

• Remember to date the report.

• When in doubt, use white paper to maintain a professional appearance.

• The report should be typed and proof read.

• Be sure to include a signature.

• The document should be neat in appearance and easy to read.

    Although many funding sources will require completion of an agency form, a supporting letter of justification is always a good idea. There is no one special format for writing a report, but there are some general rules to follow:

    Consider this excerpt from a report written for a young man with cerebral palsy. Steve has used a manual wheelchair, but his physical therapist believes he now needs a power wheelchair and a new seating system. What is wrong with this excerpt?

    This excerpt presents several problems for the reader. Does the reader know what CP, TBI, and MVA all stand for? When the therapist uses the term "chair," will the reader know she is referring to a wheelchair? Is the writer asking for a new manual wheelchair, a new seating system or both? What is the significance of the statement about a power wheelchair? The following revised excerpt gives the reader a clearer picture of Steve’s needs:

    Whether the funding source is an entitlement program like Medicaid or a private charity, there will be rules defining what AT is and what criteria must be met. Nearly all reports should address one of the following questions:

• Medical necessity (e.g., Medicaid, Medicare, insurance): Is the equipment medical or remedial in nature, is it medically necessary and cost effective or the least costly medically appropriate alternative, is the request reasonable, and will it correct, cure and/or alleviate a medical problem?

• Educational necessity (special education programs): Is the requested equipment necessary to ensure a free and appropriate education?

• Vocational necessity (VESID, CBVH): Is the requested AT necessary to allow the person to achieve a vocational goal or complete a program of vocational rehabilitation?

    Consider the statements made by a physical therapist who wants Medicaid to pay for her patient’s wheelchair. Has the writer addressed the issue of "medical necessity?"

    This writer has made two mistakes. First, by choice of language, the writer suggests that John’s need for the power wheelchair is based on "convenience," "quick" travel and "easier" movement around school. At no point does the writer state that the wheelchair is necessary for general mobility. Second, the writer is addressing "educational needs," not "medical needs." Although the ability to get around school and participate in school activities is relevant (note: the word "independence" appears in the federal Medicaid law), we recommend that this be referenced as supporting and not primary information. Finally, John’s therapist offered no information about the affects of his cerebral palsy on his mobility and overlooked the potential medical problems associated with asthma. Compare the statements made by a physical therapist who knows her audience:

    The report should serve several functions:

1. Introduce and establish the writer’s credentials.

    In most cases, the writer is reporting as an expert. The writer can establish his/her expert credentials by describing: expertise, licenses, education, current job title and how long the writer has been doing this work. Additional information can include relevant classes or clinics taught by the writer or taken as a student, and any articles written that relate to the content of the report.

    When Ms. Jones, a social worker for a group home, was asked to assist one of the residents who was asking for her family’s private insurance to purchase an augmentative communication device, she reported her credentials as follows:

    Is the report based on a one-time consultation or weekly sessions with the patient over several years? A report will be more effective when it clarifies the nature of the relationship:

    If the writer is a doctor or other health care professional, the report provides an opportunity to educate the reader about the person’s disability. The writer should discuss the patient’s primary and secondary diagnosis, if any, his or her prognosis, and what complications affect the patient, and how. Since the patient is seeking AT which will overcome the effects of a disability, those effects should be described in functional terms. Although the non-medical professional cannot address medical issues, he or she can describe the functional consequences of the disability.

    Consider these excerpts from the reports of Oakvale’s staff doctor, speech pathologist and social worker:

    Since it is common for vendors to refer to their equipment by model names or numbers, the report should give a specific description of the requested AT. The report should also describe any accessories that will be add-ons to the basic equipment. The following excerpt from the report of Mary’s speech pathologist contains the needed specifics:

    In many cases, the evaluations to determine the need for AT have been very comprehensive. Often, those evaluations have included trials on one or more pieces of equipment, including the one now recommended. The writer should describe any evaluations which have lead to the current recommendation. Again, Mary’s speech pathologist:

    The writer must address whether the requested equipment is medically, educationally or vocationally necessary. With Medicaid, for example, the writer would address medical necessity and state why the equipment would cure or correct the effects of the patient’s condition, or prevent them from becoming worse or having new problems develop. Here is how Mary’s speech pathologist addresses this issue:

    Let’s say that Mary is younger and in high school. How might this excerpt read then? Since we would be looking for the special education program to purchase the device, we need to show how the device will ensure an appropriate education.

    The difference between the focus of these two paragraphs should be obvious even though they both address the need for the same piece of equipment. One paragraph discusses the need for self expression in order to engage in activities of daily living and maintain a certain degree of health; the other discusses Mary’s inability to actively participate in a learning experience.

    Remember, cost plays a big part in getting the AT one needs. The saying, "Never seek a Cadillac when a Chevy will do," is truly appropriate here. The writer must convince the funding source that they will not be spending money unwisely. Always approach any argument regarding the cost of an item as a consumer who is well-educated and has shopped around. Provide the funding source with information about different prices for similar models or different features. What is the warranty on the parts? Are there service contracts that might appeal to the funding source?

    Here is what Mary’s speech pathologist has to say about least costly alternative:

    All well-written documents end with an effective conclusion. It summarizes the preceding information and allows the writer an opportunity to briefly restate the case.

    Every funding source for assistive technology will require some kind of report or letter of justification before funding will be approved for an AT device. Tragically, many reports fail to effectively communicate important information because their appearance or content is lacking. By following the simple suggestions in this article, the report writer will produce a report that is likely to result in the approval of funding. If the request for funding is denied, the report will make it more likely that the AT will be approved on appeal.

    As always, we encourage readers who have questions about the content of this article to call the AT Advocacy Project at 716-847-0650. We will be happy to elaborate on any of the points made in this article. This article appears on our web page (www.nls.org) at the New York AT Advocacy Project site.

Do you have decisions of interest relating to assistive technology in the following areas? Medicaid, Medicare, Vocational Rehab, VA, Special Education, Physically Handicapped Children’s Program, Private Insurance, etc.

Other advocates can benefit from your experience. If you have fair hearing decisions or are involved in or have completed litigation in these areas, we want to know about it.