Effective Date: July 1, 1996
Date Revised: July 1, 2015
Title:
CT Birth to Three System
ASSISTIVE TECHNOLOGY
Purpose: Insure that children receive assistive technology devices and services when
needed.
Overview
Assistive technology, devices and services, is one of the services required under Part C of
the IDEA:
 “An assistive technology device means any item, piece of equipment, or product
system, whether acquired commercially off the shelf, modified, or customized, that is
used to increase, maintain, or improve functional capabilities of a child with a
disability”
 “Assistive technology services means any service that directly assists a child with a
disability in the selection, acquisition, or use of an assistive technology device….”
Another way to look at what constitutes assistive technology is to see if the answer is yes
to the following three questions:
1. Does the child have a disability or a significant delay in the area of development?
2. Is this a device or adapted material?
3. Can the child perform the functional activity only with the device or adapted material?
If the answer is yes to all three then the IFSP or justification for the device should be
able to answer the question: What functional activity will this child be able to participate
in because of this device?
New England Assistive Technology Marketplace Contract
The Birth to Three System has a contract with the New England Assistive Technology
(NEAT) Marketplace and pays the membership fee for any Birth to Three program that
wishes to be a member. Here is a brief list of what NEAT provides to Birth to Three
program members:
 assistive technology devices available for trial for up to 4 weeks to determine if
appropriate for the child and family
 assistive technology devices available for loan to families
 assistance in purchasing assistive technology devices including research for
questions regarding assistive technology
 training regarding assistive technology (with approval of Birth to Three Provider
Support Team Manager or designee)
 free spaces in NEAT workshops appropriate to Birth to Three providers
 periodic vendor fairs in which the various AT vendors display their latest devices
When a child’s IFSP team is considering an AT device for a child, they should contact
NEAT to inquire about whether the device is available or whether an equivalent or
superior, but less expensive option should be considered. NEAT is very familiar with
many vendors and should be able to answer questions or research the answer.
Assistive Technology page 2
Assistive Technology Assessment
Program Responsibilities:
Any time that a child’s IFSP team thinks that a device may be needed to increase, maintain
or improve a child’s functional participation in order to achieve an IFSP outcome or
objective, an assistive technology assessment should be performed in the environment(s)
where the child will be using the device. This assistive technology assessment should be
performed by the Birth to Three program, including staff from the appropriate discipline
related to the device (i.e. Speech Pathologist for communication devices, motor therapist
for adaptive equipment). It is possible that much of the information for the assistive
technology assessment can be pulled from general assessment and intervention
information already available. Assistance with selecting the AT device is available from
NEAT marketplace when the interventionist is not sure if or what device might be
appropriate for the child.
The results of the AT Assessment should be documented on the Assistive Technology
Device Request Form 3-11 or in a more detailed written report. The assessment should
include information regarding the need for assistive technology, the child’s level of
functioning, environmental considerations, and what type of device would meet the child’s
need.
Consideration should be given for assistive technology devices ranging from low to high
tech. A low tech device enables children to do something they cannot do and may not
be able to do for a while (e.g., loops attached to puzzle pieces, picture communication
picture systems board, rolled towels or foam to enhance sitting posture). A high tech
device involves more advanced supports to increase a child’s functional capabilities
(e.g., gait trainer, walker, computerized communication device, wheelchair, or hearing
aids).
As soon as the appropriateness of item is determined, the process should be started by
the service coordinator or appropriate program staff to obtain the assistive technology
device or equipment. (i.e. NEAT Equipment Loan using Form 3-14, program purchase,
Assistive Technology request to Birth to Three using form 3-11).
