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Replacing Durable Medical Equipment and Assistive Technology Lost in Disasters

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Replacing Durable Medical Equipment and Assistive Technology Lost in Disasters

Whether it is a hurricane or a winter storm, it is important to be prepared. Part of your preparation should include knowing what to do if your durable medical equipment (DME) or assistive technology (AT), sometimes called an adaptive aid (AA), becomes lost or damaged in a disaster. Below are instructions for replacing DME or AT that was lost or damaged because of a disaster based on where you received the equipment from originally.

Vocational Rehabilitation

Any equipment purchased with Vocational Rehabilitation (VR) funds can be repurchased if damaged or lost during a disaster if the customer still has a VR goal. For individuals who have purchased DME out of pocket or through a funding source other than VR, VR funds can be used to replace the DME if the individual is working or would like to work.    

Vocational Rehabilitation recommends the following actions to replace DME that was lost or damaged in a disaster:

  • First, reach out to your local Texas Workforce Solutions location via phone or in person and ask for the Counselor of the Day.
  • The counselor will then assess the situation and recommend appropriate next steps.

Please note that how you receive services will depend on the status of your case with VR.

Medicaid Waivers

The current Medicaid medical policy allows for replacement of durable medical equipment (DME). Texas Medicaid & Healthcare Partnership (TMHP) and the 10 managed care organizations (MCOs) impacted by disasters follow the Medicaid medical policy for replacing DME as outlined in the Texas Medicaid Provider Procedures Manual (Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, Section 2.2.2.2). The policy states that purchased DME is anticipated to last a minimum of five years, unless otherwise noted, and may be considered for replacement when the time has passed, or the equipment is no longer functional or repairable. Replacement of equipment is also considered when loss or irreparable damage has occurred.

Community Living and Support Services (CLASS), DeafBlind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS), and Texas Home Living (TxHmL) Medicaid waivers each have a section in their rules regarding replacement or repair of adaptive aids or minor home modifications due to a declaration of disaster.

CLASS

The relevant Texas Administrative Code (TAC) for replacing Adaptive Aids or Minor Home Modifications is 26 TAC §259.451.

Adaptive Aids

If an individual requests the repair or replacement of an adaptive aid damaged or destroyed because of a disaster:

  1. a direct services agency (DSA) must provide to the case manager:
    1. a description of the repair or replacement of the adaptive aid that was damaged or destroyed because of the disaster; and
    2. the cost of the repair or replacement of the adaptive aid;
  2. the case manager must:
    1. include the cost of the adaptive aid or repair in the individual's:
      1. proposed renewal or proposed revised individual plan of care (IPC); and
      2. renewal or revised individual program plan (IPP);
    2. obtain the individual or legally authorized representative (LAR)'s oral agreement to the proposed renewal or proposed revised IPC and IPP;
    3. document the individual's or LAR's oral agreement on the proposed renewal or proposed revised IPC and IPP; and
    4. sign the proposed renewal or proposed revised IPC and IPP;
  3. the DSA must sign the proposed renewal or proposed revised IPC and IPP; and
  4. the case management agency (CMA) must submit to HHSC, no later than 180 days after the effective date of the order or proclamation described in subsection (a) of this section:
    1. the proposed renewal or proposed revised IPC;
    2. the renewal or revised IPP;
    3. a description of the repair or replacement of the adaptive aid that was damaged or destroyed because of the disaster; and
    4. a written statement of the case manager that the requested adaptive aid or repair is not available through a third-party resource.

Minor Home Modifications

If an individual requests the repair or replacement of a minor home modification damaged or destroyed because of a disaster:

  1. the direct services agency (DSA) must provide to the case manager:
    1. a description of the repair or replacement of the minor home modification that was damaged or destroyed because of the disaster; and
    2. one bid for the repair or replacement of the minor home modification from a vendor that includes:
      1. the cost of the repair or replacement of the minor home modification, which may be from a catalog, website, or brochure price list;
      2. the amount of any additional expenses related to the delivery of the minor home modification, including shipping and handling, taxes, installation, and other labor charges;
      3. the date of the bid; and
      4. the name, address, and telephone number of the vendor, who may not be a relative of the individual;
  2. the case manager must:
    1. include the cost of the minor home modification or repair, which must not exceed the cost described in subsection (n)(2) of this section, in the individual's:
      1. proposed renewal or proposed revised individual plan of care (IPC); and
      2. renewal or revised individual program plan (IPP);
    2. obtain the individual or LAR's oral agreement;
    3. document the individual's or LAR's oral agreement on the proposed renewal or proposed revised IPC and IPP; and
    4. sign the proposed renewal or proposed revised IPC and IPP;
  3. the DSA must sign the proposed renewal or proposed revised IPC and IPP; and
  4. the CMA must submit to HHSC, no later than 180 days after the effective date of the order or proclamation described in subsection (a) of this section:
    1. the description and bid of the repair or replacement described in paragraph (1) of this subsection;
    2. the proposed renewal or proposed revised IPC and IPP, completed as described in paragraphs (2) and (3) of this subsection; and
    3. a written statement of the case manager that the requested adaptive aid or repair is not available through a third-party resource.

