Volume III      Issue 5                                                                            May/June 1998
Copyright 1998, Neighborhood Legal Services, Inc.

    Everyone, it seems, has a web page. Through Internet browsing you can shop for a car, find out if your favorite team is losing, plan your shopping list and check out the National Institute on Disability and Rehabilitation Research links to many Internet sources of assistive technology (AT) information. You can also do legal research through a growing number of web sites which provide access to laws, regulations and many other documents in a computer-based or electronic format.

    How do you use the Internet to find helpful information without wasting valuable time? Unlike the volumes in a bookstore or library, the Internet library of web pages is not limited to materials that have been pre-screened, edited and organized by professionals. Searching the "net" is not as simple as walking over to the biography section of your local library. Many web pages have promising titles and great graphics, but contain very little useful information.

    There is an up side to the Internet, however. Our readers include a mix of persons with an interest in funding of AT: persons with disabilities; parents of children with disabilities; special educators; physical, occupational or speech therapists; rehabilitation counselors; equipment vendors; advocates; and attorneys. The Internet has something to offer each of you as you attempt to fund AT for yourself, your child, your patient or your client.

    This article will introduce you to web pages and explain some typical ways to reach them. We summarize the time-saving use of bookmarks and the links to useful web pages that exist on many of the better web pages. We then provide you with some practical examples of how to use the material (or "sites") within our web and the "links" within our web page to analyze AT funding issues.

    If you advocate for AT funding, you may need access to statutes, regulations, agency policies, case law, administrative decisions, legal treatises, manuals, articles and newsletters related to the issues you face on individual cases. Many of these resources may not be available within your office or, if they are, may not contain current information. The web pages of various government and non-government entities can bring many of these resources right to your computer screen.

    You can also find information about an individual's disability and various AT devices on the web pages of disability organizations, university departments, equipment vendors and others. These resources can educate the advocate who, in turn, will educate the decision maker who will decide if a funding source should pay for the special equipment or services in question. Many of us have accumulated information like this in file cabinets, filing it in subject files so that we can retrieve it when we need it again. Think of the Internet as an opportunity to create the electronic equivalent of those file cabinets, file drawers and manila folders that many of us currently use.

    This article uses the term "web page" to describe what you reach, for example, when you type "www.nls.org" and hit "enter" through America Online's web browser to reach the web page of our parent organization, Neighborhood Legal Services (NLS). We use the term "site" to describe a specific location within a web page, like the March-April 1998 issue of our IMPACT newsletter, one of many documents you can access on our web page. Four typical ways to reach a web page are discussed below.

    The technical term for a web page address is the "uniform resource locator" or URL. One of the better web pages you will want to check out is that of the National Health Law Project, an organization with offices in Los Angeles and Washington, D.C. Their web page address is www.healthlaw.org. If you like their web page, you will want to bookmark it or add it to what America Online refers to as your "favorites" list.

    This is where you can eat up time and obtain lots of irrelevant and poor quality information in your search for the good stuff. For example, assume you want information about Medicaid funding of power wheelchairs and, like most of us, you are not a skilled web searcher. Let's also assume you are using the popular search engine known as Alta Vista (altavista.digital.com). The results of the searches listed below will be different -- either better or worse -- if you use another search engine, like Lycos (www.lycos.com) or Excite (www.excite.com).

    You start by typing in the term wheelchair and hit enter (or "search") to search for relevant web pages. When we did this search, we turned up 21,929 documents (either web pages or sites within pages). Among the top 10 on the list is a page describing the rules for wheelchair racing and a poem entitled "Wheelchair Eddie." None of the top 20 documents contains helpful information. (You generally will not go beyond the top 20 documents found through a word search.)

    Next, you use the search terms wheelchair and Medicaid together which turns up 22,452 documents. Among the top 20 on the list are a web page from a medical transportation company which accepts Medicaid funding, web pages which discuss Medicaid legislation, and other interesting leads that are not directly relevant. Number 12 on the list is the vocational rehabilitation site on the NLS web page, something we prepared in connection with our New York State AT Advocacy Project. Oddly enough, the search brought you to a part of our web page that does not deal with Medicaid directly. Number 20 identifies the Public Benefits site of the NLS web page. This provides direct access to state Medicaid regulations, but will not provide direct information about funding wheelchairs. (The Public Benefits Unit of NLS specializes in welfare advocacy.)

