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FEDERAL POLICY BARRIERS TO ASSISTIVE
TECHNOLOGY National Council on Disability
May 31, 2000
National Council on Disability
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This report is also available in alternative formats
and on NCD's award-winning Web site (http://www.ncd.gov).
The views contained in the report do not necessarily
represent those of the Administration, as this document has not
been subjected to the A-19 Executive Branch review process.
Letter of Transmittal
May 31, 2000
The President
The White House
Washington, DC 20500
Dear Mr. President:
On behalf of the National Council on Disability (NCD),
I am pleased to submit NCD's Federal Policy Barriers to Assistive
Technology, as required by the Assistive Technology Act of 1998
(P.L. 105-394), Title II, Section 202.
As the title implies, this report describes the barriers
in federal assistive technology policy to increasing the availability
of and access to assistive technology devices and assistive technology
services for people with disabilities.
In the ideal climate, no person with a disability
should be denied the opportunity to obtain assistive technology
and transfer its inherent potential into viable, life-fulfilling
endeavors. However, it is clear that the current patchwork of federal
policies have barriers and gaps leaving many people with disabilities
without the benefits of assistive technology. This report identifies
four major barriers and makes 11 recommendations for reducing those
barriers.
NCD calls on Congress to take a hard and fast look
at what people with disabilities need to make assistive technology
readily available. We hope that this report will show the way.
Sincerely,
Marca Bristo
Chairperson
(The same letter of transmittal was sent to the President
Pro Tempore of the U.S. Senate and the Speaker of the U.S. House
of Representatives.)
NCD Members and Staff
Members
Marca Bristo, Chairperson
Kate Pew Wolters, First Vice Chairperson
Hughey Walker, Second Vice Chairperson
Yerker Andersson, Ph.D.
Dave N. Brown
John D. Kemp
Audrey McCrimon
Gina McDonald
Bonnie O'Day, Ph.D.
Lilliam Rangel-Diaz
Debra Robinson
Shirley W. Ryan
Michael B. Unhjem
Rae E. Unzicker
Ela Yazzie-King
Staff
Ethel D. Briggs, Executive Director
Jeffrey T. Rosen, General Counsel and Director of Policy
Mark S. Quigley, Public Affairs Specialist
Kathleen A. Blank, Attorney/Program Specialist
Geraldine Drake Hawkins, Ph.D., Program Specialist
Martin Gould, Ed.D., Research Specialist
Susan Madison, Fellow
Pamela O'Leary, Interpreter
Allan W. Holland, Accountant
Brenda Bratton, Executive Secretary
Stacey S. Brown, Staff Assistant
Carla Nelson, Office Assistant
Acknowledgment
The National Council on Disability wishes to express
its appreciation to the following Tech Watch members who participated
in the development of this report: Bonnie O'Day (chair), Judy Brewer,
Debbie Cook, Cindy King, Steve Mendelsohn, Kelly Pierce, and Gregg
Vanderheiden.
Contents
Executive Summary
Overarching Barriers and Recommendations
Awareness and Expertise
Accessible Product Development and Deployment
Comprehensive and Coordinated Funding
Research, Development, and Technology Transfer
Introduction
Stakeholder Validation
Consumer Survey
Provider Survey
The Current Landscape of Assistive Technology
Policy
Assistive Technology Policy in Education
Assistive Technology Policy in Employment
Assistive Technology Policy in Health Care
Assistive Technology Policy in Telecommunications and Information
Technology
Assistive Technology Policy in Alternative Financing
In Conclusion
Appendix
Mission of the National Council on Disability
Executive Summary
Citizens of all ages have come to increasingly rely
on technology in every aspect of life: home, work, play, and community.
For most people, technology makes life easier, broadens horizons,
or for the young provides an earlier start to learning. For people
with disabilities, however, technology changes the most ordinary
of daily activities from impossible to possible. In an ideal climate,
no person with a disability should be denied the opportunity to
obtain assistive technology and transfer its inherent potential
into viable, life-fulfilling endeavors.
Congress has long recognized its leadership role in
providing assistive technology (AT). In response to a growing need
for AT and the momentum of the disability rights movement, a myriad
of federal laws and policies have been enacted, reauthorized, and
amended to address the provision of assistive technology and accessible
mainstream technology.
Congress recognized the existence of barriers and
gaps in the current network of federal policy regarding assistive
technology through the Assistive Technology Act of 1998 (P.L. 105-394).
One of the three purposes of the Act is "to identify federal policies
that facilitate payment for assistive technology devices and assistive
technology services, to identify those federal policies that impede
such payment, and to eliminate inappropriate barriers to such payment."
Title II, Section 202 of the Act requires the National Council on
Disability (NCD) to prepare a report "describing the barriers in
federal assistive technology policy to increasing the availability
of and access to assistive technology devices and assistive technology
services for individuals with disabilities."
In the following section, NCD provides recommendations
to address specific overarching policy barriers identified as a
result of its extensive research. In the next section, NCD briefly
describes the results of stakeholder surveys. The subsequent section--patterned
after the policy areas identified by Congress in Title I of the
Assistive Technology Act--provides an overview of the current status
of federal assistive technology policy with specific attention to
the areas of education, employment, health care, telecommunications
and information technology, and alternative financing. The information
in this section is organized for ease of use and ready access by
federal agency administrators and program executives. A brief conclusion
completes the document.