Trial of AT Devices as part of the AT Assessment process:
As part of the AT assessment process, NEAT Marketplace has a limited supply of
devices from vendors available to Birth to Three providers for trial purposes. The
purpose of this trial period is to assess if a particular assistive technology device
(including adaptive equipment) is appropriate to maintain or improve the child’s
functional participation related to an outcome identified as a priority by the family. The
trial assistive technology device or equipment will only be left with the family for a
maximum of 4 weeks. The process for requesting items for trial from NEAT is as
follows:
Assistive Technology page 3
a) The program staff person requesting trial equipment/devices fills out the Request
For Short Term Trial of Assistive Technology Devices, Form 3-13, including
program staff and director signatures
b) If necessary, set up joint visit with NEAT for assistive technology consultation
c) The trial assistive technology equipment/devices will only be left with the family
for maximum of 4 weeks. It is the program’s responsibility to ensure the timely
return of the device. The program is responsible for dropping the trial device off
to NEAT Marketplace or their satellite offices. Large, trial equipment can be
picked up by NEAT at the family’s home with the program staff present, per
stipulations on Form 3-13
d) The cost to replace trial assistive devices/equipment that is not returned to NEAT
Marketplace will be charged to the program. Responsibility for damaged
equipment will be assessed on a case by case basis by Birth to Three
Administration
e) Assistive devices or equipment not returned within 4 weeks MAY RESULT IN
THE PROGRAM LOOSING BORROWING PRIVILEGES
Formal AT Evaluation:
Alternatively, the program may seek a formal Assistive Technology evaluation by someone
who is certified by RESNA (Rehabilitation Engineering and Assistive Technology Society of
North America). Names of available assessors should be obtained through the NEAT
Marketplace or on the RESNA website (RESNA.org). Some of the larger Durable Medical
Device vendors may also employ RESNA certified professionals. Funding for the portion of
any formal assistive technology assessment that is in excess of $400 will be shared by the
Birth to Three System with prior approval from the Director or their designee. This type of
formal assessment is rarely necessary for children under 3 years of age. (See Payment
Procedure for information on reimbursement).
Including Assistive Technology “Devices” on the IFSP
A device is considered a required assistive technology device only if it relates to the
developmental needs of the child. It is not required if the device is provided to meet the
medical, daily living, or life-sustaining needs of a child.
Because Assistive Technology is a Part C service, all AT, regardless of cost, must be
written in the Outcome section 6 of the IFSP as part of a strategy or objective for a
functional developmental outcome.
If Medicaid Is Payor:
For a child covered by Medicaid, “Assistive Technology Device” should be documented
in Section 6: “Other Services Related to this Outcome That are in Place or That are
Needed” with “Medicaid” listed as the payor. The AT device should also be listed in
Section 8: “Part C services are paid for by the Birth to Three System unless otherwise
indicated here” (eg. “Assistive Technology device paid for by Medicaid” or “Assistive
Technology device partially paid for by Insurance”).
Assistive Technology page 4
If Commercial Insurance or Birth to Three is Payor:
When a child is covered under commercial insurance or if Birth to Three is paying for part
or all of the device, “Assistive technology device” should be listed on Section 8 “What is
going to happen”. On Section 8 of the IFSP service grid, the “Delivered by” box should list
the discipline responsible for overseeing use of the device.
Regardless of the funding source, the boxes for location, how often, how long, and end
date may not apply and can be left blank. In the box for start date, write the expected date
of delivery of the device or service, allowing for processing of insurance claims and
ordering time.
Including Assistive Technology “Services” on the IFSP
“Assistive technology services” assist with the selection, development, maintenance,
repair, and training in the use of the device. Most often this will be addressed by Birth to
Three program staff. If desired “assistive technology services” can be included on
Section 8 of the IFSP “What is going to Happen”, or it may also be rolled into the Early
Intervention visits already being provided by the interventionist responsible for
supporting use of the device.
“Assistive Technology Services” may also be noted on the IFSP (section 8) when
consultation with NEAT Marketplace is desired as part of the program’s AT
assessment.
REFER to Chart at end of document for “How to Add Assistive Technology to the IFSP”.
