~ AUGUST 28, 2012 ~

CAROLYN PHILLIPS: Okay. We're going to go ahead

and get started.

Really glad you're with us today. It's a rainy day

here in Atlanta. And I know that a lot of our friends all

over the south and moving towards the midwest are

experiencing a lot of difficult weather today. So

definitely thinking about them as we move through this


Really appreciate y'all spending time with us

today. I say it all the time that time is the most

valuable thing we've got, so we definitely don't want to

waste your time.

And we want to focus on ways that you can grow your

reuse program and keep it moving in a forward direction and

be sustainable. And so that's the whole purpose behind

this presentation today, looking specifically at Medicaid,

a look at reuse in current programs so that y'all can grow

your programs and learn more about this important subject.

I'm going to turn it over to Caroline, who can help

us learn more about the Adobe Connect system. Caroline

Van Howe has been a great partner and great friend of the

Pass It On Center.

And we sure do appreciate everything you do for us.

So, Caroline, take it away.

CAROLINE VAN HOWE: Thank you so much, Carolyn.

Welcome to the Adobe Connect webinar system. This

is an accessible webinar system. So you should be seeing

three pieces of information.

On the left-hand side is the opening slide of the

presentation. In the middle section is the chat area. So

anybody can ask a question or make a comment in the chat

area if you wish to do so. And then on the right-hand side

is a list of all the attendees, including the hosts for

this particular webinar and also all the other


We have enabled a telephone line. So the telephone

line is active. Some of the presenters will be using the

telephone line. Others will be using their computer mics.

So a couple of logistical housekeeping items I'd like to

cover on that.

If you are using the telephone line to access this

webinar, either to speak or to participate, you may get

some stereo or reverb if you have your computer speakers

on. So I advise you to mute your computer speakers, which

to do that, go to the green speaker icon on the upper

toolbar of the webinar room, and you can mute your computer

speakers if you are listening via the telephone line.

If you are listening via the computer access line,

you'd also have your microphone activated if you have a

microphone built into your PC or you have a separate

headset. And if you'd like to participate and ask a

question by your microphone, you would click on the

microphone icon, which is to the right of the speaker icon

on the upper part of the toolbar.

If you're not speaking, I would ask that you mute

your microphone. It does sometimes get some feedback and

sound back. For example, if you're typing or listening to

the webinar, we do hear that on the computer keyboard.

So if you're not speaking and you are accessing it

via the computer mic, please mute your computer mic when

you are not speaking.

I encourage everybody to make this a very

interactive presentation. I know we've got a great line-up

of speakers. I'm sure they'll want to take questions and

get your comments as we go through.

The archived recording does include the slides,

also the audio and a list of the chat area. So the

questions and answers and comments do exist, and the

individuals who are looking at this from an archived point

of view are getting a real live experience of how the

webinar was.

And I think that's everything for now from a

housekeeping point of view.

I'd like to hand back to Carolyn Phillips to

introduce the rest of the speakers in the webinar.

CAROLYN PHILLIPS: Excellent. Thank you so much,

Caroline. We really do appreciate it.

And I'm going to have Trish helping me out. Trish

Redmon with the Pass It On Center has done an excellent job

pulling this webinar together and working with our

speakers. Y'all are definitely in for a treat getting to

learn from the folks that we have on with us.

We've got Dr. Sara Sack from Kansas with us. And

then we also have Linda Jaco from Oklahoma and of course

Nicole Bartel from South Dakota. And I'll be giving you

more information about who these speakers are and why we

picked them to help us out today.

I'm going to talk to you first about the CEUs and


And so, Trish, if you'll push the slide. Thank


So we do offer CEUs through the Georgia Institute

of Technology Professional Education here at Georgia Tech.

So what you would need to do is just get in touch with Liz

Persaud. And you can e-mail her directly at

liz@passitoncenter.org. And you would need to send just an

e-mail with your name, organization, city, state, your date

of birth, and your e-mail address. And she can help you

out with the CEUs.

For those of you who are getting CRC -- the

Commission on Rehabilitation Counselor Certification --

credits, then you can get in touch with Liz for that also.

And you would need to send the same information. So just

an e-mail with your name, organization . . . (Lost audio)

CAROLINE VAN HOWE: Carolyn, this is Caroline.

We've just lost your sound. Is there anything we can do to

help, or is Trish able to help out on that one?

CAROLYN PHILLIPS: Can you hear me, Caroline?

CAROLINE VAN HOWE: I can hear you now. Please go


CAROLYN PHILLIPS: Okay. I'll continue. So we

definitely want to hear from you. And we encourage you to

evaluate us. We want you to give us your opinions, let us

know if this is a helpful webinar and also how we can help

you in the future.

I'm posting right now the -- there you go -- the

SurveyMonkey address. And I'm glad -- I just heard that

somebody says it sounds great. We definitely don't want to

have sound issues. So thank you.

So go follow this link, SurveyMonkey. And you

click right there, and then we definitely want to hear your

thoughts so that we can continue to improve and also serve

you and get the information to you that you need.

So our learning objectives. They're pretty simple.

There's four of them. And we want to help you become more

familiar with successful models for durable medical reuse

and working collaboratively with the Medicaid program.

We also want to identify some of the societal

issues involved when device reuse is included in

government-sponsored health care programs. And there's

definitely some issues that we want to bring forth and

think about.

We also want to understand how reusing durable

medical equipment helps contain Medicaid costs, and it also

meets the needs of folks with disabilities and the aging

population. And obviously all of us are curious about that

and thinking about some of those things.

And then also become more familiar with the general

process and key issues in developing a partnership with

Medicaid. Partnership, that's really what a lot of this is

about and developing a healthy sustainable relationships.

And so we're going to walk through some of that.

As I'm looking through the list -- and once again,

welcome to everybody. So glad that you're with us -- I see

that some folks I'm very familiar with, and I know who you

are, and so hello to all of you. And it's great to see

some new folks on with us.

And we're going to do a few definitions just to

make sure that we're all speaking the same language. We

will try to avoid acronyms.

And so durable medical equipment. Federal Medicaid

regulations cover durable medical equipment under home

health services, medical supplies and equipment and

appliances suitable for use in the home.

And that's important because it's important to know

how your state defines durable medical equipment. And we

have found that there are various definitions around, and

they vary.

But they must specify able to withstand repeated

use, serves a medical purpose, not useful in the absence of

illness or injury, appropriate for home use. And so those

are some of the things we'll be addressing.

We also want to talk about what is Medicaid. I've

actually had that question even this week. And so we want

to continue to educate folks about this.

So it's a state-administered -- with some matching

funding -- health insurance program. That's what it

basically is. The third largest source of health insurance

after employer-based insurance and Medicare.

So the eligibility, it primarily focuses on helping

folks that are low-income families with children and also

people with disabilities. It also provides long-term care

for folks who are older and people with disabilities and

supplemental coverage for low-income Medicare


Just so that we are kind of working from the same

things, I just wanted to make sure you had that


And once again, Trish, I appreciate you pulling

that together.

So the big key question, the thing that we wanted

you to be thinking about, whether you are representing

Medicaid -- and it looks like some of you are here from

Medicaid -- or if you're within the Assistive Technology

Act program or within the reuse program and our network

with the Pass It On Center, is partnership. So do you want

a partnership with Medicaid?