The report uses the term "assistive technology" as
defined in the Assistive Technology Act to include "any item, piece
of equipment or product system, whether acquired commercially off
the shelf, modified or customized, that is used to increase, maintain,
or improve the functional capabilities of individuals with disabilities."
Overarching Barriers and Recommendations
NCD's research for this report included (a) a review
of the professional literature; (b) a review of federal policies;
(c) stakeholder surveys; and (d) a review and analysis of findings
by Tech Watch. As a result of this research, NCD identified four
major barriers and makes 11 recommendations for reducing barriers
to assistive technology access for individuals with disabilities.
Barrier: Awareness and Expertise
Aggressive awareness initiatives are needed to educate
individuals who could benefit from assistive technology, their families
and friends, service providers, and the public about the assistive
technology available today. Assistive technology expertise needs
to be cultivated and expanded in pre-service preparation programs,
consumer empowerment activities, and other training venues. Ensuring
a cadre of expertise in assistive technology is somewhat akin to
swimming upstream, given the incredible pace at which technology
itself is changing. More and more individuals with disabilities
and elders find themselves in need of assistive technology to remain
independent and productive, yet access to expertise to assist in
obtaining such technology is limited. While modest investments have
been made in increasing the pool of individuals with assistive technology
knowledge and skills, we continue to fall further and further behind
the need.
A classic example of change in federal policy dramatizing
the void of expertise can be seen with the new Individuals with
Disabilities Education Act (IDEA) requirement for every individualized
education program (IEP) team to "consider" the assistive technology
needs of the student. It is impossible for an IEP team to "consider"
assistive technology effectively when no team member is familiar
with the range of AT available to address desired goals.
Recommendations:
1. The Department of Education and Department of Health
and Human Services should ensure adequate support for assistive
technology competency development within and across a variety of
personnel preparation and training programs such as instructional
technology, computer sciences, information sciences, special education,
rehabilitation counseling, social work, medicine, nursing, and related
services (occupational therapy, physical therapy, speech-language
pathology, and audiology).
Training should provide awareness-level information
for practitioners in all disciplines along with consumers and advocates.
Training should also develop expertise-level competency in sufficient
numbers of providers to meet growing consumer need.
Barrier: Accessible Product Development and Deployment
All technology products and services should be accessible
to people with disabilities. Assistive technology must be thought
of in the context of the full range of mainstream technology--information
technology, educational technology, instructional technology, entertainment
technology, medical technology, and so on. To the maximum extent
possible, mainstream technology should be produced with accessibility
built in, utilizing the principles of universal design. When it
is not possible to build in accessibility, products should be compatible
with assistive technology to allow access.
Currently, public dollars are being spent on technology
for schools, community centers, libraries, and other public entities
without clear policy guidance regarding accessibility. As a result,
individuals with disabilities frequently find themselves unable
to use the newly installed technology and the public agency is left
scrambling trying to fix the access problem--usually at significant
cost. In addition, in far too many instances, the public entity
asks a "special" disability program, with already limited funding,
to bear the cost of fixing the access problem. For example, some
states and schools are requiring special education budgets to bear
the costs of accessibility adaptations for educational technology
rather than utilizing general educational technology dollars to
provide access. This would be similar to requiring special education
to fund the cost of an elevator when building a new school facility.
Accessibility costs should be included in overall technology budgets,
not shuffled off to special funding sources.
Recommendations:
2. Congress should extend the provisions of Section
508 to apply to any agency expenditure of federal dollars for electronic
and information technology. When assistive technology, beyond built-in
access features, is needed for accessibility, Congress should encourage
the use of generic federal technology funding streams to purchase
such "add-on" technology.
Access for persons with disabilities should be viewed
as a standard benchmark for the use of federal funds for development
and procurement of information and telecommunications technology.
Just as agencies that receive federal funds are prohibited from
discriminating on the basis of disability by Section 504 of the
Rehabilitation Act, they should be prohibited from utilizing federal
dollars to develop or procure technology that is inaccessible, as
is required currently for federal agencies under Section 508. In
addition, generic federal technology funding streams should be used
to purchase assistive technologies necessary for accessibility.
Agencies that administer federal dollars should require an assurance
from all funding recipients that information and telecommunications
technology developed or procured will meet accessibility standards
and that the funding stream will be used to provide assistive technology
needed for access.
Funding applications with inherent substantial technology
usage should further require a specific description of the methodology
used to deliver built-in access and should identify the proportion
of funding that will be used to purchase assistive technologies.
Examples of federal funding systems with inherent technology usage
and application include a number of library funding streams, a number
of educational technology funding streams, E-rate funding, 21st
Century Community Learning Centers, and many others.
An example of the need for application of Section
508 requirements on expenditure of federal funds can be seen in
the development of the "One-Stop" employment centers through the
Workforce Investment Act. While the Americans with Disabilities
Act (ADA) requires basic accessibility in programs such as One-Stop
Centers, it does not clearly require that the information and telecommunications
technologies so critical to One-Stop Center service be accessible.