    If you took some time looking at numbers 12 and 20, those sites would lead you back to the NLS "home page" or main menu page. There you would see that separate sites are set up for our State and National AT Advocacy Projects. However, if you spent the last two hours chasing down dead leads, you are likely to quickly conclude that numbers 12 and 20 are irrelevant.

    For your third search, you use three terms -- wheelchair, Medicaid and power. Now your search turns up 52,833 documents, but your top 20 closely resembles the top 20 found through search number two, including the same two sites from the NLS web page. Here again, having chased down many previous leads to dead ends, it is likely the searcher will quickly rule out these sites as irrelevant.

    Finally, you search using four terms -- wheelchair, Medicaid, power and funding. This turns up 55,626 documents and this time you hit pay dirt. Number four on this list references what we have titled the "Assistive Technology Funding Link" within the NLS web page, specifically zeroing in on the New York State AT Advocacy Project's sites. When you put the cursor on the highlighted language of number seven and hit enter, you go directly to what we often call our State AT sub-page. Number four on the list also references the AT Funding Link, this time zeroing in on our National AT Advocacy Project's sites. When we see two very relevant sites come up in the top seven of 55,000 hits, we know that we have used good search terms. We also know that our web master has done a good job of choosing key words for registering our web page with the major search engines, like Alta Vista.

    Our example may lead you to the mistaken conclusion that your search for information is a simple matter of trial and error. The problem is that web searching often takes hours, not minutes and sometimes you never hit pay dirt. If you are going to do your own web searching, you should invest in a handbook or magazine that will teach you some web searching tricks. You should also review the help sections and tutorials offered by your Internet service or the search engine you are using. Finally, talk to others and learn from their experiences. When you do find a site that you expect to use again, bookmark it for future use.

    A bookmark is typically a descriptive listing of a web page or a site within a web page that you store on your computer for future access. For example, you may want to create the bookmark, "New York AT Advocacy Project." Then, when you go to your bookmark list, you can easily get to our web page without the necessity of remembering our web address and re-typing it each time. You can also bookmark it so that you go right to our AT-related sites rather than starting at the home page or main menu.

    Let's use the analogy to the library or bookstore again. If you use the library or bookstore often, you instinctively go to the section that contains your favorites, such as biographies, sports books or the works of Hemingway. In your own mind, you have bookmarked that section of the library and will come back to it. Similarly, if you regularly use a law library or a university’s library, you know where to find the reliable resources.

    As you use the Internet, you should strive to create your own customized bookmarking system. Using what Windows 95 calls "folders," you can create any number of subject matter folders or sections within your list of bookmarks and then file your bookmarks under the respective folders so that you can easily keep coming back to the web pages and specific sites within web pages that you find most useful. Over time, you may create additional folders and delete some bookmarks as you add others, just as you might add and delete materials from your office file cabinet.

    Here is how you might customize your bookmarks list. Two categories (or folders) a disability advocate might want to create would be Legal Back Up and Legal Research. Under your Legal Back Up folder, you decide to set up bookmarks to the web pages of:

• the New York AT Advocacy Project (www.nls.org) and
• the National Health Law Project (www.healthlaw.org)

Here is what that folder might look like:

    For your Legal Research folder, you decide you want to start out with bookmarks that will take you to the United State Code, the Code of Federal Regulations and the Federal Register. Now you are going to name your bookmarks by the category of information they take you to, rather than by the web page they take you to. Here is what your folder might look like:

    0 LEGAL RESEARCH
                        / U.S. Code
                        / Code of Federal Regulations
                        / Federal Register

    As you find additional web pages that allow you access to state laws, state regulations or case law, you will want to consider bookmarking them and listing them within this folder. If you get too many of them, you may want to either delete some or reorganize your folders and bookmarks. As you really get into this, you may wish to add folders titled Disability Organizations and Assistive Technology.

    Always take maximum advantage of the work that others have done to make the Internet a tool you can use. Many organizations have devoted hundreds of hours to searching the Internet to find the best resources available for specific purposes. Take advantage of the work they have done and don't spend endless hours redoing it.