And we're finding that a lot of Medicaid programs

throughout the country are expressing a strong interest in

partnership or at least exploring what that is. They're

seeing an increased interest in reuse of durable medical

equipment. And so that's going to be the guiding question


We are lucky to have some great speakers with us

today and some good friends.

And so Sara Sack. Dr. Sara Sack is with us. As

most of you know, she is also part of --

CAROLINE VAN HOWE: Excuse me. This is Caroline.

I'd just like to ask folks on the line -- we're

getting some background noise that will affect the quality

of the sound recording. If you're on a telephone, please

use star six to mute your telephone line. And if you're on

a computer microphone, please use the green icon to mute

your computer microphone. This will be a better quality of

sound recording. Thank you very much.

Sorry for the interruption, Carolyn.

CAROLYN PHILLIPS: No worries. I appreciate your

support, Caroline.

So Dr. Sack is a senior research professor at the

University of Kansas and directs several state and federal

programs related to assistive technology access and

acquisition, including the Assistive Technology for Kansans

program, which has five assistive technology access sites

to serve the state.

Sara also serves on numerous state and national

committees and enjoys the challenge of working with groups

to establish programs and to improve program operations.

She has consulted with 18 states about Medicaid and reuse


And she's also a lot of fun to hang out with. So

I'd encourage you to get to know her and reach out to her

and really learn from her. Take advantage of this


We're also excited that Linda Jaco is with us


Thank you, Linda, so much for being with us.

She became program manager of Oklahoma ABLE Tech in

October of 1995. And we actually met soon thereafter. In

February of 2006, Linda was appointed as director for

sponsored programs at the Seretean Wellness Center where

she oversees a number of private, state and federal grant

programs totaling in excess of $4 million annually.

Linda has served in a number of roles, including

national, state and local task forces and boards related to

disability issues. And she also is the past chair of the

Association of the Assistive Technology Act Programs.

And I'm very happy to have served with her. She's

a wealth of information and, once again, somebody that you

can learn a lot from.

So thank you, Linda, so much for being with us


And then we have Nikki Bartel, who I've enjoyed

working with. I met her about a year ago, actually, when I

came up to South Dakota. And so she's worked as a nurse

for the division of medical services since October of 2005.

Her responsibilities include the supervision of

prior authorizations and the utilization management process

as well as ensuring early periodic screening, diagnosis and

treatment services are accessible for all children under

the South Dakota Medicaid and the CHIP program.

Very glad, Nikki, that you're with us.

And so what we wanted to encourage is a diversity

of voices: folks that have been doing this for a long

time, folks who are just starting out, folks that have

worked with the Assistive Technology Act.

And then, of course, Nikki, very glad you're with

us, wearing a different hat, if you will.

So I'm going to go ahead at this point and turn it

on over to Sara. So, Sara, take it away.

And thanks again everyone for joining us.

SARA SACK: All right. Thanks, Carolyn.

The slide on the screen right now just has my

contact information. So if at any point you want to get

ahold of me, this is how you can do it. And I'd be glad to

talk with you.

One of the things we wanted to talk about was

what's really driving this increased interest in reuse

within Medicaid programs and other government agencies. In

a word, talking about Medicaid today, but the same

information applies throughout your other government


As we all know, the unemployment levels are high

and the weak economy, so the number of uninsured

individuals and the increasing numbers that are becoming

eligible for Medicaid is part of this driving issue.

Also the new implementation of the Affordable Care

Act, which changes your eligibility, and it's going to add

a number of individuals to those roles, and so that will

create the need for additional technology.

And then, as we know, DME is a major cost. It's a

major cost for Medicaid. We've had manufacturer studies

that shows that 28 percent of the wheeled mobility

equipment and seating was actually paid for by Medicaid.

And so it's one of the things that Medicaid is

going to want to look at is: Where is this equipment

going, and is there some way we can recover this equipment

and use it again?

So what do we know about the benefits of AT? I

think probably everybody on this list and on the call can

make your own list quickly.

But if you needed to tell someone else what the

benefits of AT are, you'd probably talk about things like

we know that the access to appropriate durable medical

equipment helps improve safety and improve health.

It minimizes doctors' visits and returns to

hospitals because it keeps people safer. They're not

falling as much. They're in better shape. They're more


It reduces or delays assisted living and nursing

home placements. And research shows that it enables

persons to return to work. It supports them in doing that.

And it may enable caregivers to continue working and keep

that family unit more solid.

In the last few years we've had a lot of interest

from Medicaid programs across the country. At this point

we're now up to 20 states that have considered durable

medical equipment reuse at some level. And the Pass It On

Center has actually consulted with now 18 states about

Medicaid reuse in this past five years.

Where we are today -- programs are at different

levels, and states are at different levels.

Programs that have some Medicaid component are

listed here: Kansas, Delaware, Oklahoma, Indiana,

Virginia, and -- whoops, I got it backwards -- and Idaho.

We know -- and you're going to hear -- I'm trying

to talk fast today so you get to hear Nicole, because you

really want to hear Nicole, and you don't want to hear so

much from me.

South Dakota has done a fabulous job. And I think,

Nicole, we can move your program out to more than just

starting, because you're way down the road.

You'll hear about Georgia. You'll hear about Iowa.

Other states that are investigating and moving up

along there or at least considering it are Colorado,

Minnesota, Ohio, Alaska, Nebraska, Connecticut --

Connecticut's probably moving into that just starting

stage -- North Dakota, New Jersey, Vermont, Washington, and


So at least all of these states I think listed have

some interest in the topic or the area of Medicaid and the

reuse of durable medical equipment.

The different models for involvement. As you've

heard, if you've been a part of the Pass It On Center

webinars in the past, there are a lot of different models

out there for developing your reuse program.

Medicaid, in some instances, has been interested in

the inventory tracking of their equipment and then the

refurbishing of that equipment. I'll talk briefly -- try

to talk briefly about the Kansas program. That's a

component of our program.

The Vermont and the Virginia program has components

where the Medicaid purchase equipment is stickered for

return to a reuse program.

You have some centers for independent living that

provide billable Medicaid services related to reused

equipment. Examples of that are Idaho and Paraquad from


Proposed Georgia model, which I think we'll talk a

little bit about, is to provide lightly used, low-value

durable medical equipment like manual wheelchairs to five

hospitals in the state with most of the Medicaid patients

to three additional Medicaid funds for complex rehab

equipment. So that's an interesting proposal.

So when we talk about collaborating on these

programs, we want a win/win situation, win for everyone.

We want to retain consumer choice. So that's

always a concern that we put out there right away whenever

we're talking about building a reuse program.

We want reused equipment not to be (audio

skipped) . . . priority and used equipment as an option.

We want safe and appropriate reuse. So matching

patient to a needed device not the device to the patient.

Focus on reuse as an interim solution, when delays

occur, as a secondary device or use it as a transition


Want to maintain a positive or at least neutral

impact on the durable medical equipment industry and their

providers. So clearly want to focus on maintaining healthy

partnerships with the vendors and avoid reducing the supply

of equipment available for reuse. We want to really be

careful there.

The challenges for our partnerships, you've got a

lot of administrative issues. And if we really dig into

this, we'll have a companion piece that we're working on

where we talk about just the things that you need to think

about: legal compliance, accreditation, the transfer of

ownership, the warranty requirements and so forth. So

those are some of the challenges along those lines.

Financial challenges. How you're going to fund the

program. And you're going to hear from our speakers today

on how they did that. So I'm just kind of working through

this really fast.

You've got this piece to go back and think about.