The ADA and Section 504 allow for other accommodations to be used
to provide access, such as "a person will do the on-line job search
for you." Federal policy intervention is needed to require direct
access to information and telecommunication technologies integral
to the core employment services offered by one-stop centers with
access delivered by built-in features and assistive technology.
Such policy should provide standards for technology access
and could be added to the existing regulations governing One-Stop
Centers. Many states have begun initiatives to address accessibility
at the One-Stop Centers, but absent federal policy, such activities
will be slow-moving and inconsistent nationally.
3. Congress should support the Access Board's role
in delivering technical assistance and training to federal
agencies implementing Section 508 and should establish a national
resource center to provide technical assistance and training to
support state and local application of Section 508 standards.
Federal training by the Access Board should be coordinated
with the ongoing efforts of the General Services Administration's
(GSA) Center for Information Technology Accommodation and the federal
chief information officers. To help address state and local training,
the Access Board could convene a state information technology (IT)
access advisory committee to review federal Section 508 standards
and the variety of state laws regarding IT access and to provide
suggestions for achieving uniform IT accessibility in state and
local programs. Membership on the committee should include core
representation of the National Association of State Information
Resource Executives, National Association of State Procurement Officers,
Association of Tech Act Projects, and other state and local consumer
and affected entity organizations. This advisory committee could
suggest core services for state and local entities that should be
provided by a national technical assistance center.
4. Congress should authorize GSA to develop testing
protocols and mechanisms to evaluate, verify, and report on product
adherence to Section 508 accessibility standards.
For consistent application of Section 508 accessibility
standards, testing protocols and reports that verify product adherence
to established standards are needed. Manufacturers and providers
of devices and services, along with those procuring such devices
and services, must be able to test and evaluate products for adherence
to established benchmarks. Without testing protocols and verification
mechanisms, it is likely that some entities will take independent
action and will establish a system that meets their goals for procurement
decision making, and others will dismiss adherence to standards
until such a system is developed. Ether way, the result will be
an inconsistent application in which quality, consumer-responsiveness,
and cost-effectiveness are compromised.
5. Congress should expand the copyright exemption to
eliminate consent requirements for reproducing any audiovisual material
for the purpose of adding accessibility through captions, video
description, or other technologies that provide access for persons
with disabilities.
In 1996, Congress eliminated the need to obtain the
permission of publishers or copyright owners to reproduce or distribute
a nondramatic literary work in a "specialized format" for the exclusive
use of blind persons or others with physical disabilities. Entities
authorized to use this copyright exception are nonprofit organizations
or governmental agencies whose primary mission is to provide specialized
services related to the training, education, adaptive reading, or
information access needs of people who are blind or other people
with disabilities. "Specialized formats" specifically includes braille,
audio, or digital text exclusively for use by people who are blind
or other people with disabilities. Unfortunately, there is no similar
exemption from the copyright requirements for adding captioning
or video description, and as a result it is very burdensome to do
so. Often, obtaining such permission can take upwards of six months,
eliminating entirely the benefits of such materials for educators
and students during a given learning period.
Barrier: Comprehensive and Coordinated Funding
Existing laws and policies that fund assistive technology
have gaps that fail to address the needs of many individuals with
disabilities. In addition, the laws and policies are frequently
misinterpreted or implemented inappropriately by those charged with
service delivery and oversight. Federal agencies and others that
implement federal policy (such as states and local agencies) commonly
lack the expertise and resources necessary to implement existing
AT laws and policies.
Laws and policies that provide or fund assistive technology
must be more comprehensive, more consumer-responsive, better coordinated,
and more consistent across agencies and systems to allow for increased
access. Today's policies are a maze of conflicting definitions,
eligibility criteria, philosophical models, and requirements for
access to assistive technology. Consumers are left with the daunting
task of learning each system's policies to be able to advocate for
the assistive technology they need. Federal policy should be comprehensive,
coordinated, and consistently implemented at the state and local
levels to ensure equitable delivery of AT to all individuals with
disabilities who are eligible for services.
Recommendations:
6. Congress should support a network and infrastructure
of state assistive technology programs designed to improve and expand
state assistive technology policy.
Access to technical assistance and policy advocacy
from a state assistive technology program can be effective tools
in helping consumers navigate complex federal-state policies and
in reducing frustration-driven litigation. Such technical assistance
and policy advocacy are also critical to develop the coordination
and resources necessary for a comprehensive AT system. State assistive
technology programs should work with state agency staff, elected
officials, and other critical decision makers to expand state resources
and fill in gaps not addressed by federal programs. State assistive
technology programs should advocate for the development and implementation
of state policies that support and compliment federal policy.
7. Congress should ensure that the Health Care Financing
Administration (HCFA) revises the Medicare and Medicaid definitions
and description of "medical care," "medical necessity," and "durable
medical equipment" to broaden the range of assistive technology
provided.
The current definitions of durable medical care, medical
equipment, and medical necessity were enacted in the 1960s, when
medical care was viewed primarily as curative and palliative, with
little or no consideration given to increasing an individual's functional
status. This bias often severely restricts funding of assistive
technology that improves function or helps prevent secondary disabilities.