Obtaining Assistive Technology Devices
A. Loan of Assistive Technology Devices from NEAT Marketplace
The Birth to Three system has an assistive technology loan program available to
providers through NEAT Marketplace. A child may keep the loaned assistive
technology device as long as he/she needs it, regardless of whether they have exited
the Birth to Three system. The Birth to Three System will not be responsible for any
service or upgrade after the child exits.
For Loan of Assistive technology devices:
a) Prior to a loan request from NEAT Marketplace, an AT assessment is completed
and documented, including appropriate inclusion of “AT Device” on the IFSP
(see p.3 of this procedure)
b) Interventionist completes Request for Loan of Assistive Technology Device,
Form 3-14 following instructions at the top of the form and submits Form 3-14 to
NEAT Marketplace
c) Devices will NOT be loaned without a completely filled out Form 3-14, including
program signature.
Assistive Technology page 5
B. Purchasing of AT Devices by Birth to Three Programs
Payer of Last Resort for Assistive Technology
The Birth to Three System funds assistive technology devices and services as the payer of
last resort. This means that it is the responsibility of the family, program, and vendor to
pursue all other funding options prior to receiving funding from the Birth to Three System.
Potential payment sources could include commercial insurance, Medicaid as part of the
EPSDT Screening (Early and Periodic Screening, Diagnosis and Treatment), Children with
Special Health Care Needs or Board of Education and Services for the Blind. Programs
should check with the NEAT Marketplace for devices that are already in the Birth to Three
inventory for loan, or for reconditioned equipment for sale. If parents are concerned about
the use of reconditioned devices, they should be informed that Birth to Three’s legal
obligation is to provide appropriate Assistive Technology devices, not necessarily new
devices, and certain pieces of equipment will not be funded by Medicaid unless refurbished
equipment had been tried first.
Accessing Third Party Reimbursement for Assistive Technology
It is quite likely that if the program is working with one of the large vendors of durable
medical equipment (DME), the vendor will handle the insurance billing. In order to access
insurance or Medicaid funding (for a device of any amount), the program must include with
the claim:
A Letter of Medical Justification including identification of the reason why the device is
necessary (e.g. orthopedic consequences - without it range of motion will decrease,
deformities will develop); possibly a statement that a more intrusive procedure will be
necessary in the future if the device is not provided (e.g. surgery may be needed if
adequate positioning cannot be achieved). Check with the DME vendor on this,
because there are very specific requirements that facilitate successful approval of the
device. Sample letters are also available on many manufacturers’ websites.
Insurance and Medicaid customarily fund equipment that fits under the category of Durable
Medical Equipment. Durable medical equipment may include, but is not limited to, aids for
daily living and personal care, mobility aids, standing and walking aids, wheeled mobility
aids, seating and positioning systems, prosthetics and orthotics, augmentative
communication aids, and hearing aids. They are less likely to cover learning and
developmental aids such as computers, play equipment, adapted toys, or cognitive and
learning aids. If Medicaid pays for a device as durable medical equipment, the vendor must
accept that amount as payment in full and the program cannot bill Birth to Three for any
balance. The same is true if the vendor is in-network with the child’s insurance plan. If
commercial insurance pays for all or some of the cost of a device, that amount may be
applied against the annual and lifetime caps of the child’s health insurance plan.
Products that are life-sustaining are typically covered by insurance and Medicaid, and
are not considered assistive technology devices and not covered by the Birth to Three
System. Life-sustaining equipment is considered medical in nature and includes, but is
not limited to, suction machines, glucose monitors, feeding pumps, apnea monitors,
enteral and parental solutions and supplies, nebulizers and ventilators.
Assistive Technology page 6
Accessing Birth to Three Funding for Assistive Technology Devices
All programs are responsible for the purchase of an assistive technology device costing
less than $250. These devices should be included on the IFSP but it is not necessary
to submit Assistive Technology Device Request Form 3-11 for AT devices under $250.