    Back to the library analogy. When you set foot in a library you are taking advantage of the work others have done to make the library a tool you can easily use. Somebody created an indexing system, somebody reviews potential books and decides which ones go into circulation, and somebody evaluates when to purge old volumes to make room for new ones. Just as you would not attempt to re-do the work of the library staff, you should not attempt to re-do the work of others in creating a personalized Internet resource library.

    Our Neighborhood Legal Services web page contains many good links to legal information. On our home page or main menu, you will find a listing for "Legal Research Links." When you move your mouse to that listing and hit enter, you are taken to a separate site within our page containing 14 different categories of links. It looks something like this:

    When you select one of these categories, you are then taken to a listing of relevant web pages and links that allow you to go directly to those web pages. You may want to borrow some of our links for your own bookmarking system, but most likely you will simply create the bookmark on your computer to allow you to go quickly to the NLS page where you can take advantage of the many hours we have invested to make life easy for those who visit our page. If you find that the links provided by our page or another agency's web page meet your needs, you will want to come back to it again and again as a starting off point for your Internet-related research.

    The New York AT Advocacy Project plans to develop additional links over the next few months so that the users of our web page will have ready access to many of the best sources of non-legal, disability-related information. If you have some favorite web pages that you like to use, share them with either Bill Mastroleo or Jim Sheldon at the AT Advocacy Project.

    Our regular readers are persons who have a need to know how various funding sources will react to a request to fund an AT device. They may wish to know if Medicaid can be expected to fund a power wheelchair with a tilt in space function. They may also need to know if New York’s Office of Vocational and Educational Services for Individuals (VESID) can be expected to pay for repairs to a van lift it has purchased for an individual who is sponsored by VESID to attend a college program.

    In both cases, whether our reader is an individual with a disability, a service provider, an equipment vendor or an attorney, he or she will ultimately need to know what legal criteria will govern Medicaid or VESID in each instance. Both case issues and many others can be addressed by using the resources available on our web page.

    Using your Internet provider (such as America Online, Prodigy or AT&T WorldNet), you go onto the Internet. If you bookmarked the Neighborhood Legal Services web page as we suggested, you go right to our page using the bookmark. If you have not bookmarked it, you will have to type in our web address or URL (www.nls.org) to get to our page.

    When you get to the NLS home page, you will be asked to select either "text" or "graphics." If you are visually impaired and use voice output software or screen readers, you will want to select "text." Having made your selection, you are taken to what we call our "main menu" page, which gives you several options to go to sub-pages: e.g., "New York AT Advocacy Project," "Vocational Rehabilitation" or "SSI Work Incentives." Select New York AT Advocacy Project and you will be taken to our project’s sub-page.

    You are confronted with a new menu for sites within the project’s sub-page. You decide to see if our newsletters offer any guidance. You select "IMPACT - The Project’s Previous Newsletters." This takes you to a table of contents for our newsletters which you scan. You decide to check out the January 1996 Medicaid article first which deals with the Medicaid prior approval process for persons seeking durable medical equipment. You decide to download or print the January 1996 newsletter for later reading so you can move on with your research.

    Some of you may want to do some more digging into the general Medicaid issues. You are still on the Internet and still on our web page (or you can easily get back to it). You go back to our main menu page and select the National AT Advocacy Project. On the National AT Project’s menu page you select "Article on Funding AT for Persons with Disabilities." This article, which was originally published in the May-June 1997 issue of Clearinghouse Review, provides a very in-depth analysis of Medicaid, special education programs and state vocational rehabilitation agencies with many references to law, regulation, policy and court decisions.

    In the Medicaid section of this longer article, you find a reference to the federal law which states that a primary goal of Medicaid is to furnish persons with services to help them "attain or retain capability for independence or self care." See 42 U.S.C. § 1396. You decide that you want to look up 42 U.S.C. § 1396, so you return to our web page’s main menu and select "Legal Research Links." Go to the box or menu item titled "Federal Laws" and click your mouse. That takes you to another screen (or "site") where we have listed web pages that provide access to federal statutes. Under the subheading "U.S. Code," you select "Univ. of Calif., GPO Gate" (www.gpo.ucop.edu/search/uscode.htm). On the GPO Gate page you are offered the opportunity to type the full cite and you type in 42 U.S.C. § 1396. You now bring up the full text of this federal law and you have still not left your computer.