DBMD

The relevant Texas Administrative Code (TAC) for replacing Adaptive Aids or Minor Home Modifications is 26 TAC §260.451.

Adaptive Aids

If an individual requests the repair or replacement of an adaptive aid damaged or destroyed as result of a disaster:

  1. instead of the service planning team completing the HHSC Rationale for Adaptive Aids, Medical Supplies, and Minor Home Modifications form, the program provider must obtain:
    1. a description of the repair or replacement of an adaptive aid that was damaged or destroyed because of the disaster; and
    2. one bid for the requested repair or replacement of an adaptive aid from a vendor that complies with §260.305(b) of this chapter; and
  2. the case manager must submit to HHSC, no later than 180 days after the effective date of the order or proclamation described in subsection (a) of this section:
    1. the renewal or revised individual plan of care (IPC);
    2. the renewal or revised individual program plan (IPP);
    3. the description and bid of the repair or replacement described in paragraph (1) of this subsection; and
    4. a written statement that the requested adaptive aid or repair is not available through a third-party resource.

Minor Home Modifications

If an individual requests the repair or replacement of a minor home modification damaged or destroyed because of a disaster:

  1. the program provider must obtain:
    1. a description of the repair or replacement of a minor home modification that was damaged or destroyed because of the disaster; and
    2. one bid for the requested repair or replacement of a minor home modification from a vendor that includes:
      1. the total cost of the requested minor home modification, which may be from a catalog, website, or brochure price list;
      2. the amount of any additional expenses related to the delivery of the minor home modification, including shipping and handling, taxes, installation, and other labor charges;
      3. the date of the bid; and
      4. the name, address, and telephone number of the vendor, who may not be a relative of the individual;
  2. the case manager must:
    1. include the cost of the minor home modification or repair in the individual's proposed renewal or proposed revised individual plan of care (IPC)and individual program plan (IPP);
    2. obtain the individual or legally authorized representative (LAR)'s oral agreement;
    3. document the individual's or LAR's oral agreement on the proposed renewal or proposed revised IPC and IPP; and
    4. sign the proposed renewal or proposed revised IPC and IPP;
  3. the program director or the RN designated by the program provider must sign the proposed renewal or proposed revised IPC and IPP; and
  4. the program provider must submit to HHSC, no later than 180 days after the effective date of the order or proclamation described in subsection (a) of this section:
    1. the proposed renewal or proposed revised IPC;
    2. the renewal or revised IPP;
    3. the description and bid of the repair or replacement described in paragraph (1) of this subsection; and
    4. a written statement that the requested minor home modification or repair is not available through a third-party resource.

HCS

The relevant Texas Administrative Code (TAC) for replacing Adaptive Aids or Minor Home Modifications is 26 TAC §263.1000.

Adaptive Aids

The service limit of adaptive aids for an individual who resides in the disaster area may be exceeded if:

  1. the requested adaptive aid that causes the service limit to be exceeded is:
    1. an adaptive aid that replaces an adaptive aid destroyed because of the disaster; or
    2. the repair of an adaptive aid that was damaged because of the disaster;
  2. the addition of the requested adaptive aid to the individual's individual plan of care (IPC)does not result in:
    1. the service limit of adaptive aids being exceeded by more than $5,000; or
    2. the individual's IPC cost limit for HCS program services being exceeded as described in §263.101(a)(3)(A), (B), and (C) of this chapter (relating to Eligibility Criteria for HCS Program Service and CFC Services);
  3. the program provider:
    1. includes the cost of the requested adaptive aid on the revised IPC; and
    2. submits to HHSC, within 180 days after the effective date of the order or proclamation described in subsection (a) of this section, a written request to HHSC to approve the requested adaptive aid that includes:
      1. a description of the adaptive aid that is replacing the adaptive aid destroyed because of the disaster, which may include pictures or other descriptive information from a catalog, website or brochure;
      2. a description of the repair to an adaptive aid that was damaged because of the disaster;
      3. one bid for the requested adaptive aid from a vendor that includes:
        1. the total cost of the requested adaptive aid; and
        2. the name, address and telephone number of the vendor who must not be a relative of the individual; and
      4. a statement from the program provider that the adaptive aid is not available through a third-party resource; and
  4. the requested adaptive aid is approved by HHSC.