But I think you really want to use our time today with our


But we want to talk about how the programs are

funded, what items they're reusing, what their

reimbursement models are and how they make that work. So

what kind of agreements are in place; what kind of health

and safety standards? Do they have priority holds? How do

they really operate the program? Who conducts the repairs?

How do you pay for those? Those are some of the operation


From the user side, matching, as we've said, the

appropriate equipment. Compliance with state laws for the

setup of equipment, follow-up and outcome measures are all

parts of the program we need to think about.

So how does the Kansas model work? I'll try and

rip through this. We have a collaboration that Assistive

Technology Act program for Kansas collaborates with the

Kansas Medicaid. We also work very, very closely with our

durable medical equipment providers and consumers. And the

collaboration is specified in a contractual agreement.

This next slide, which is kind of a mess, if you

wanted to study it, it just shows you how the equipment

comes into the program through our five access sites that

Carolyn told you about.

We work with our local vendors to bring the

equipment back up to high-quality standards, and we work

with network teams, and we get that equipment back out to


The Kansas organizing factors. We're one of those

programs -- we track new equipment for Kansas Medicaid. We

recover their equipment when it's no longer being used. We

refurbish it and reassign it. We focus really on

high-cost, lightly used devices.

We talk about the appropriateness and the safety.

We work on those issues. And the refurbishment is

conducted by trained professionals through our DME vendors.

Our program staff conduct minor just general

maintenance. Otherwise, the durable medical equipment

providers are conducting the refurbishment activities.

Here's a list of items that the Kansas program

accepts. And we worked this out with our -- through Kansas

Medicaid. And it's kind of grown over time. But again,

our focus is -- we try to have our focus be on high-cost,

lightly used.

Now, you'll see some of the items -- you'll say,

"Wait a minute. I see some commodes or some quad canes

here." Well, those are, granted, not high-cost items. But

over the years, we've kind of added some of those other

high-need items that Medicaid asked us to pass on.

So how do we get our inventory? We recover the

Medicaid equipment, as we said, that is no longer being

used. When the equipment is purchased originally, there's

a sticker put on it. The items are tracked. There are

follow-up calls to make sure that the individuals have that

equipment and are doing well with it.

In fiscal year 2011, 72 percent of our donations

though -- or our recovered equipment though came from

general donations and were from, in the most case, private

pay sources. So this was a great advantage to Medicaid,

because then they had access for their beneficiaries for

this equipment that they didn't repurchase. So that's gone

over very, very well.

We have active efforts to increase the awareness

about our program and the need for specific equipment. And

we do that through a lot of different public awareness

activities, primarily radio advertisement and so forth.

The Kansas Equipment Reuse Program, as I said,

tracks that equipment. We follow up. We collect the

consumer satisfaction data. We notify folks in the case of

a recall for equipment. We recover unused equipment. And

we provide equipment primarily for short-term use. And

that is quite helpful.

We have increased coverage to the clients. So from

the Medicaid side (audio skipped) . . . and we cover the

uninsured or underinsured.

The data from our fiscal year 2011, so you can kind

of see what's happening within our program. As I said,

we've had a program in place since 2003. So when you look

at this last full year of data, we had 1,158 requests for

items; we had 777 devices donated that year at a value of a

little over a million, 1.1 million; our reassignments were

701 devices valued at 949,000 during that period.

Our program, to run the program, costs about

$271,000 a year for our five access sites where the

refurbishment of equipment, for the promotion of the

programs. We have one full-time coordinator who

coordinates the activities of the five access sites in

regards to reuse.

The Medicaid-purchased equipment that was

recovered -- if you just look at what Medicaid equipment

was valued during that particular period of time, it was


The other equipment that was recovered by the

program but not -- you'll see a difference between what's

recovered and what's reassigned. Of course not everything

is able to go back out to individuals, and so at the end of

the year you may still have some in your inventory. So

that's why those numbers don't quite line up for you.

But if you look, see, you had $436,000 of

Medicaid-purchased equipment that came back into the

program and was available for another individual. And then

you had 689,000, almost $690,000 worth of equipment that

came from private-pay sources during that period of time.

So your return on investment for every dollar that

the program received, the return on investment was $3.15

after those costs were recovered. So very high, good solid

return on investment.

People always ask "What is your eligibility for

your program in Kansas?" And it's available primarily --

first priority goes to Medicaid beneficiaries; next,

Medicaid eligibles; third, those likely to become eligible

for Medicaid; those eligible for limited medical coverage

by virtue of limited income and assets, their disability as

determined by State Medicaid, and their pending application

for disability through the Social Security Act.

Okay. Real quick. What were some of our tips and

lessons learned?

Safeguards for liability. Everybody's always

rightfully concerned about liability. So we feel like

programs really want to work on safe pickup and delivery

practices related to equipment.

Professional consultation requirement for specific

devices. Making sure that that assignment or reassignment

of equipment is done in a safe manner and that the

beneficiary really knows how to use the equipment

appropriately and safely and that it does meet their needs.

Training on equipment matching. Again, that we are

getting the right equipment into the person's life.

Instruction on how to use the devices, we have

learned over the years, is a very important feature to


Policies and procedure manuals and staff training

that really ensure the fidelity of the program so that you

are doing what you intend to be doing, and you're confident

that everybody that comes into contact with your program is

working along the same guidelines.

And that the inventory be linked to the consumer

records is, in our case, an important feature so that we

can let individuals know if there is something happening

with that equipment that needs to be shared.

And at this point let me take a second. I'm here

in my office by myself, so I'll read some of the

comments -- how about that -- and see what we have.

Can we, for the use of time, move on and share the

platform with Linda. And then I'll chime back in as I've

read some of the comments here. Thank you.

LINDA JACO: Okay. I hope everyone hears me. This

is Linda Jaco. I'm delighted to be with you this


I want to thank Carolyn for the nice introduction.

And -- yes? Did someone say something?

There's so much -- I have to say, from Oklahoma's

point of view, we have learned so terribly much from

Carolyn and Joy with the Pass It On Center as well as from

Sara with the Kansas program. They have been a wealth of

information to us.

We're relatively a newbie group, having really just

gotten going this year, as you will see when I begin going

through the slides. However, we have been interested in

doing this program for about 12 years now.

So for those of you out there who have yet to begin

a program, don't give up. The opportunity is there. And I

see more and more national attention and growth in this

effort. And so please feel free to call me after today.

Or any questions I might be able to answer by the end of

today, I'm more than happy to do. We are really delighted

to have this program.

And I can see that Stan Ruffner is on this webinar

today as well. And a big thanks to Stan, who is the DME

director with our state Medicaid agency. He has been

incredibly instrumental in helping us to get this program


So to begin, I should let you know that the

Oklahoma Health Care Authority is a fancy name for our

Medicaid agency here in Oklahoma. And several years ago

they were actually legislatively mandated to develop and

implement a retrieval durable medical equipment program.

Their policy for some time had indicated that they

retained ownership of the durable medical equipment. But I

think it was very helpful, once the Oklahoma legislature

actually mandated them legislatively, to secure the funds

and to be able to move forward in a direction to implement

such a program.

ABLE Tech is the State of Oklahoma's Assistive

Technology Act program. And as I indicated, we had been

incredibly interested in partnering with Medicaid for a

number of years. And so when Medicaid put out a request

for a proposal this last fall, we responded to that and

were very fortunate and delighted to be awarded the

contract to be able to begin this program.