For example, Medicare does not routinely fund shower chairs that
are necessary for an individual with a disability to bathe safely
and independently, hearing aids necessary for an individual to communicate
effectively with his or her physician, or electronic enlarging equipment
necessary for a person to read prescription labels and follow diet
directions specific to a disease.
New definitions of medical care and medical necessity
could use the model found in workers compensation statutes that
provide for increased functioning. A new definition and description
of "durable medical equipment" could either add assistive technology
not currently included in the definition or could add AT as a separate
category that must be provided if it increases, maintains, or improves
functional capacity. These changes would pave the way for comprehensive
coverage of assistive technology, such as hearing aids, power mobility,
and augmentative communication devices, critical to the health,
well-being, and independence of individuals with disabilities. These
changes would also affect private insurance plans, as many defer
to Medicare definitions in the interpretation of their covered services,
and would be one method of driving changes in private insurance
without intrusive regulation.
Recognizing that differing technological inputs can
yield different types and degrees of functional improvement, it
is critical that HCFA work collaboratively with the Agency for Healthcare
Research and Quality, in relation to the recommendations below,
to develop standards and measures to ensure that the most effective
and the most cost-effective AT interventions will be deemed eligible
for coverage and reimbursement.
8. Congress should ensure access to basic telephone
service to individuals who cannot utilize a traditional telephone
due to disability.
Telephone access is fundamental to the safety and
well-being of all Americans. For individuals with disabilities who
need adaptive telephone equipment, there is currently no system
with responsibility to ensure access to such equipment. According
to Jim Tobias, Inclusive Technologies (1999), approximately half
the states in the nation have programs to distribute telecommunications
equipment to people with disabilities. They range from small, means-tested,
TTY-only programs to large, entitlement-based programs carrying
a wide variety of adaptive telecommunications devices. Unfortunately,
the availability of an equipment distribution program, eligibility
requirements, and the level of program benefits are quite variable
depending on the state or local telephone company that operates
the program. A consumer's ultimate ability to access and benefit
from an equipment distribution program may be restricted by the
mere fact the consumer resides in a state, county, city, town, or
street in which a program is not offered.
As a foundation for legislation to support access
to adaptive telephone equipment for all Americans, a study could
be undertaken on the current status of the myriad of state adaptive
telephone equipment distribution programs, including identification
of the program content and benefits, eligibility criteria, geographic
saturation, and funding mechanisms. The study should be conducted
in concert with members of the Telecommunications Equipment Distribution
Program Association (TEDPA), telecommunications industry personnel,
and state and federal officials. Recommendations for a consistent
national policy, identified funding sources, and funding mechanisms
needed to ensure the availability and support of universal access
could then be developed.
9. Congress should fund Title III of the Assistive
Technology Act of 1998 to establish low- interest or no-interest
loan programs to purchase assistive technology.
Currently, some tax incentives exist (e.g., Disabled
Access Credit, Architectural and Transportation Barrier Removal
Deduction) to make AT more affordable to persons with disabilities
and to businesses that need to make expenditures on AT to become
more accessible to employees and members of the public with disabilities.
In a number of states, AT projects are working to implement state
tax incentives such as removing state sales tax on many devices
and pieces of equipment. For high-cost AT, the savings to an individual
with a disability can amount to hundreds of dollars. Yet the initial
purchase costs of AT devices, equipment, and services are beyond
the financial reach of many individuals with disabilities. The availability
of low-interest or even no-interest loans to people with disabilities
through Title III would significantly increase the availability
of a whole host of AT devices, equipment, and services to people
who currently have little or no access to AT.
Barrier: Research, Development, and Technology Transfer
Research and development should be sufficient to ensure
that a full range of mainstream and specialized technology is available.
Federal dollars currently devoted to research and development of
assistive technologies and technology transfer are fairly limited
and fragmented among multiple federal agencies. Insufficient dollars
in mainstream technology research and development are focused on
access features (universal design) and compatibility with assistive
technology. Frequently, when new assistive technologies become available
they are priced far beyond the range of most individuals with disabilities
or elders. Similarly, when mainstream products are produced with
access features, they tend to be the "deluxe" models, which are
not affordable. In addition, new assistive technologies, with high
costs, are frequently not covered by public and private funding
sources.
Recommendations:
10. Congress should ensure that the Agency for Healthcare
Research and Quality undertakes a study on the role of assistive
technology in improving the functional abilities of persons with
disabilities.
The growth of managed care has contributed to the
development of measures of quality health care delivery for public
and private providers; however, few measures have been developed
to address health care delivered to persons with disabilities. There
is a need to develop and implement quality assurance in managed
care for persons with disabilities, with particular attention focused
on assistive technology. Congress recently passed legislation that
changed the mission and the name of the Agency for Health Care Policy
Research. The bill directs the new Agency for Healthcare Research
and Quality to study preventive and long-term health care and to
focus on services for several groups, including persons with disabilities
and the elderly. Part of this new focus should include attention
to assistive technology delivered via the health care system.