When a program identifies a device costing more than $250 the following process
should be used:
1. If reimbursement for the purchase of an AT device costing more than $250.00 is
being sought, the program must submit an Assistive Technology Request Form 3-11
prior to ordering the device. However, it is recommended that Form 3-11 be
submitted even if third party payment is anticipated, in case funding sources
change. If a program receives approval ( Form 3-11) and a third party payer does
cover the full cost of the device, the requesting program should notify the Birth to
Three fiscal office so that funds are not set aside unnecessarily. Form 3-11 should
be submitted to Birth to Three Administration by email using:
DDS.BirthtoThreeFiscal@ct.gov
2. The program should check with NEAT Marketplace for the appropriate device, or
for a comparable or superior device that could be loaned to the child until he/she
no longer needs it. If the device is not available through NEAT Marketplace, a
previously submitted Form 3-11 would also function as the means for the
program to request reimbursement from the Birth to Three System.
3. If the AT device is not available for loan and if there is no third party
reimbursement or partial reimbursement, the program must obtain bids or submit
documentation that the cost of the device is the same or lower than existing
Medicaid or Medicare rates – and note this on Form 3-11. In the case of a
device that will be covered or partially covered by insurance, the insurance
company may have an approved list of vendors with whom they have a prearranged fee schedule. Hearing aids are excluded from the bid requirement but
programs must ensure that if a child is covered by Medicaid, they order a hearing
aid that will be fully covered by Medicaid.
4. Birth to Three staff will review the request for the Assistive technology device,
along with the estimate, denial or partial approval of third party funding, if known.
If the result of third party funding is unknown at the time of the original request
the program should indicate an estimated reimbursement.
5. When approved, the program will receive a copy of Form 3-11 indicating the date
of approval and the maximum amount of reimbursement that will be allowed.
NEAT Marketplace or the selected vendor will be contacted by the program and
arrangements made for loan or purchase of the device, as noted on Form 3-11.
6. The program will arrange for the delivery of the device to their program office or
the child’s home and will insure that the family and early intervention team
receives appropriate training and technical assistance in the use of the device. If
a replacement device is needed, the program will repeat the original process of
purchasing the device. Birth to Three Administration will accept requests for
reimbursement of modifications to previously-approved devices even if the
Assistive Technology page 7
modification is less than $250. The program should submit a copy of the original
approval along with the request for a modification costing less than $250.
7. If the cost of the device has been fully covered by third party payers, the family
owns the device. If Birth to Three funding is used for more than 50% of the
actual cost of the device, the device is owned by the Birth to Three System.
Programs are responsible for tagging all equipment purchased with more than
50% of Birth to Three funds with inventory tags that are supplied by the Birth to
Three Fiscal office
8. Requests for hearing aids should include the cost of the dispensing fee and
warranty until child turns 3. The Birth to Three System has an approved
dispensing fee for services needed to acquire hearing technology for young
children (see Hearing Aid Dispensing Protocol.)
9. Please Refer to Payment procedure for further instructions on the reimbursement process.
10. Whenever possible, parents should insure equipment costing more than $500
under their homeowner’s or renter’s insurance policy.
Assistive Technology and Transition Planning
Children may keep assistive technology devices purchased or loaned by the Birth to
Three System as long as the family is using the device with the child. When a child is
transitioning, the device must be listed on the transition plan on the IFSP and
addressed at the transition meeting with the LEA. If a child continues to use equipment
after the age of three, the Birth to Three System will not assume responsibility for repair
or maintenance. The program must notify NEAT marketplace of the exit of a child for
whom Birth to Three has purchased or loaned equipment. After exit from Birth to Three,
the NEAT Marketplace will routinely contact families for whom assistive technology
devices have been purchased or loaned to determine whether they are still in use.
They will arrange for pick-up or shipping of devices that can be returned to Birth to
Three.
The Birth to Three System is only responsible for funding assistive technology devices
necessary to achieve functional outcomes identified on the IFSP. No new devices or
equipment should be requested for children who are 2 years, 9 months of age or older,
with the exception of hearing aids, as assistive technology devices requested during
this period would not be available long enough to make progress on identified
outcomes.