And that actually did begin in December of 2011.

So as you can see --

(Lots of background noise and chatter going on.)

CAROLINE VAN HOWE: Excuse me. Could whoever has

got either their computer mic or their telephone line

unmuted, please mute your line. To mute your line, you

press star six. And to mute your computer microphone, you

should press on the computer mic icon to the right of the


We're getting a lot of background noise which is

affecting the quality of the recording.

LINDA JACO: Thank you, Caroline.

So to continue, we actually began in December of

2011. So we're relatively new. And as you can see, we

came up with a very exciting name, the Oklahoma Durable

Medical Equipment Reuse Program.

So to continue, what our reuse model looks like, we

have finally gotten to the point where we like to refer to

it as the four Rs. And as I work through these slides,

you'll see the four Rs being highlighted.

So basically Medicaid pays for us to be able to

track retrieved durable medical equipment from our

SoonerCare members -- that's what Medicaid beneficiaries

are called in Oklahoma, SoonerCare members -- and to be

able to donate the durable medical equipment. We also, of

course, take donated durable medical equipment from

Oklahoma citizens at large.

And I would have to agree with something Sara said

earlier, which is that, even in just five months of having

implemented the program, we can already see that we've been

able to retrieve considerably more from the citizens at

large in Oklahoma as opposed to SoonerCare members.

Basically the equipment is sanitized and

refurbished, returning the durable medical equipment to

what we believe is peak performance. Again, taking what is

gently used, high-end equipment. And in a moment I'll be

sharing that list with you.

If actual repairs are needed to the equipment, then

we do contract with Medicaid-contracted vendors, which has

been very successful in developing a very good working

relationship with those vendors to date.

The DME is then appropriately matched and

reassigned to eligible Oklahomans and delivered free of


Of course, given the fact that our Medicaid agency

is providing the contractual funds for this brand new

program, priority is given to SoonerCare members during the

first 60-day period.

And if you were to visit our website, it will show

you all the devices and pictures of them that are available

in that first 60-day period. And then on day 61, any

Oklahoma resident is eligible to receive the durable

medical equipment as long as there is a completed


Currently -- I would love to say -- and maybe in a

year or two I will be able to say -- that we have been able

to expand the program. But currently the program is being

funded to provide pickup and delivery of the durable

medical equipment within a 50-mile radius of Oklahoma City.

Any Oklahoman, of course, who might wish to donate

is strongly encouraged to do so. But we are not able to

provide the transportation for either the delivery or the

pickup of that DME.

So currently, if folks outside of that 50-mile

radius are wishing to participate, we ask that they be able

to bring the equipment to Oklahoma City to donate it and/or

come to Oklahoma City if there is an appropriate match for

them to be able to pick up the equipment.

We have been able to do a few exceptions with that

thus far. And that is with mailing smaller items,

light-weight items such as CPAPs.

This slide shows you the current durable medical

equipment that's being offered. Again, this is through our

contract with Medicaid.

So you can see anywhere from CPAPs, AAC devices,

gait trainers, nebulizers, quad canes, shower chairs,

walkers, bath benches, commodes, patient lifts, scooters,

standers, both electric and semi-electric hospital beds,

and both power and manual wheelchairs.

In large part, this list is quite similar to the

list that Sara just shared from Kansas but with a few


How do we get our inventory? In a number of ways.

I already mentioned that we get equipment from SoonerCare

members who might wish to provide us with equipment that

they no longer need. We also are receiving it from

privately insured Oklahomans who wish to donate.

We've also been successful in receiving some vendor

donations to date and also plan to do some agency equipment

drives. In fact, our very first one is scheduled for

September 26th.

We happened to have a -- in fact, it happens to be

where our Medicaid agency is currently housed. There is a

rather large mall that was converted. And most all of the

office space in the mall houses various state agencies.

And so we're going to do an equipment drive on

September 26th at that particular facility.

What are some of the services that we currently

have that I think are worth noting? We appropriately match

and reassign the used DME to eligible Oklahomans, making

sure that we have an appropriate match for those

individuals, as Sara said, not just giving the equipment to

anyone who might apply, but making sure we have a match.

We're also able to provide equipment for a

short-term use, if needed. We provide all of the

individuals with a tax donation documentation for the DME

that they've donated.

We are able to provide increased coverage to

customers, much the same way Sara said. In some instances,

the SoonerCare member is actually able to acquire durable

medical equipment more quickly by using us.

We're also able to provide service to Oklahomans in

some instances who would not be covered otherwise. We're

able, as you can see from the italics here, to sometimes

even cover insured individuals in instances where their

co-pay or deductible is too costly, uninsured, and of

course underinsured Oklahomans.

We offer training and technical assistance on the

reassigned DME when it's delivered.

We've been very excited about establishing

networking relationships with various DME vendors. This

has been quite successful to date in the immediate Oklahoma

City area. And plans are underway to begin networking with

vendors in some key other areas across the state to

establish some of those relationships as well.

And another thing that I think is quite exciting

and that we're pleased about, because the Assistive

Technology Act program is working closely with this

partnership, we're able to provide many of the individuals

with a lot of appropriate information and referral services

on other-needed Oklahoma resources that we're aware of.

So even if they cannot benefit from our particular

service, we're able to refer them or put them in touch with

another resource or entity that would be beneficial to


Again, as I indicated, we're brand new. So we're

still within our first year. The data that we had

collected for the first initial four months of our

program -- because we did receive the contract in December,

but it took a few months to find a facility, hire staff,

get them trained and all those kind of things. So we

actually went live, if you will, in the first of April.

So our data of April through July, there were 74

devices that were reassigned to 56 individuals for a cost

savings of 31,000. Of those 54 individuals, you can see

that -- I mean of those 56, 54 were highly satisfied, one

satisfied, one somewhat, and one not at all.

And in case you're curious, because I certainly

was, why was the one not at all satisfied? It was actually

because that individual needed bariatric equipment, and

unfortunately we didn't have it at that time. So we tried

providing them with what we hoped would be helpful to them,

but it was not a good match, and they were not satisfied.

Before I go into the tips and the lessons, one of

the things I'd like to mention -- when Sara mentioned it,

it made me think about some of the things that we've done

to actually be able to advertise this market.

We've done a number of things. We have billboards

in Oklahoma City that have captured a lot of attention. We

also have been able to market the program on various --

inside of buses on various bus routes. And we've also done

quite a bit of marketing on bus benches throughout the

Oklahoma City area.

Additionally, we've received a lot of good press.

We originally did a lot of press releases ourselves. But

we've been able by now to secure some interesting success

stories and have been able to promote some of those stories

through some of the larger newspapers.

And, in fact, just on Sunday, there was a rather

large story in the "Daily Oklahoman" that captured a lot of

attention, and the phone has been ringing off the wall. So

I'm real delighted that that's been happening.

Various tips or lessons learned in just our short

few months. Increased support. I think initially some of

the vendors might have been a little bit anxious or nervous

about the fact that perhaps we were going to be taking

business away from them, so to speak. But, in fact, I

think the opposite has proven to be true. We've had

increased support from DME vendors with the repair and

distribution of the durable medical equipment.

Individuals who get the devices from us frequently

need to purchase various DME supplies from participating

vendors, such as CPAP tubing and masks, mattresses, lift

seating, commode pails, nebulizer tubing. And so I think

that the DME vendors are beginning to see this as a real

win/win, which has been very good.