11. Congress should undertake a focused study of the
technology research and development activities of the Department
of Defense, National Institute for Standards and Technology, Department
of Commerce, National Science Foundation, federal laboratories,
National Institutes of Health, Department of Veterans Affairs, and
National Institute on Aging to identify projects that should be
initiated to develop universally accessible products and to apply
existing research to meet the needs of individuals with disabilities
through development and commercialization of assistive technologies.
AT is in a constant state of change and evolution
because it is, after all, technology. That means that new information,
proven practices, and AT policy should be well coordinated, communicated,
and accurately transferred among government agencies, industry,
and consumers. Technology transfer involves the transmittal of developed
ideas, products, and techniques from a research environment (i.e.,
hosted by many of the federal agencies listed above) to one of practical
application by consumers. Many government agencies have programs
that are designed to facilitate technology transfer. There is, however,
no well-organized mechanism for the development, identification,
and distribution of research findings and products by federal agencies
to those providing AT services or to industrial partners or consumers.
If the nation is to increase its public sector investment in, and
reliance on, technology to provide government services and resources,
the above named federal agencies must improve their delivery of
cutting edge research results and proven products.
Introduction
As we begin the millennium, citizens of all ages have
come to rely increasingly on technology in every aspect of life:
home, work, play, and community. For most people, technology makes
life easier, broadens horizons, or for the young provides an earlier
start to learning. However, for people with disabilities, technology
changes the most ordinary of daily activities from impossible to
possible. In an ideal climate, no person with a disability should
be denied the opportunity to obtain assistive technology and transfer
its inherent potential into viable, life-fulfilling endeavor.
Congress has long recognized its leadership role in
providing assistive technology (AT). In response to a growing need
for AT, and the momentum of the disability rights movement, a myriad
of federal laws and policies have been enacted, reauthorized, and
amended to address the provision of assistive technology and accessible
mainstream technology. Examples of such laws and policies include
the Rehabilitation Act, Workforce Investment Act, Individuals with
Disabilities Education Act (IDEA), Medicaid, Medicare, the Telecommunications
Act, and the Assistive Technology Act. In addition, appropriation
bills are passed each year with billions of federal dollars directed
toward technology research and development with a small portion
addressing assistive technology and accessibility of mainstream
technology.
Congress recognized the existence of barriers and
gaps in the current network of federal policy regarding assistive
technology through the Assistive Technology Act of 1998 (P.L. 105-394).
One of the three purposes of the Assistive Technology Act is "to
identify federal policies that facilitate payment for assistive
technology devices and assistive technology services, to identify
those federal policies that impede such payment, and to eliminate
inappropriate barriers to such payment." Title II, Section 202 of
the Assistive Technology Act requires the National Council on Disability
(NCD) to prepare a report "describing the barriers in federal assistive
technology policy to increasing the availability of and access to
assistive technology devices and assistive technology services for
individuals with disabilities."
Stakeholder Validation
As a part of this report, a survey of consumers, providers,
and experts was completed to ensure that the recommendations of
this report were based on the actual 1999 experiences of stakeholders
who deal with these issues every day. Due to the extremely short
time frame of two months, this unscientific survey was done via
e-mail and fax. The responses validate the conclusions that the
overarching barriers that continue to limit access to AT are lack
of awareness, lack of access to expertise, and lack of funding.
Local or even regional eye care professionals have
little or no information about Assistive devices beyond magnifiers.
I have spent years going to conferences to find out information
on my own because there was no one to help me. Accessibility is
a fantasy to those of us who desperately need it. We read about,
it but cannot possibly afford it on Social Security Disability Insurance.
Are we supposed to sit in our chairs all day and listen to talking
books until we die? I am only 50. I do not fit in any category except
the 'left out.' Charla McMillan, Red Oak, OK
Consumer Survey
The goal of the survey of AT users was to discover
what barriers most frequently prevent access to necessary AT and
how people have dealt with those barriers. The survey was distributed
to 2,000-plus users of AT through various stakeholder networks.
Responses were received from parents of children with disabilities;
center for independent living participants; individuals with disabilities;
membership of organizations of individuals who are deaf and hard
of hearing, blind, or veterans; and people with brain injury. There
was wide geographical representation. Consumer responses were returned
from Puerto Rico and 47 states. Provider responses were received
from the state special education director in Wyoming and the state
Medicaid director in Arkansas.
A special effort was made to include those over 65
years of age, minorities, and traditionally underserved populations.
The responses were consistent across all demographic and geographic
groups. The barriers identified in the survey were faced by all
the respondents, whether they were rural, inner-city, over 65, African
American, Hispanic, low-income, or members of other minority groups.
These barriers were also identified no matter whether the respondent's
disability was cognitive, sensory, or physical. Wide cross-disability
response was received.
The two biggest barriers identified by consumers were
lack of information and knowledge about appropriate AT, and lack
of funding to purchase the needed AT. Consistently, those who responded
to the survey do not have information on what AT is available, where
to get it, who pays for it, where to get an evaluation, or what
their rights are. Overwhelmingly, respondents said they do not have
the money to purchase AT--either they did not have the out-of-pocket
cash, their insurance companies did not cover it at all or denied
their claims, or no public funding available was available.
