Integrating Adaptive Design Services into Managed Care
Special Projects Fund
October 11, 2016
Standardized equipment for children with disabilities serves many purposes, but cannot meet all the requirements of children with nonstandard body types and learning needs.
Adaptive Design Association (ADA) builds custom adaptations to wheelchairs, hearing aids, and modified computers—using a collaborative design process with members of the child’s care team—that allow children with disabilities to be more independent at home, in school, and in the community, as well as improve their physical and emotional health. The majority of adaptations and educational services provided are covered by grants from private and community foundations, which is not sustainable. As New York State moves towards a new reimbursement system under Medicaid Redesign and the Delivery System Reform Incentive Payment (DSRIP) program, ADA received funding from the New York Community Trust to hire a managed care consultant to explore reimbursement possibilities for its services. In 2016, NYHealth awarded ADA a grant to supplement the consultant’s work to ensure financial sustainability of ADA services.
Under this grant, ADA worked with the consultant to (1) explore how ADA services could be incorporated into treatment programs for children with disabilities under the new managed care organization (MCO) system; (2) identify channels of reimbursement through MCOs (or other means) for those services; and (3) build general organizational capacity. Specifically, the consultant educated ADA staff on MCOs and coordinated meetings with appropriate stakeholders and experts. Additionally, the consultant identified the cost of services; feasibility of reimbursement for those services; requirements for participation in managed care networks; and the best strategy for outreach to MCOs and how to commence negotiations, contracting, and coordinating with one or more plans.