Also we have learned that the program cannot

function on an emergency basis. We have, in a few

instances, been able to accommodate people rather quickly,

but that's not our ultimate goal here. And so we're not

trying to -- on weekends or at nights -- we're open 8:00 to

5:00, and we're trying to accommodate as quickly as

possible but not functioning as an emergency program.

Quite a bit of flexibility with donated items.

Working with other statewide resources, I think, is helping

us to learn that this is going to ensure a supportive

network for sustainability over time.

And if you have other questions -- I can see one of

the things that Stan has written in -- and, of course, you

would see this, and I sent all of this information into the

Pass It On Center, and it will be there in the knowledge

base on their website.

But most of the items, through the application

process, it does require a doctor's prescription. And, in

fact, if individuals are trying to apply for something like

an augmentative alternative communication device and/or a

power wheelchair, of course one would still need to not

only have a doctor's prescription but a therapeutic

assessment of these items as well.

So all of that information can be found in our

operational manual, which is on our website and has also

been shared with the Pass It On Center website. And our

three-page application is also very self-explanatory. It's

also been shared with the Pass It On Center and is also on

our website, as has other materials been shared with them,

all of our fact sheets that we've been using to market with

and those kinds of things.

So again, that's my contact information. Please

feel free -- and if you have any questions, please let me


SARA SACK: Thank you, Linda.

I think we'll shift now and ask, Nicole, to share

her information with us.

NICOLE BARTEL: Hello? I'm Nikki Bartel, South

Dakota Medicaid. Thanks for having me. And I appreciate

the introduction earlier.

I'm not sure how I'm able to find how I switch my

slides over.

SARA SACK: Do you have the arrow at the bottom of

the page, Nicole?

NICOLE BARTEL: No. I had it earlier.

SARA SACK: Okay. I can advance them for you,

Nicole, if that would be helpful.

NICOLE BARTEL: Okay. Sure. I'm ready for the

next one.

How South Dakota Medicaid got started and our

interest started as a result of a Medicaid Solutions

Workgroup. That Medicaid Solutions Workgroup listed some

recommendations in November 2011.

There were 11 different recommendations in order to

contain costs in the South Dakota Medicaid program. One of

those, of course, was the AT reuse program. Others things

included things like a dental coverage limit and

implementing health home initiatives and things like that.

On the next slide.

To get started we wanted a workgroup. We needed

professionals in this areas that could speak to all of

these things. So we identified people that we would need

on this workgroup and got them to participate. One of the

most, of course, is the Pass It On Center.

And durable medical equipment providers, we don't

have very many in the State of South Dakota, so that was

easy. I mean we picked our biggest durable medical

equipment providers.

Department of Human Services, they have a division

for people with developmental disabilities as well as a

rehabilitation division. So that was very helpful.

Independent living agencies, Adult Services and

Aging, they're under the Department of Social Services as

well. But they provide services for adult population and

the elderly.

Community providers. The South Dakota Health Care

Association, Coalition For Citizens With Disabilities, and

Dakotabilities as well. They provide services and support

for people with disabilities.

So that really comprised our whole workgroup there.

And the plan of this workgroup was to have three

meetings. We ended up having four. There was just a lot

of material to go over and things to discuss.

But we also wanted just to establish a good plan.

So we knew we had all the information we needed to move

forward with this and in hopes that we'd be able to develop

a request for a proposal or an RFP to increase the access

to quality equipment in Medicaid.

We also wanted to gauge provider buy-in. As was

mentioned before, we didn't want providers to be upset by

this. We need their participation. So we wanted to get

input on how we can best suit this program to get their

participation and make sure that it's provider neutral,

that we don't have any negative providers. And that also

is a cost savings to Medicaid. And like I said, we need

their expertise in order to develop a sustainable process.

They also were able to provide input on our

indicators of quality table, which is on the Pass It On

Center website.

We had lots of different workgroups discussions in

those four meetings. These are the main ones here that we

discussed and spent a lot of time on.

Provider and recipient participation; what

standards should be used; liability and accountability

issues; what process we would use; who has priority;

current Medicaid coverage -- what we do now, what we'd need

to change in order to make this program work; ownership

issues of the durable medical equipment, especially in

Medicaid population; and looking at what other states have

done and what we would want to adopt and what would and

wouldn't work for our state.

And of course all the questions that we needed to

answer. Our workgroup had a lot of questions. And I'm

sure Sara can speak to all of those questions we had. We

gave her a lot of those questions.

Some of the conclusions that our workgroup was able

to agree on was that we kind of want a blended program. We

grabbed little bits and pieces from lots of different


We used Oklahoma's RFP as a guide. That was a very

similar format to what we were looking to do. There's been

a lot of similarities in the program that they have that we

would also want to have. Same with Kansas. We'll look

probably very similar to that.

The durable medical equipment providers will be the

ones to assess and reassign that equipment. Everybody

agreed this is a process that already works well for South

Dakota. We have durable medical equipment providers all

over in South Dakota. That's where people go anyway, and

they have the professionals already there to be able to

measure and provide the services that people need to get

fitted for proper equipment.

They initially would like to see a budget ceiling

in our request for proposal, although we agreed that, if we

just list our goals and expectations based on Medicaid

spending, that would be sufficient. So we'll provide that

in our request for proposal so they kind of have an idea

what ballpark we're looking to spend on this program and

what we're looking to save.

What we're looking to spend is obviously going to

be what we're hoping to save as well. So we want to make

sure our bidders on that contract are aware of what that

ballpark is.

We also discussed outreach and marketing. The

group really thought we can rely heavily on organizations

as much as possible to save money with this program.

There's lots of organizations out there that would be

willing to get the word out to their customers.

Also hold for Medicaid priority. We want to make

sure that Medicaid recipients get first dibs on all this

equipment. So we would hold that equipment for 90 days and

then reopen it to the whole population, anybody in South

Dakota needing this equipment.

And of course we can see how that goes. If it

doesn't work well down the line, we could change that to 60

or see how that works.

We also agreed on a durable medical equipment list.

It's very similar to what Kansas has, although we have ours

very, very specific. We have a long list based on what we

billed in 2011.

Provider participation required. That's something

the group was able to agree on, although we all agreed we

did not want recipient participation to be required.

Recipients would have the option of choosing a refurbished

piece of equipment or not or a new one.

And then we also agreed that we would use Medicare


The next slide.

The services South Dakota would plan to use when we

request this proposal and get it a contractor, the

contractor would track the new Medicaid-purchased devices,

collect follow-up data regarding the acquisition of new

devices. They would collect consumer-satisfaction data,

recover the unused equipment for the program.

However, reassigning equipment to customers, again,

this would be through our durable medical equipment

providers. I mean that's obviously a part that needs to be

done, but we already have a mechanism for people to go and

get fitted for equipment, so would utilizing the

participation of durable medical equipment providers.

Providing equipment for short-term use is fine. As

long as the person needs it, they can have that equipment,

whether it's short or long.

Providing increased coverage to better serve our

clients and also for individuals that are underinsured or

uninsured would also get access to this equipment after the

90 days.

Next slide.

In drafting the RFP. The key elements, we included

all the things that the workgroup decided on. We wanted to

make sure those are part of the request for proposal.

One of those things was the indicator of quality

tool. The group spent time looking through all the pieces

on that, making sure we agreed, adding little details we

thought were important. And that's on the Pass It On

Center website. And we included that as an attachment to

our RFP. The equipment list is also another attachment.