Other common themes were the lack of trained, qualified
professionals to evaluate what AT was appropriate; the difficulty
finding and trying out AT; the red tape and bureaucracy of public
programs and insurance companies; the difficulty of keeping pace
with technology developments; the lack of maintenance and support;
and the lack of access to AT in other areas, such as housing and
transportation.
The cost of computer voice output software is outrageous.
Many disabled people are low income and will never have the funds
to obtain Assistive technology such as accessible computers.
Tony Jorgensen, assistant manager, Training Department, Lighthouse
for the Blind, Seattle, WA
I borrowed seven thousand dollars from a bank to
get the most up-to-date equipment at home. I have continuously purchased
equipment over the past five years. I spend about three thousand
dollars a year on new equipment. I call it job retention expenses.
Vincent Martin, Atlanta, GA
For many people with present or increasing hearing
loss, shame is a huge barrier to getting or using assistive listening
devices. Patricia Schmieg, Boston, MA
I went to Vocational Rehabilitation for a job but
eventually had to quit because my hearing was so poor that interpreting
was impossible. The other jobs that were offered were low paying
and not in the least interesting to me. Even the VR counselor did
not understand hearing loss and how it impacts your chances of finding
employment. She [the VR counselor] wanted me to work as a phone
person for the Social Security Office. The SS Office said that a
TTY would not be the ideal way of communicating with clients. I
dread going back to VR. Claudia Damian, Dearborn, MI
These barriers most often translate into poor quality
of life for people who need the assistive technology they cannot
get. A significant number of the respondents said these barriers
meant they went without the AT, and a significant number said they
had to pay out of pocket. These results have serious consequences.
Going without necessary AT can lead to a medical emergency, loss
of job, poor education, and isolation from community activities.
Paying for AT out of pocket is a difficult reality for people with
disabilities. Seventy percent of people with disabilities are unemployed
and so do not have an income or savings to purchase AT. The high
cost of some assistive technology devices can also be prohibitive
for people who are employed. Purchase of AT can mean going without
something else or paying off loans for a number of years. This can
be especially hard on families as siblings might have to go without
in order to cover the expenses of the chid with the disability.
I had to be dependent on someone. Sometimes you
would get caught in the bed rails and get bruised. Debbie Michel,
Park Hills, MO
As a result of the lack of assistive listening devices
at two different theaters, I left the auditorium in one situation,
and in the other situation struggled through the play with about
a 35 percent understanding of what was happening. I picked up on
body language, a few words, laughed when appropriate and generally
faked it. It is a social necessity to attend things like this with
my wife, even though I can't enjoy it the way she does. James
Horn, Toms River, NJ
I lost a job because of no adequate hearing accommodations.
Mary Martin, New Orleans, LA
The results of this survey clearly show that the current
system places the burden on the individuals or families who need
AT. They have to find out what is out there, navigate the system
and funding streams, and know their rights and fight for them. The
few success stories that were found in the results were successes
only after the parents or individuals became experts at the law
and government procedures, spent months fighting the many systems,
went through a legal battle, or lobbied legislators. For many, the
battle does not seem worth the reward.
I find I've given up fighting for bare necessities.
The battle isn't worth it and it makes me suffer. Lynda Brown,
Cortland, NY
Provider Survey
Surveys were also sent to directors of agencies that
provide assistive technology, policy experts, and agencies that
help people with disabilities to obtain AT. Responses were received
from centers for independent living, the National Association of
Protection and Advocacy Services, state special education directors,
state Medicaid directors, state information executives, and members
of the Consortium of Citizens with Disabilities. They were all asked
what strategies they had used to deal with barriers in the AT system
and what two policy changes would they ask for to improve the federal
AT delivery system if they were granted two "wishes." Medicaid directors
were asked additional questions specific to their field. The response
from Auburn Cooper, the director of the Bureau for Medical Services,
was to the point:
"Send Money. Send More Money."
Just as in the assistive technology user surveys,
funding was a priority issue for the providers and policy experts.
All noted lack of adequate resources as a problem. Staff at centers
for independent living asked for more funding for direct purchase
of AT. The state program directors asked for more money to fund
more fully AT services they provide.
Gordon Riffel, special assistant to the superintendent
for special education, Springfield, IL, described his two "wishes":
1. Most people agree that finding the appropriate
equipment is crucial to the successful utilization of a specific
piece of assistive technology. Once a general area of need has been
recognized and several devices are recommended for consideration,
each recipient needs time to use the device to see if it works for
them. Therefore, my first wish would be to have Uncle Sam provide
funding to establish a statewide loan network that could provide
30-, 60-, or 90-day loans to determine the practicality of a device
in the environments in which it will be used. The bank could be
maintained with rental fees based on the cost of the equipment.
2. The second wish would be to have Uncle Sam establish
a "statewide warehouse of assistive technology" (SWAT). This warehouse
would allow the equipment that was tried on a loan basis to stay
with the student user if the device proves itself to be appropriate
for the student's needs. Keeping the device that works would eliminate
long delays in acquiring the device and not require reprogramming.
The learning curve for the student, teacher, parents, and others
involved in the child's education would not be interrupted. The
district could then pay the SWAT for the device (already in use
by the student) and SWAT could purchase a new device for the warehouse,
hopefully at a negotiated volume-buying discount.
