AT-Who Does What
The IFSP team will discuss the need for Assistive Technology. All recommendations will address how the use of AT will assist in achieving a stated outcome on the current IFSP. Note: This is a summary of each team member’s responsibility for completion of prior authorizations. It is not intended to be a step by step guide.
Assistive Technology not requiring a PA from a Bureau Consultant
The therapist:
- completes and signs the Assistive Technology (AT) form
- provides a written justification as to how the AT will assist in achieving an outcome on the IFSP
- obtains a doctor’s order for the AT
- forwards all of the above to the ongoing Service Coordinator (SC)
The Ongoing Service Coordinator:
- reviews the related outcome(s) on the IFSP to ensure the request is related to the achievement of a functional outcome
- documents a discussion with all team members in order to obtain consensus
- signs and dates the bottom of the AT form if the team supports the request
- notifies the family in writing of rights and procedural safeguards due to the change in IFSP services
- completes a change page with the parent for the purpose of adding AT to the IFSP and obtaining a parent signature on the change page documenting agreement with the addition of the AT
- submits the AT form, justification, script, and change page to the SPOE for data entry
The SPOE:
- data enters the request—not to exceed the maximum rate listed on the AT form
- requests submitted without all supporting documentation will be returned by the SPOE to the SC for completion
- the start date entered for the AT will be the date signed by the parent or physician, whichever signature occurred last
Assistive Technology requests requiring a PA from a Bureau Consultant
The therapist:
- obtains a doctor’s order
- provides a written justification as to how the request will assist in achieving an outcome on the IFSP
- obtains two documented product quotes
- provides a HCPC code
- submits all of the above to the ongoing Service Coordinator
The Ongoing Service Coordinator:
- reviews the related outcome(s) on the IFSP to ensure the request is related to the achievement of a functional outcome
- documents a discussion with all team members in order to obtain consensus
- completes and submits a PA Request form to their Bureau Consultant
The completed request must include: eligibility documentation, the related IFSP outcome, prescription, written justification from the acting therapist, and a transition plan or statement signed by the parent for equipment that will remain property of the State of Indiana.
| If the PA is approved: | If the PA is denied: |
|---|---|
The Ongoing Service Coordinator:
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The Ongoing Service Coordinator:
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