And then, of course, the scope of work, similar to

Oklahoma's, although we added other various details that

the workgroup had decided on.

And then, in addition to the scope of work, we make

sure we ask very specific questions on what our

expectations are so we get a detailed response of how the

contractor would provide those different services.

Budget issues. Those are some of the things we're

still working on before we release that RFP. We're looking

at what amount was spent in 2011. We want to make sure we

contain spending as much as possible. And part of the way

we can do that is through Medicaid Match or the FMAP. If

we can get federal dollars to back that up for things that

are covered under Medicaid, we want to make sure we utilize

those channels.

The durable medical equipment to bill for services

versus new equipment. We don't know yet whether we will

have durable medical equipment providers bill directly to

Medicaid for things like repairs of a wheelchair that are

provided to a Medicaid recipient; or if they can somehow

send invoices to our contractor, and then they would be

able to approve those services and pay for that and then

get reimbursement from Medicaid. That might be an easier

process, but that's something we're still exploring.

So the process concept. We wanted to make sure we

all were on the same page and had the same idea for what we

expect of the program, how we expect it to flow.

The acquisition of the durable medical equipment

would come from the contractor. They would be responsible

for that piece. Refurbishing new equipment, that could be

done by the contractor, or it could be subcontracted

through different durable medical equipment providers or

who they're able to find to refurbish those items.

Transportation would need to be provided by the


And the database, that is something that is very

important to the workgroup, that there is a database

already available. And we'll make sure that we include

that information in the RFP so they can see what is already

out there. We would use Kansas's format.

That way they know they're not going to have to

build their own database. That would be a huge project and

cost a lot more money. But there's already something out

there they can use that also includes reports. So that's

just a lot less work for them to have to redo.

Then we also discussed Medicaid's involvement.

There were lots of questions: Would we be doing reviews to

make sure people looked for refurbished equipment first?

Would we be doing prior authorizations and reporting?

We don't anticipate doing prior authorizations for

every piece of durable medical equipment. We don't do that

now. We don't intend to be doing that in the future.

The contractor may be able to look at what is

needing to be refurbished and provide some guidance as far

as what's cost effective for those pieces of equipment.

And then the nonMedicaid population. We would need

to get some sort of fee for the refurbished equipment that

is provided to them. And that would go back into the

program to keep it sustainable.

And then the next steps: Of course, releasing that

RFP -- I think we're very close to getting that done;

evaluating those proposals; get a contract awarded for

somebody to facilitate that program; and then of course

we'd monitor progress and adjust as needed.

For example, if we need to expand our list of

durable medical equipment or change the way things are

billed to Medicaid, we can certainly do that if what we

propose isn't working.

The durable medical equipment that we will

accept -- you'll see here the categories -- very similar to

the Kansas program. And again, we have a long list based

on the HCPCS codes that have been billed to Medicaid in

2011. So we have a very detailed list of what we would be

able to accept and provide at this time.

Tips and lessons learned. As I'm sure you've

noticed, that workgroup was just crucial. We needed that

expertise from the professionals that work in that area in

order to design a good plan for this workgroup.

Technical assistance. Collaboration with Pass It

On Center was also essential. That was just a resource to

get all our questions answered, see what other states have

done so we don't have to come up with all that information


And that's all we have so far.

SARA SACK: All right. Great job both Nikki and

Linda. Thank you very much.

Well, I've been going back and reading the

questions as we go down. So how about if we answer the

ones that I saw first. And then as -- y'all can formulate

your questions as you think about what Linda and Nikki have

just shared with us.

Louise writes, in a question that was way early

during my presentation, of: What is the percentage of

equipment that comes -- that is Medicaid-purchased

equipment that is coming into the program?

And of course it's going to vary depending on which

window of time you're looking at. But it's roughly 39

percent of the equipment that Medicaid purchased that's

coming back into the Kansas program.

It looks like the Medicaid equipment purchase

program -- purchased equipment is staying out and in use

for a long, long period of time, which is good. It's a

good outcome.

The equipment that I mentioned that we were getting

donated to the program is much more lightly used equipment,

and that's the equipment that's coming through the

private-pay, private-insurance forces. And so that's one

of the reasons the Kansas program is always kind of

suggesting to reuse programs that they look really

carefully at getting that word out to those individuals

that might have technology and might have just used it for

a short period of time.

The question about our contracts. Yes, we've got

those contracts. I have a collection of contracts from

Delaware, from Oklahoma, and of course the Kansas contract

that I've shared with folks and that folks -- I guess,

Oklahoma, you're still willing to share. And I think,

Delaware, if you're on, they were still willing to share.

So we can share those, and we can get those -- see about

getting those posted on the Pass It On website.

Chris Brand's question: Calculating the

financial -- the value of equipment that's not ready or not

eligible for reassignment.

We do not -- if it's not high-quality equipment

that's going back into someone's hands, we don't put a

financial value behind that equipment. That's not entered

into our database.

We do keep track of the volume of that equipment.

So we will have statistics on so many pounds of metals from

whatever type of equipment. So items that we've kept out

of landfills by sending to qualified, certified recyclers.

So that figure is not calculated into the cost savings.

Then there's a question -- I saw, Allan, your

question about how the program's gain the -- getting

through the political process and how do you get support

for these programs. I know Allan and I -- Allan's from

California, and I know that we talked for quite a period of


Those of you that have talked very much with me

know the Kansas story is that our legislators were looking

at the Medicaid budget and asked the general question of:

Do you track this equipment, and do you have a way of

recovering this equipment when it's no longer being used?

Because we happened to see it on various other places, flea

markets and on the side of garage sales and so forth.

So the legislators wanted to know. And at that

time our director of Medicaid simply wasn't sure. And our

budget hearing was completely stopped until he had an

answer that he would track and recover the equipment. So

that's how the Kansas program got started, was just from

that question and then the contacts between Kansas Medicaid

and the assistive technology program. So that's the story


I don't know if Stan and Linda, or Nikki, if you

guys would want to talk about how your programs kind of got

started and through that political process, where the

impetus really came from.

LINDA JACO: Well, this is Linda.

And thank you, Sara.

As I had indicated earlier, in Oklahoma, what

really began the impetus was when our health care authority

or Medicaid agency changed their policy to read that they

would retain ownership of the durable medical equipment. I

think I mentioned that during my brief presentation.

Prior in policy, when they purchased it, it was the

individual who retained the ownership. But once they

changed that to be that Medicaid was going to retain

ownership, we -- the Assistive Technology Act program began

having a number of conversations with the Medicaid agency

about the need to then develop and implement some sort of a

retrieval program. Because if you're going to retain the

ownership, how are you going to go about then doing that?

And so we were able to submit a number of

proposals. But, unfortunately, Medicaid agency wasn't in a

position financially at that time -- and I think they had a

number of legal questions and concerns, understandably,

because this all began 12 years ago, and the whole idea was

relatively new at that time.

And I think, based on the Pass It On Center and

Kansas and other states that were in a position to pave the

way and seeing that some of those programs were being

launched and being launched without legal repercussions, it

began I think to put other states more at ease.

And then we had an opportunity -- I was serving on

a legislative task force several years ago, and we were

doing various pieces of legislation. And so one of the

pieces that we were successfully able to get passed in

Oklahoma was this notion of mandating the health care

authority, if you will, as part of our disability policy

here in the state to put forward a notion of going ahead

and implementing -- retrieving and implementing such a


And we were able to pick Stan -- it was just about

that time that Stan came on to the health care authority as

the new DME director, which previous to that point in time

there had not been one. And we took him to the Pass It On

Center conference in Georgia, and he began to learn more

and see more.