The results of the survey also highlighted inconsistencies
among the states. For example, answers to the questions on Medicaid
coverage of AT demonstrated the variance among states.
The Current Landscape of Assistive
Technology Policy
Why does the vision of readily available AT for all
Americans with disabilities still seem so elusive? The challenges
identified in the findings of NCD's 1993 report on financing assistive
technology have not been vanquished. Why not? The factors are varied
and many. The number of AT users has increased, and there has been
an explosion in the sophistication and variety of devices, many
of which are more high tech and costlier than ever. It is difficult
to find assistive technology expertise and to see and try out devices.
Federal policies that govern systems providing AT, such as IDEA,
the Rehabilitation Act, Medicaid, and Medicare, have limited funding,
are poorly coordinated, and have been inconsistently implemented
at the state and local levels.
Efforts to improve access to assistive technology
are akin to chasing a moving target. For example, just as inroads
were made in ensuring AT coverage in health care plans, the health
care industry underwent a fundamental change from fee-for-service
to managed care, and work began anew to ensure access to AT in managed
care plans. Even when federal policy is stable, the vast majority
of federal programs are implemented at the state level with a corresponding
myriad of state policies. As a result, AT access barriers continue
to be created and removed at the state level, even when federal
policy is unchanged.
People with disabilities, providers, advocates, and
policy makers are faced with a need to become knowledgeable about
assistive technology and the maze of assistive technology policies
and procedures that govern funding. Each federal funding system
varies in its policies and procedures and further varies with state-level
implementation parameters. Assistive technology that is "medically
necessary" for a person under age 21 is suddenly no longer "medically
necessary" when the person turns 21. Assistive technology that is
considered medical restoration can be funded if necessary for employment,
but not if necessary for education. To navigate the AT policy maze,
one must understand the AT portions of many different pieces of
federal legislation.
In addition to policy information, consumers, advocates,
providers, and policymakers must have or be able to readily access
knowledge about the range of assistive technology available and
how it can be used to address consumer needs. In many states and
regions, expertise in specialized areas of assistive technology
is in critically short supply. Pre-service preparation programs
in education, health care, and other human service areas are simply
not producing sufficient numbers of personnel with AT knowledge
to minimally meet needs. Similarly, consumers and students themselves
are faced with the enormous task of trying to stay current in a
technology area that is undergoing unprecedented change.
Recent reports (Mann 1994 and Tobias 1999) continue
to illustrate that consumers with disabilities are not aware of
currently available assistive technology that could address their
functional limitations. Studies also show that persons with disabilities
tend to rely on personal interactions with families, friends, and
service providers to obtain information about devices and services.
Not surprisingly, consumers and providers identify the ability to
touch, feel, and try out devices in a comfortable environment as
an effective way of enhancing their ability to select a device that
will work for them.
Over a 10-year period, state assistive technology
programs funded under the Assistive Technology Act (formerly the
Tech Act) committed more than $32 million to partnerships with local
community-based organizations--such as independent living centers,
United Cerebral Palsy affiliates, Easter Seals chapters, and aging
organizations--for the establishment of community- based resources
with assistive technology expertise and the capacity to provide
equipment demonstration. These resources respond to the needs of
persons with disabilities to get information in their communities.
In addition, a handful of states have allocated state dollars to
support statewide short-term equipment loan programs operated through
community distribution points. Some state education agencies have
also used IDEA discretionary dollars to fund statewide training
and technical assistance centers devoted to special education technology
for students with disabilities. Many of these state special education
technology programs include short-term equipment loan programs,
and some provide volume buying agreements and/or long- term loan
of certain devices.
Existing resources can respond only to a limited range
of such training and technical assistance needs. While national
Internet sites, training centers, and other technical assistance
programs perform needed functions, they cannot stay abreast of the
state and local policies that drive AT access at a consumer level.
In addition, underserved groups frequently do not use national sources.
One commonality noted among many underserved groups--such as elders,
low income people, migrants, and persons who live in rural areas--is
that they get their information from their peers and "trusted" providers.
As a result, technical assistance, consumer support, and policy
coordination must be done at state and local levels to supplement
any federal initiatives.
Sometimes assistive technology is not yet available
to meet the needs of a specific functional limitation. When new
assistive technology is needed, limited resources are available
to support such development. Technology transfer is the transmittal
of developed ideas, products, and techniques from a research environment
to one of practical application. Many government agencies have programs
that are designed to facilitate technology transfer and thus increase
access to assistive technology and accessible mainstream technology.
There is, however, no well-organized mechanism for distribution
of research findings to those providing services or industrial partners.
In addition, the limited profit associated with products in the
AT market frequently makes transfer less attractive to traditional
industry investors.
Assistive Technology Policy in Education
...commitment to free quality education for all
has been a bedrock principle of our nation. The Internet, in time,
will be the blackboard of the future. Knowledge of technology is
increasingly essential for life and work. How
can we allow some children to have access and leave others out?
--Secretary of Education Richard W.