    Having used our web page and links to gain some general understanding of the Medicaid issues, you turn your attention to the specific issue of the power wheelchair with the tilt in space function. You go back to our IMPACT newsletters on our New York AT Project sub-page and scan through our five or six most recent newsletters to see if we have reported on a Medicaid decision involving a tilt in space wheelchair. You zero in on three of our newsletters that mention relevant fair hearing decisions:

    Based on the three decisions you just identified from our web page, you use the "Feedback" form on our web page to send us an e-mail requesting that we send you copies of these three decisions. Alternatively, you make a note to either call us and ask for Marge Gustas [716-847-0655 ext. 264] or to fax us your request [716-847-0227].

    What you will want to know to address this issue is whether federal law or regulation would require VESID to pay for repairs to van lifts under some circumstances. Staying right on our web page, you go back to that longer article on funding of assistive technology and go to the section which discusses the obligations of state vocational rehabilitation agencies. There you find references to the federal law [29 U.S.C. §§ 701 et seq.], to the federal regulations [34 C.F.R. Part 361] and to the February 11, 1997 issue of the Federal Register where these new federal regulations first appeared.

    Once again, you can return to our main menu and select "Legal Research Links." There, in addition to the menu choice for Federal Laws, you will also be offered menu choices for Federal Regulations and the Federal Register. By selecting any of these menu choices, you will be taken to web pages where you can follow instructions to bring the relevant federal regulations or federal register pages directly onto your computer screen.

    Without going through all the steps to take you there, using this method you are able to review the federal regulations which define "assistive technology device" and "assistive technology service." See 34 C.F.R. § 361.5(b)(7)(iii). Reviewing the definition of AT service, you see that it includes repairs, maintenance and replacement of AT devices. Since AT service is part of the definition of rehabilitation technology [see 34 C.F.R. § 361.5(b)(39)]which is a mandated service under Title I of the Rehabilitation Act [see 34 C.F.R. § 361.48(a)(18)], it would appear that VESID would have an obligation to pay for repairs to a van lift for a person still enrolled in VESID-sponsored training if that repair is needed to ensure the person’s safe transportation to and from the training or education site. You either print or download the relevant provisions of law and regulation, making a note to call the AT Advocacy Project to discuss this issue with us.

    The Internet should clearly be considered as a resource for advocates and others who are looking to obtaining funding for AT devices and services. Unless you have time to devote to mastering the art of web searching so that you can create your own system of folders and bookmarks, we recommend that you find a few good web pages that contain useful information and useful links to other web pages. For some, the web page of the New York AT Advocacy Project and the links within it will be enough to allow you to get maximum use of the Internet with the smallest investment of time.

    During the upcoming months our project will be creating additional links on our web page to a range of non-legal, disability related web pages. For those of you who wish to begin exploring that area, we suggest that you look at the following web pages and the links within them:

• the National Institute of Disability and Rehabilitation Research (www.ed.gov/offices/OSERS/NIDRR)

• the United Cerebral Palsy Associations’ Assistive Technology Funding and Systems Change Project (www.ucpa.org/html/innovative/atfsc/index.html)

    When you see how long some of these web page addresses are, you will understand why we recommend that you bookmark them.

Important Web Sites

United States Code www.gpo.ucop.edu:80/search/uscode.html
Code of Federal Regulations www.access.gpo.gov/nara/cfr/cfr-table-search.html
Federal Register www.gpo.ucop.edu:80/search/fedfld.html

AT COURT WATCH

Massachusetts Court Orders Medicaid Funding
for Handi-Move Wall-to-Wall Lift System

    Gatto v. Bullen, Mass. Superior Court, # 97-2787-G (2/26/98): A 40 year-old woman sought Medicaid funding for this $5,466 system. Medicaid denied the request claiming there were less costly and equally appropriate alternatives to allow for transfers in the bathroom and other parts of the house. In reversing, the court reasoned that the Handi-Move meets the Massachusetts definition of medical necessity in that this is the only device that will decrease the number of needed transfers, thereby preventing the worsening of the plaintiff’s condition (i.e., the back pain which frequently occurs when transfers are made). The court also found that the hearing officer’s disregard of the report of plaintiff’s treating physician "was arbitrary, capricious and otherwise not in accordance with the law."

    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.

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