Loan and Use of iPads and other Hand Held Electronic Devices as Assistive
Technology for Communication
There are many devices with associated apps that can assist children to communicate.
Use of these devices and apps should be evaluated in the same way as other more
traditional types of AT and be purchased. Purchasing and maintaining these devices
will depend on whether the family or Birth to Three owns the AT device.
Assistive Technology page 8
A) Family owned device: a Birth to Three team recommends as part of the IFSP
meeting that a child needs an assistive technology device in the form of an app on a
handheld electronic device that the family owns. The program would be responsible to
purchase any app that costs less than $250. Neither the program nor the Birth to Three
System is responsible for purchasing a protective case for a family-owned device.
The team should consult with NEAT to determine the most effective app(s) given the
child’s current needs and abilities and the family’s device. If the app cost(s) more than
$250, then the program would need to submit an Assistive Technology Device Request
Form 3-11.
The program must consistently connect their decision to purchase an app with the IFSP
and AT procedures as with any AT request.
B) Loan of an electronic device and app(s) owned by Birth to Three System:
1. During an IFSP meeting, the Birth to Three team identifies the need to include
assistive technology for communication outcome(s) on the IFSP.
2. The team completes an assessment and consults with NEAT to determine if the
loan of a handheld electronic device and an app for the device is appropriate to
meet the identified need for communication. The assessment should include
consideration of the child’s ability to use low and high tech devices, and if the
child has the pre-requisite skills necessary to use a communication device. In
most cases, a child should be successfully using a low tech device for
communication before a high tech device is recommended for communication.
3. Program submits an Assistive Technology Device Request, Form 3-11 to the
Birth to Three Administration by using DDS.BirthtoThreeFiscal@ct.gov along with
the necessary information including a justification for the specific device and app
being requested for the child.
4. Birth to Three will forward Form 3-11 back to the program with approval or
denial.
5. If approved, the program will contact NEAT Marketplace using Request for Loan
of Assistive Technology Device Form 3-14. NEAT will:
a. Loan the device and load the app(s)
b. Restrict the use of the device to only the specified app(s)
c. Activate the GPS feature if available on the device.
d. Apply or attach any protective covers as appropriate to the device.
e. Arrange delivery or pick-up with the Birth to Three program and offer a brief
tutorial on the use of the device if requested.
f. Track the app(s) that are loaded onto Birth to Three purchased devices, and
arrange to update the device or app as appropriate while the child is still
enrolled in the Birth to Three System.
g. Continue to contact the family after the child is no longer in Birth to Three to
determine whether the specific app(s) are still in use. If not, NEAT will make
arrangements to retrieve the device for recycling.
Assistive Technology page 9
The Birth to Three program that requests a handheld electronic device as a piece of AT
is responsible to:
1. Make sure that the family understands that the device, when loaned by Birth
to Three, is considered a dedicated device solely for communication, they will
not be able to use it for anything other than this purpose.
2. Ensure that the plan for the future use of the device is covered, as all
assistive technology must be, in the transition plan. This will not include
updating the apps.
3. Notify the parent that when that particular device or app no longer meets the
child’s needs or the child is no longer in Birth to Three, they will need to
return it so that it can be recycled for someone else to use.
4. Contact NEAT if the device is lost or destroyed. If the child destroys the
device, the appropriateness of that device for that child will need to be
reviewed and re-evaluated.
Process for general program to request the purchase and fitting of a hearing aid
by a Birth to Three specialty program
Pre-requisites for Hearing Aid Fitting Process
 Hearing loss has already been diagnosed by an audiologist.
 Hearing aid use is recommended by an audiologist.
 Family has obtained prescription for hearing aids from an ENT.
Procedure:
1. General program lists “Assistive Technology Device” on the IFSP: “AT device hearing aid” should be listed as a means to achieve a functional outcome(s) in
Section 6. See Including Assistive technology Devices on the IFSP (p. 3) of this
procedure for more information.