And still money was a challenge because,

unfortunately, that was all occurring right as the economy

fell out of -- not only Oklahoma but the entire nation.

And so even though the legislation indicated a start date

of December 2010, we weren't quite able to meet that

deadline date.

But Stan was a real champion inside the agency.

And fortunately, last fall as the economy and budgets

loosened up a bit, I think they were finally in a position

to put forward an RFP, and so the 12 years paid off. We

were just sitting there waiting.

And so then we responding to that RFP and were very

fortunate in being able to be awarded the contract. So it

was sort of a roundabout, long, 12-year history but one

that ended quite successfully for Oklahoma, I think.

And, Stan, if you'd like to add something, please

feel free.

SARA SACK: I'm not sure if Stan has access to a

phone or -- oh, there he goes. He's not on a phone but

only on a computer.

LINDA JACO: Thank you. He's saying I did okay.

SARA SACK: He's saying wonderful job.

And, Nikki, how about in South Dakota? I know

you've talked about the reuse as one of your 11

considerations for cost containment.

Can you talk to us a little bit -- I mean was that

coming up through your Medicaid program, or did the

suggestion come from other sources?

NICOLE BARTEL: I believe it was through our

Medicaid program, a voluntary project to try and contain

costs within the Medicaid program.


NICOLE BARTEL: However, I did learn that there

were various legislators involved in that workgroup. There

were a lot of different people on that workgroup. And I

think they're going to be very supportive of us

implementing all the measures -- all the 11 measures from

our Medicaid Solutions Workgroup.

SARA SACK: Great. Great. You guys -- obviously

both states, Oklahoma and South Dakota, that's why they're

on this call. They've just done a great job of moving

forward and being very thoughtful and very inclusive in the


And I see Joy Kniskern's question here of: What

were some of the initial concerns, if any, of the DME

vendors in your states?

And I think -- at least I'll launch it off from the

Kansas side. When we started and we built this program,

the DME providers were right there with us and were the

major drafters of the program.

And actually, when you see our materials and the

checklists that we have to make sure that the equipment is

ready to go back out to consumers were created by the DME

providers themselves. So that was their contribution to

the program.

And let's see. Linda, I know you're typing here

too. Would you like to talk a little bit about the DME

providers in Oklahoma and their involvement?

LINDA JACO: Sure. I think initially there was a

fear that such a program might compete or take away funds

from them.

We, again, were very lucky in that, oh, probably

about two years ago now, Stan began a DME, oh, committee,

workgroup, if you will, within the agency there at Health

Care Authority. And a number of DME vendors participated

in that particular group.

And ABLE Tech was fortunate enough to be invited to

that group as well. So as they approached the date of

releasing an RFP, we were able to visit with them and I

think assuage and reduce some of the fears that they were

having about it and instead point out to them that it could

be a win/win and that we would want to partner with them.

And they, I think at first, were, "Partner how?"

But as I explained during the presentation, we're able to

actually pay them when they assist in repairing the


And we provide no consumable, if you will. In

other words, we're only providing the actual device. So if

the device, such as a hospital bed, needs a mattress or the

nebulizer needs tubing or the commode needs a pail, then

the individual then will also need to work with their DME

vendor to get that sort of accessory piece.

And so I think then they began to see that there

was a win/win in this situation. And the outcome has been

that the ones who are now working with us are incredibly

supportive and are going above and beyond to try to assist

us with the program and taking it outside of just the Metro

area, beginning to work to see how we can have them assist

in delivering some of the equipment to further, more remote

places and that sort of thing. So it's been a terrific

relationship thus far.

SARA SACK: That's fabulous.

And I also look back at, Louise, your questions.

And I saw that Stan has answered your first question right

away, whether this program is a mandatory acceptance of the

reuse item. And Stan was quick to answer that and said,

no, this is strictly a voluntary program.

And that's the way also that it is in Kansas. The

individual is asked if they would accept a used piece, if a

used piece is available and is exactly what would have been

provided otherwise.

And then you also ask about low-tech aids for

dressing and eating and cooking and grooming. And as Stan

answered, he said that wasn't part of the plan in Oklahoma,

and it's not part of the plan for reuse in Kansas.

Now, I know in -- and primarily because we have

focused on the high-cost items that really would warrant

your computer tracking, your looking to see if there were

recalls available out there for them and then contacting

the person and moving them across the state.

Now, that being said, we have expanded, and we do

have some of those more low-cost items. We talked about

the quad canes earlier.

In the case that you're talking about, you know,

dressing and eating and cooking and grooming items,

generally we have other groups in our state that would be

collecting those items and would have larger inventories.

Our independent living center would have some access to

those items.

In some cases the sites that also have our

Assistive Technology Act program would have those types of

devices. But this program we've focused on items with

sufficient costs that's really going to need that tracking

and moving of the item.

Okay. Then Joy's question: Clarify the steps you

take to assure that person is under- or uninsured. In

Georgia we learned that some applicants required assistance

in learning what, indeed, were their benefits.

Joy, we've had exactly -- and I know you and I have

talked about this. So this is no surprise to you. But

we've had exactly the same issue in Kansas.

Through our assistive technology access sites we

have individuals that assist the person and talk to them

and find out what -- as they identify the pieces of

technology that -- look at their eligibility and look to

see what benefits that they are eligible for and look at

their insurance and actually help them with submitting

those requests.

And I think that's -- I'd be interested to see what

other folks across the country say. But this is one of the

areas that I see that we could probably all focus on a

little bit more and look to see that individuals know what

they're eligible for and have some assistance in following

through with that.

Let's see. Boy, this is just jumping all over.

Louise asked then: Did you ask Medicaid recipients to then

give back the equipment after they could no longer use it?

Yes, we do. And Oklahoma, I belive you do too.


SARA SACK: The way we do that through Kansas is we

have kind of a different step. When they receive the

equipment initially that we're tracking, we call them

within a month and make sure they have it, everything is

going well. And if they need more help, we get it to them


You know, if it's not fit quite . . . (Lost

audio) . . . call another six months later. And we figure

that probably, if something has changed, it might have

changed during that period of time. And so if it's no

longer being used or the health has changed or whatever, we

bring it back.

But we've talked to the individual. And there is a

sticker on there saying, if it's no longer in use, please

call the 800 number. So that's how we get the equipment


We've also, through the Medicaid mailings, put in

general statements of, if you have assistive technology

such as -- kind of a list -- that you're no longer using,

please contact this number.

Even however gently we seem to phrase that

statement, for some individuals that was still confusing

and caused alarm. So we're kind of careful when we use

that. But we do ask clearly that the Medicaid

beneficiaries return equipment if it's still in good


Let's see. Louise also answers: Can a family sell

it or put it on eBay after a family member dies?

I'm not sure, Stan -- your answer -- I got part of

it. "We offer --"

In Kansas you are told -- you sign, actually when

you receive the item initially, that you understand that it

is yours to use as long as you need it, but when you no

longer need it, you should return it to the reuse program;

and that individuals from this reuse program will be

calling you, and so it would be good if you would take

their phone call and talk about it.

So they pretty much know that they shouldn't put it

on eBay or sell it. Does it happen? Oh, I'm sure it

probably does. We have not seen much of it, though. So

I'm not sure if other folks want to chime in there on that


Chris, let see. You asked: Is there a fee

schedule for the DME vendors for repair or delivery?