Minor Home Modifications

The service limit of minor home modifications for an individual who resides in the disaster area may be exceeded if:

  1. the requested minor home modification that causes the service limit to be exceeded is:
    1. a minor home modification that replaces a minor home modification that was destroyed because of the disaster; or
    2. the repair of a minor home modification that was damaged because of the disaster;
  2. the addition of the requested minor home modification to the individual's individual plan of care (IPC) does not result in:
    1. the service limit of minor home modification being exceeded by more than $3,750; or
    2. the individual's IPC cost limit for HCS program services being exceeded as described in §263.101(a)(3)(A), (B), or (C) of this chapter;
  3. the program provider:
    1. includes the cost of the requested minor home modification on the revised IPC;
    2. submits to HHSC, within 180 days after the effective date of the order or proclamation described in subsection (a) of this section, a written request to HHSC to approve the requested minor home modification that includes:
      1. a description of the minor home modification that is replacing the minor home modification destroyed because of the disaster, which may include pictures or other descriptive information from a catalog, website, or brochure;
      2. a description of the repair to a minor home modification that was damaged because of the disaster;
      3. one bid for the requested minor home modification from a vendor that includes:
        1. the total cost of the requested minor home modification; and
        2. the name, address and telephone number of the vendor who must not be a relative of the individual; and
      4. a statement from the program provider that the minor home modification is not available through a third-party resource; and
  4. the requested minor home modification is approved by HHSC.

TxHmL

The relevant Texas Administrative Code (TAC) for replacing Adaptive Aids or Minor Home Modifications is 26 TAC §262.801.

Adaptive Aids

The service limit for adaptive aids for an individual who resides in the disaster area may be exceeded if:

  1. the requested adaptive aid that causes the service limit to be exceeded is:
    1. an adaptive aid that replaces an adaptive aid destroyed because of the disaster; or
    2. the repair of an adaptive aid that was damaged because of the disaster;
  2. the addition of the requested adaptive aid to the individual's IPC does not result in:
    1. the service limit of adaptive aids being exceeded by more than $5,000; or
    2. the individual's individual plan of care (IPC)cost limit for TxHmL program services being exceeded as described in §262.101(a)(4) of this chapter (relating to Eligibility Criteria for TxHmL Program Services and CFC Services);
  3. the program provider:
    1. includes the cost of the requested adaptive aid on the revised IPC; and
    2. submits to HHSC, within 180 days after the effective date of the order or proclamation described in subsection (a) of this section, a written request to HHSC to approve the requested adaptive aid that includes:
      1. a description of the adaptive aid that is replacing the adaptive aid destroyed because of the disaster, which may include pictures or other descriptive information from a catalog, website, or brochure;
      2. a description of the repair to an adaptive aid that was damaged because of the disaster;
      3. one bid for the requested adaptive aid from a vendor that includes:
        1. the total cost of the requested adaptive aid; and
        2. the name, address, and telephone number of the vendor who must not be a relative of the individual; and
      4. a statement from the program provider that the adaptive aid is not available through a third-party resource; and
  4. the requested adaptive aid is approved by HHSC.

Minor Home Modifications

The service limit for minor home modifications for an individual who resides in the disaster area may be exceeded if:

  1. the requested minor home modification that causes the service limit to be exceeded is:
    1. a minor home modification that replaces a minor home modification that was destroyed because of the disaster; or
    2. the repair of a minor home modification that was damaged because of the disaster;
  2. the addition of the requested minor home modification to the individual's individual plan of care (IPC)does not result in:
    1. the service limit of minor home modification being exceeded by more than $3,750; or
    2. the individual's IPC cost limit for TxHmL program services being exceeded as described in §262.101(a)(4) of this chapter;
  3. the program provider:
    1. includes the cost of the requested minor home modification on the revised IPC;
    2. submits to HHSC, within 180 days after the effective date of the order or proclamation described in subsection (a) of this section, a written request to HHSC to approve the requested minor home modification that includes:
      1. a description of the minor home modification that is replacing the minor home modification destroyed because of the disaster, which may include pictures or other descriptive information from a catalog, website, or brochure;
      2. a description of the repair to a minor home modification that was damaged because of the disaster;
      3. one bid for the requested minor home modification from a vendor that includes:
        1. the total cost of the requested minor home modification; and
        2. the name, address, and telephone number of the vendor who must not be a relative of the individual; and
        3. a statement from the program provider that the minor home modification is not available through a third-party resource; and
  4. the requested minor home modification is approved by HHSC.