2. Transportation is a required Part C service and should be added to the IFSP
when the child will need to travel in order to receive the AT device or service.
3. General program discusses options for getting hearing aids with parents
4. General program calls the Hearing Specialty Program with whom they would like
to share the child to discuss the fact that they have a child with hearing loss who
needs hearing aids.
5. In the Birth to Three data system, on the child’s “case info” tab, the general
program chooses “hearing aid purchase and fitting”, chooses one of the hearing
aid specialty programs, and enters the date. The specialty program will then see
“hearing aid purchase and fitting (P&F)” on their screen, and will be able to see
the child’s information.
6. The audiologist from the hearing specialty program will set the appointment with
the parent.
THE FOLLOWING STEPS WILL BE COMPLETED BY BIRTH TO THREE HEARING
SPECIALTY PROGRAM AS PART OF THE DISPENSING FEE (3 appointments)
Assistive Technology page 10
1. At the 1st audiological appointment, review audiological record with parent;
reassess hearing, as needed; explain the hearing loss and discuss hearing aids
with family; do tympanometry; make ear molds; select hearing aids.
2. Order the hearing aids, maintenance supplies, batteries
3. Follow procedures for submitting the paperwork to insurance and/or the Birth to
Three Administration for reimbursement
4. Provide 2nd audiological appointment to dispense hearing aids, introduce parents
to how to put them on/take them off, maintain hearing aids in good working
condition.
5. Provide 3rd audiological appointment together with the service coordinator or a
team member from the general program to adjust hearing aids, test child’s
responses in audiological booth, as appropriate; counsel parents and service
coordinator on hearing aid use and future audiological needs; demonstrate
troubleshooting. An IFSP review may happen here to ensure appropriate
services are on the IFSP.
Unless the general program makes arrangements with the hearing specialty
program to continue providing services, this ends the services provided under this
arrangement. The hearing specialty program will enter the date of hearing aid fitting
was complete in the data system and the child’s information will no longer be
viewable by the hearing specialty program. It is recommended that general
programs review the IFSP with the hearing specialty program at this juncture, as it
is necessary for children to continue to be monitored for audiological needs.
Additional ongoing needs for IFSP team to address*:
1. Ongoing computer verification to ensure optimal functioning of hearing aids.
2. Ongoing hearing aid programming, as needed.
3. Ear molds (approximately six per year —more often for small babies whose ears are
growing quickly)
4. Audiological evaluation (minimally four times per year until exit from Birth to Three)
5. Batteries and supplies. These can be listed in the original AT request but will need
to be the responsibility of the general program to distribute and bill for.
6. Plan for maintenance and repair of the hearing aids
7. Parents’ need for additional information and guidance regarding troubleshooting and
maximizing the use of the hearing aids.
8. Determination if additional assistive technology is necessary.
9. General program staff’s need for more information about hearing loss, technology,
process of learning to listen and talk
10. Child’s need to learn to listen with the device
11. Child’s need for ongoing spoken language intervention through listening
12. Determination of whether device is adequate for meeting child’s needs, or if different
technology should be considered.
Assistive Technology page 11
*Please note that these needs can be met by continued services from a Birth to Three
Hearing Specialty Program or from medically-based pediatric audiologists.
Hearing Aid Dispensing Protocol
(to be used by all audiologists seeking reimbursement from the Birth to Three System)
If a general program chooses to use an audiologist outside the Birth to Three System,
this is the protocol recommended for obtaining the dispensing fee from Birth to Three:
1. Review all previous audiological test results
2. Explain the test results and recommendations regarding amplification to parents
3. Obtain medical clearance for the use of amplification from a physician
4. Fabricate ear mold impressions, order ear molds, then package and ship
impressions to earmold manufacturer (this is usually done twice during the trial
period)
5. Review current hearing aid technology
6. Select an appropriate trial hearing aid - make and model
7. Obtain selected trial hearing aid(s) from loaner bank or order 60-90 day trial aid
from vendor.
