Memorandum on the Interagency Task Force To Examine the Role of Medicare and Medicaid Coverage of Assistive Technologies in Encouraging the Employment of Persons with Disabilities

Memorandum for the Attorney General, the Secretary of Health and Human Services, the Secretary of Education, the Secretary of Labor, the Secretary of Veterans Affairs

Subject: Interagency Task Force to Examine the Role of Medicare and Medicaid Coverage of Assistive Technologies in Encouraging the Employment of Persons with Disabilities

The Ticket to Work and Work Incentives Improvement Act of 1999, the last legislation that I signed during the 20th Century, was a breakthrough in helping persons with disabilities enter the workforce. Persons with disabilities can now return to work and retain their Medicare and Medicaid coverage. No longer will they be forced to make an unfair choice between work and essential health care coverage. The Work Incentives law affirms that persons with disabilities can and do make valuable contributions to society through participation in the American workforce.

In ensuring that persons with disabilities have the same opportunities to work as all Americans, our next step is to take advantage of the remarkable advances in "assistive technologies"—the innovative devices that facilitate independent living and meaningful employment for persons with disabilities. This year I have included $100 million in my budget, an increase of $14 million over FY 2000, for disability and technology research, including assistive technology research, at the National Institute on Disability and Rehabilitation Research. I have also included in my budget this year $41 million for State-based assistive technology programs through the Department of Education. The National Center for Medical Rehabilitation Research, which is overseen by the National Institutes of Health, and the Department of Veterans Affairs, each provide $30 million in grants for assistive technology research. Together, these funds will support comprehensive research and education on the use of assistive technologies to further integrate persons with disabilities into their community and the workforce.

While the Work Incentives law extended Medicare and Medicaid to workers with disabilities, the Federal Government must make a comprehensive effort to determine how best to make these programs more effective for persons with disabilities, including improved coverage of assistive technologies. It is especially important to examine how medically necessary assistive technologies may facilitate independent living and also support employment for persons with disabilities.

I hereby direct the Secretary of Health and Human Services to convene an interagency Task Force on Health Care Coverage of Assistive Technologies that includes the Departments of Health and Human Services, Justice, Education, Labor, Veterans Affairs, and other agencies, as appropriate. The Task Force shall study the role that Medicare and Medicaid does and should play in the coverage of assistive technology devices. The work of the Task Force is intended to provide a framework for future Medicare and Medicaid coverage decisions that complements my Administration's overall efforts to promote employment opportunities for persons with disabilities.

I direct the Task Force to conduct a study on the role of Medicare and Medicaid in covering assistive technologies that encourage employment of individuals with disabilities. The study should:

(a) examine current Medicare and Medicaid coverage of assistive technology devices and the cost of providing such coverage. Assess the current coverage criteria under Medicare and Medicaid with comparisons to the private insurance market. Review and evaluate other past and on-going research on Medicare and Medicaid coverage of assistive technologies;

(b) seek input from the disability community to identify the types of medically necessary assistive technologies that facilitate independent living and employment. Develop criteria for identifying such devices;

(c) determine whether provision of assistive technologies may substitute for other Medicare and Medicaid health care services such as personal care services and, if so, provide an estimate of the potential savings;

(d) analyze Medicare and Medicaid medical necessity guidelines to determine whether they can support employment while continuing to meet the health care focus of the Medicare and Medicaid programs. As we move toward an increased employment of persons with disabilities, there is a need to study the intersection of the concepts of disability, medical necessity, and employment;

(e) determine an appropriate delineation of responsibility for coverage of assistive technologies between publicly financed health care and employers by evaluating employers' responsibilities under the Americans with Disabilities Act, section 504 of the Rehabilitation Act, and the Assistive Technology Act; and

(f) make recommendations for administrative and legislative changes to the Medicare and Medicaid programs, including an estimate of costs, to encourage coverage of medically necessary assistive technologies that also support employment of persons with disabilities.

This memorandum does not create any right or benefit, substantive or procedural, enforceable by a party at law against the United States, its officers or employees, or any other persons.

WILLIAM J. CLINTON