And I'll let the -- I know we just had a nice phone

conference call with Nikki and the South Dakota group.

In Kansas, ours is an item-specific repair

cost/refurbishment cost. So the vendor looks at the item.

And then -- according to what needs to be replaced and

repaired, and then we look at and either approve -- a prior

approval is needed.

There is a range of costs. And we always, of

course, negotiate those with -- our DME vendors have been

fabulous in that area. And as Linda even said earlier,

they are our best champions. They've given us floor

models. They really work with us.

And many times I've got fabulous data on the items

that we've taken, and they really look good to us. And our

DME colleagues will look and say, "Yeah, you're right. It

does look really good. But, no, I would not invest in

repairing this item because it's been used harder than you

think, and here's the following reasons."

So our DME providers really understand that we are

trying to contain costs, and they are just fabulous at

helping us do that.

Does the DME technology typically include adaptive

devices and technology for the visually impaired?

The Kansas program does have devices for the

visually impaired, but that's a different program. That's

not handled through this Medicaid program. So yes.

And I'm looking here to Joy's comment to Chris that

Paraquad does have an item-specific repair cost list. I'm

sure they'd be glad to share.

And Stan is saying that they use the CMS allowable

cost. That's what we use, and then we negotiate.

Let's see. Allen, your question is: Do recipients

in Kansas and Oklahoma have a choice to deny used equipment

in preference of a new?

Absolutely. In Kansas they do. Kansans are pretty

frugal folks, and they're told, "We have this device. It's

available. It's high-quality. It's nearly new." And then

they're asked would they accept it.

Kansans most of the time do that. And of course

then they're told if -- again, same thing applies, that if

this equipment needs repair, that Medicaid will stand

behind it.

LINDA JACO: Likewise in Oklahoma, Sara. It's

strictly voluntary. It's not forced on them. In a couple

of instances they've been eager to do so because it was

going to save time for them to get the equipment through

our program rather than waiting to get it through the

traditional Medicaid means.


And so, Nikki, in South Dakota, how are you going

to answer that question?

NICOLE BARTEL: Very much the same as what you guys

were just explaining. We're looking at implementing things

the exact same way.

SARA SACK: That's what I thought, but I thought

I'd make sure that you were still thinking that direction.

Good deal.

Okay. It looks like we have a message coming from

Joy Kniskern. Yes, absolutely. Joy is saying that

consumer choice is crucial.

Oh, Stan. You're so nice.

He said he tried to follow in our footsteps all the


Well, we've learned a lot as we've thumped along.

And we're quite happy this year. And you obviously were --

Oklahoma, all you guys, were easy learners, quick learners,

quick studies. It's been fun.

So are there other questions out there that we can

help you with? You've got wonderful folks here on this

call to ask those questions of.

And if, as you go away, after this call or around

the coffee pot you're thinking of questions, please contact

any of us, contact the folks at the Pass It On Center.

There's a wealth of information out there, and folks are

really willing to share.

SHARON from Vermont: Sara, it's Sharon in Vermont.

And I was just going to --


SHARON from Vermont: Hi. Thank you for doing

this. It's been wonderful. And we had Sara come to work

with us in Vermont, and we're working toward improving our

program here. And I lost Internet connection; otherwise,

I'd be e-mailing you.

So I would love to hear more. I'm very excited

about hearing what Oklahoma and South Dakota have been able

to do.

And I remember meeting the Oklahoma folks way back

at the Pass It On Center AT reuse meeting in Atlanta. So

I'm glad to hear it's working really well, Linda. That's


LINDA JACO: Thanks. Thank you.

SARA SACK: Vermont has done -- Vermont has one of

the oldest Medicaid collaboration programs in the country.

And they have just done a terrific job and have reassigned

a lot of good quality equipment. So again, good folks to

call and ask questions of.

SHARON from Vermont: That's great.

SARA SACK: I see Trish has posted the comment.

And absolutely. If you're from a state with reuse involved

with your Medicaid program or you're thinking about it,

we'd like to hear from you and hear where you are in the

process and kind of what's going and what's making you

scratch your heads.

We are working on just a paper, trying to put our

best spots together and just kind of a roadmap of how do

programs work together, and how do you establish these

partnerships with other entities, and how can you make it

really work well for your whole state and work well for

everyone, including your DME providers and your other


CAROLYN PHILLIPS: Excellent information. Thank

you again, Sara and Linda and Nicole. I definitely learned

a lot, and I know quite a bit about this. And so it's

exciting to see the conversation continue to grow and

develop. So thank y'all so much.

Any other questions for them? Just like Sara was

saying, I wouldn't miss this opportunity when you've got

folks right here. But know that this is a conversation

that can continue. So please get in touch with these


Linda, I'm glad it was your pleasure. Yeah, it is

a lot of fun working together. So that's great.

So thank you all for your time. As Trish said,

this will be posted online as far as the transcript. It's

already posted on the knowledge base.

And if you are from a state with a reuse program

involving Medicaid, we really, really do want to hear from

you, just like Trish said. So please e-mail her directly

at trish@passitoncenter.org.

And as I started out, I said we wanted to hear more

from you. So please evaluate us. We have an evaluation

posted, and it's at SurveyMonkey. We've got it up here,

surveymonkey.com/s/r325kjx. And we'll post that again so

that you can just click on it and get to that survey.

Caroline, thank you again for your assistance.

And, Trish, excellent job pulling this together.

Joy is really knee deep working on a lot of really

good things for us. And so I'm honored to have stepped in

and helped moderate today.

But I was glad you were able to join us, Joy, from

your location. I know you're about to dive back into the

work you're doing.

So please keep in touch with us, everyone. And

thank you for your time. We do hope this was helpful. As

I said, I learned quite a bit.

Any closing thoughts, Sara, Linda, or Nicole?

LINDA JACO: I think it was a lot of fun. I

appreciate you asking me to participate so that I could

share with others all that Oklahoma has learned. And we've

learned so much from everyone else. It was fun to be in a

position to give back.

SARA SACK: You're right. It's a great topic.

Always fun to talk about.

And thanks, Linda and Nicole, for being brave and

sharing where you are.

NICOLE BARTEL: No worries.

CAROLYN PHILLIPS: Nicole, anything else?

NICOLE BARTEL: No, no. Thanks. I'm flattered to

be a part of this. Thank you.

CAROLYN PHILLIPS: Excellent. Great.

Well, it is always a risk you take whenever you're

just jumping in and you haven't got it all solved. And so

thank you again, Linda and Nicole, for jumping in and

telling your story where you are and letting the rest of us

kind of look at and poke around. So that's great.

And, Stan, thank you so much for joining. I see

you posted a bunch of comments, and that was very helpful

as you added to the story. So thank you very much.

All right. Well, Caroline, I think that's it.

Thank you for helping me moderate.

And the rest of you, please keep in touch with us.

We look forward to hearing from you via the evaluation

process. But then also feel free to e-mail us or just

reach out and call us. And check us out online on our

website and the knowledge base.

And, Trish, thank you for posting -- she posted the

SurveyMonkey address right there for you in the public


So I'll be on for a little bit longer. If y'all

want to get in touch with me, feel free to.

And the rest of you have a wonderful afternoon. We

are sending positive thoughts to all of our friends that

are being affected by this weather. So everybody take care

and be safe out there.