8. Test hearing aid(s) to ensure that they are operating properly
9. Adjust hearing aid settings so that they are appropriate for the child’s hearing loss
10. Fit hearing aid(s) to child
11. Counsel parents regarding the proper use and care of the hearing aid(s) and
possible future audiological needs.
(Steps 7-11 may need to be repeated several times to ensure optimal
amplification prior to recommendation)
12. Perform aided testing with the selected trial hearing aid(s) - this will involve
multiple testing sessions and a second tester
13. Determine the most appropriate permanent hearing aid for the child.
14. Confirm hearing aid funding sources (e.g. commercial insurance, Medicaid, etc.)
15. Monitor and maintain trial aids
16. Perform in-house hearing aid repairs on trial aids when necessary
17. Send out trial aid for repair when necessary
18. Test, set, and fit a back-up hearing aid for the child to use while the trial aid is out
for repair.
19. Notify vendor of purchase. Send invoice to child’s Birth to Three program.
20. Obtain and check permanent aid(s) to ensure that they are operating properly and
then adjust the settings for the child’s hearing loss.
21. Fit permanent hearing aid(s) to child
The Birth to Three System will reimburse for a one-time dispensing fee for each
occasion of fitting a child with a hearing aid(s) when documentation is included with the
monthly invoice. This fee will be paid to the child’s early intervention program for their
services or for any audiologist with whom the program contracts. The amount of the
fee will be posted on the DDS website.
Assistive Technology page 12
Other Information about Hearing Aid Dispensing
1. A request for the dispensing fee should be submitted with the Form 3-11 and listed
on the Birth to Three monthly invoice when submitting for the payment of the device.
Three bids are not required for hearing aids on form 3-11.
2. The Birth to Three System will reimburse programs to purchase up to three-year
extended warranties on all hearing aids, not to extend beyond the child’s third
birthday.
3. The Birth to Three System will reimburse programs for hearing aids to be repaired
when the aids are no longer under warranty and for replacement costs (if any) while
the device is under warranty while the child is enrolled in birth to Three.
4. The Birth to Three System will pay for ear molds, batteries and supplies purchased
for a child during their enrollment in the Birth to Three System.
5. The number of different hearing aid manufacturers used by programs is not limited.
6. Programs working with children that are hard of hearing or deaf may write an Interim
IFSP at the time of the initial visit that determines eligibility in order to begin the
process of providing a hearing aid as soon as possible. Early intervention services
may begin for a child who is eligible for Birth to Three services and the child’s family
prior to the completion of the evaluation and multidisciplinary assessment with
parent consent. The interim IFSP must be signed by the child's primary health care
provider (faxed copy is permissible) before services may begin and the
multidisciplinary assessment (and review of the interim IFSP which then becomes
the initial IFSP) still must be completed within 45 days from the child’s date of
referral to CDI. See the IFSP Procedure for more information on the development
of an Interim IFSP.
Process for Ordering Hearing Aids
1. Program completes the child and staff information on the top of Assistive
Technology Device Request Form (Form 3-11). Briefly state the child’s identified
need in the appropriate box. If requested the program may be asked to send a
copy of the IFSP outcome page that identifies the assistive technology as a
strategy, and Section 8 of the IFSP form listing “Assistive Technology Device –
hearing aid” and the primary physician or APRN’s signature. Any additional
information that the program feels is needed for the request to be considered and
processed should be attached, an audiogram is not necessary.
NOTE: Audiology and Transportation are additional Part C services that would also
be listed on Section 8 of the IFSP. When entering the IFSP in the CT Birth to
Three data system the box indicating Assistive Technology equipment is part of the
plan should be checked.
2. In the box labeled Device requested list the item(s) being requested for this child
and the estimated or known costs for each item. If the model or type of device
changes to a comparable priced model then the program will note that there has
been a change in the request when sending in the final invoice. Should the model
Assistive Technology page 13
change to one with a significantly higher price, a new Form 3-11 will need to be
submitted with this information and approved by the Fiscal Office.