Managed Care Organization (MCO)

Some individuals in the waivers may also receive AA or DME items from their managed care organization (MCO). Under UMCC Section 8.1.29, the Texas Health and Human Services Commission (HHSC) requires the MCO to have a continuity of Member care emergency response plan. Additional information can be found in Section 16.1.13 of the Uniform Managed Care Manual.

Medicare

A physician’s order is needed to reaffirm the medical necessity of the item.

There should be documentation in the supplier’s records detailing the incident, e.g., police report, insurance claim report, or beneficiary statement.

Original Medicare

If Original Medicare already paid for durable medical equipment (DME) (like a wheelchair or walker) or supplies (like diabetic supplies) that were damaged or lost due to an emergency or disaster, in most cases Medicare will cover the cost to repair or replace your equipment or supplies, but only when you get them from a supplier that Medicare approves.

If your equipment is damaged and needs to be repaired, generally Medicare will cover the cost of rentals for items like wheelchairs.

  • First, get in touch with the supplier you used to get your DME. Let them know about the damage or loss due to a disaster.
  • The supplier will then contact Medicare to make sure Medicare will pay for the replacement DME.
  • After Medicare approves the replacement, the supplier will get back in touch with you to arrange for pickup or delivery of the DME.

Medicare Health Plan

Contact your plan to find out how it replaces DME or supplies damaged or lost in an emergency or disaster. Generally, you can find your plan's contact information on your plan membership card. Or you can search for your plan's contact information. You can also call CMS at 1-800-MEDICARE.

This will be like the process for replacing DME/AT through private insurance.

Texas Department of Insurance

If you received your DME or AT through your insurance, the Texas Department of Insurance recommends these steps when recovering from a disaster.

Protecting your property

  • Call your insurance company to report damage.
  • Take pictures and video of the damage. Don’t throw anything away until your insurance adjuster tells you.
  • Make temporary repairs to prevent more damage. Remove standing water. Cover broken windows and holes to keep rain out.
  • Keep a list of the repairs and save receipts. Don’t make permanent repairs before the insurance adjuster sees the damage.

Filing a claim

Call your insurance agent or company as soon as possible to report property damage.

For company phone numbers, use the Texas Department of Insurance (TDI) Company Lookup or call TDI at 800-252-3439.

  • Keep a record of everyone you talked to with your company.
  • Be ready to answer questions about the damage.
  • Ask about an advance payment if you need help quickly.
  • Ask about living expenses. Most policies will cover some of the costs you have if you are unable to live in your home because of damage that is covered by your insurance. Keep your receipts for these costs.
  • If you need shelter or emergency food or water, contact the Red Cross at 800-733-2767.

FEMA

Assistance from FEMA may help you and members of your household affected by a disaster take care of necessary expenses and serious needs that cannot be met through insurance or other forms of assistance. FEMA can provide medical/dental financial assistance to pay for medical or dental expenses or losses caused by the disaster. This includes, but is not limited to, hospital and ambulance services, medication, and the repair or replacement of medically necessary assistive devices or technology.

Internet or Smartphone Application

Disaster survivors may apply for the Individuals and Households Program or check their application status at www.DisasterAssistance.gov. Disaster survivors may also access FEMA via smartphone by downloading the application from www.fema.gov or through their mobile provider’s application store.

By Phone

Disaster survivors may call FEMA toll-free at 800-621-3362 to register for assistance or check their application status. Disaster survivors who are deaf, hard of hearing, or have a speech disability and use a Text Telephone (TTY) may call 800-462-7585. Disaster survivors who use 711 or VRS (Video Relay Service) may call 800-621-3362.

In Person

Visit a Disaster Recovery Center.

  • For locations, check FEMA's mobile app www.fema.gov/mobile-app or call 1-800-621-3362 or visit www.DisasterAssistance.gov.
  • Disaster Survivor Assistance team members may visit door-to-door in your area. They will have official FEMA photo identification.