3. The dispensing fee and insurance/warranty costs for the hearing aids should be
listed separately from the device but be included in the total amount on the initial
request form.
4. The program will also submit an estimate of the cost for supplies required to insure
the device is fitted and working properly. This estimate will cover the time until the
child turns three and may be updated as needed. The program will keep a running
tally of the costs per child and submit them with their monthly invoice. Please refer
to Payment procedure for further instructions.
5. The program will check the appropriate box under Medicaid Billed or Insurance
Billed on Form 3-11. If the results of this billing are known it should be indicated,
otherwise the program will note that the result of 3 rd party billing is pending and
submit the request to the Birth to Three with this indicated on the form.
6. Programs do not need to list additional vendors/bids on Form 3-11 for hearing aids.
7. Once complete, this form should be sent to the Birth to Three Central Office for
approval.
8. Once the program has received the invoice for the item(s) and the result of
Medicaid or insurance billing is known, refer to payment procedure for further
instruction on submitting for re-imbursement.
9. The Birth to Three Fiscal Office will maintain a record of requests and the status of
their payment. This will be reviewed with the programs at least annually or as
needed to determine the status of outstanding requests.
10. A tag will be sent to the program for any piece of equipment that has been
purchased with greater than 50% of Birth to Three funds. This tag will be given to
the family and they will notify the program or the Birth to Three System via the Child
Development Infoline (1-800-505-7000) when the device is no longer being used.
The program should then notify the NEAT Marketplace, which will arrange for pickup, storage, and refurbishing. NEAT may also contact families annually to see
whether they have a device that is no longer being used.
See Attached Flow Chart: How to Add Assistive Technology to the IFSP
_______________________________
References:
Form 3-11, Assistive Technology Device Request
Form 3-12,
Form 3-13, Request For Short Term Trial of Assistive Technology Device
Form 3-14, Request for Loan of Assistive Technology Device
CFR 34 Section 303.13 (a) (1) and 303.510
IFSP Procedure, Payment Procedure
Assistive Technology page 14
How to Add Assistive Technology to the IFSP
(For Connecticut’s purposes, hearing aids are considered “Assistive Technology Devices”)
Assistive Technology (AT) required under Part C:
1.
2.
AT Device – any item, piece of equipment or product system used to increase, maintain, or improve the
functional capabilities of a child with a disability
AT Services – assistance with the selection, acquisition or use of and AT device
Child
Covered By
Medicaid
Commercial Insurance/Birth to
Three Funding
Section 6:
Child/
Family
Outcome
Section 6:
“Other
Services
Related”
Section 8:
EI Services
& Supports
AT Device must be linked to an
outcome, objective or strategy that
addresses a functional need of the child
AT Device must be linked to an outcome,
objective or strategy that addresses a
functional need of the child
List “Assistive Technology device” in this
area
For AT Devices:
Do NOT put AT device in this section
_________________________________
If you are requesting AT Services:
 List “Assistive Technology
services” under “What is going
to happen”
 List Delivered By, Location, How
Often, How long, Start Date and
End Date
For AT devices:
-List “Assistive Technology device” in this
section under “What is going to happen”,
-Put the program staff discipline under
“Delivered by”
-Put the location of delivery
-Leave “how often”, “how long” blank
-Start date: list anticipated delivery date of
device (leave end date blank)
______________________________________
If you are requesting AT Services:
 List “Assistive Technology services”
under “What is going to happen”
 List Delivered By, Location, How Often,
How long, Start Date and End Date
Section 8:
List “Assistive Technology device paid
If child has insurance coverage for AT device:
“Services
for by Medicaid”
List “Assistive Technology device paid for by
are paid for
insurance” or “partially paid for by insurance”
by Part C
unless…”
Transportation is a Part C service and should be put in section 8 if required to enable the child to
receive Assistive Technology devices or services.