Riley, 1997 (emphasis added)
Educational services for students with disabilities
have changed dramatically over the past 10 years. Technology for
all students and assistive technology for students with disabilities
has become more commonplace in schools across the country. Federal
policy regarding school obligation to deliver assistive technology
has also changed dramatically in the past decade. Special education
law has required the provision of assistive technology if needed
as part of a "free appropriate public education" (FAPE) for more
than 10 years. In 1990, amendments to IDEA included broad definitions
of assistive technology devices and services and a specific requirement
for schools to provide AT if needed for FAPE as part of special
education, related services, or supplementary aids and services.
The 1997 reauthorization of IDEA added a requirement that each individualized
education program (IEP) team consider AT as one of a number of "special
factor considerations."
As the technology has become more complex, so have
the policy dilemmas. The recent U.S. Supreme Court decision in Cedar
Rapids Community School District v. Garret F. has yet to be
clearly interpreted in its application to assistive technology determinations
of "medical" versus "educational." Schools continue to communicate
confusion regarding their responsibility to provide life-sustaining
technology such as respirators and suctioning equipment even after
Garret F. They also express concern about their obligation
to provide assistive technology such as wheelchairs, hearing aids,
and eyeglasses when other funding sources (such as Medicaid and
private insurance) are not available or refuse to pay for such devices.
Policy conflicts continue to exist that increase confusion as illustrated
by the IDEA Part C and Medicaid policies for order of payers. Federal
regulations stipulate that Part C dollars can only be used after
Medicaid dollars that can only be used after private insurance dollars.
However, Part C also prohibits requiring the use of private insurance
dollars; thus, one of the policies must be violated to get both
Medicaid and IDEA funding for early intervention services.
With the new IDEA special factor requirement, every
IEP team must consider the assistive technology needs of every student.
This new federal mandate has created a policy development and implementation
need in every state and local school district. Using IDEA child
count information, IEP teams will need to "consider" the assistive
technology needs of 5.6 million students each year. This consideration
and documentation through the IEP process will be repeated annually
for every student, resulting in a minimum of 5.6 million assistive
technology considerations per year. Billions of dollars are being
expended on technology for schools, with the promise of every school
being wired and every student having a computer. Computer usage
for instruction and learning is found today in most every type of
program, at every grade level, in every school across the country.
From 1997 to 1998, the number of instructional classrooms with Internet
access increased from 27 percent to 51 percent (Digest of Educational
Statistics, 1998). If that rate of growth continues, almost all
classrooms will have Internet access in the next few years.
Unfortunately, the rapid acquisition of educational
technology has not sufficiently addressed the needs of students
with disabilities. Access for students with disabilities is just
beginning to be identified as an important factor when purchasing
educational technology. Barriers to the use of advanced telecommunications
for students with disabilities in public schools include special
education teachers not sufficiently trained to use equipment; insufficient
evaluation and support services to meet special technology needs;
too few computers with alternative input-output devices; too few
computers available to students with disabilities; and school administrators
not seeing telecommunications as relevant for many students with
disabilities (National Center for Education Statistics, 2000).
There currently are no federal policies or standards
regarding accessibility of educational media and materials, and
limited resources have been devoted to promoting the concept of
universally designed curricula and educational assessment materials.
A few states have begun to address the issue. For example, Texas
requires textbook publishers who sell to Texas elementary and secondary
schools to provide a standardized electronic version of the text
for accessibility purposes (e.g., expedient braille production).
Missouri recently passed legislation that requires elementary, secondary,
and postsecondary schools to procure educational materials from
publishers who will provide standardized electronic text. New California
legislation requires publishers to provide their products in electronic
format for students with disabilities attending state and community
colleges in California. In support of these efforts, the American
Printing House for the Blind is establishing a central repository
of electronic textbooks that will make such files available to schools
throughout the country.
Assistive Technology Policy in Employment
Increased access to health care, more assistance
at home and in the workplace, remarkable new technologies made more
available: This is how we can make sure that all Americans can take
their rightful place in our 21st century workplaces.
--President Bill Clinton, 1999
Unfortunately, the unemployment rate for Americans
with disabilities remains unchanged from more than a decade ago.
It is similarly safe to say that there have been only small strides
in the use of assistive technology in the workplace as a tool to
level the playing field between workers with disabilities and those
without.
For workers with disabilities from diverse backgrounds,
this is also particularly true. While there is evidence that AT
can improve prospects for successful employment outcomes, and some
attention has been devoted to cultural sensitivity involving the
families of children with special needs, little has been published
about the utilization of such services by American Indians/Alaskan
Natives. Current anecdotal evidence suggests that AT utilization
rates are lower on American Indian reservations than in urban areas,
and that significant barriers include lack of knowledge of cultural
issues by providers of AT services and lack of knowledge about AT
services by the consumers who need them. Another barrier is that
ADA is not binding on Indian reservations because of their sovereign
status.
People with disabilities want to work but often encounter
barriers such as trying to secure health insurance when they leave
the public health care system and enter the workforce. For many
individuals with disabilities, the decision of whether to choose
employment or health care does not take much in the way of deliberation:
Health care is often the more critically needed service, especially
for individuals whose disabilities include expensive technology
needs. However, this fact does not negate the desire for employment.
It is just not an option given the limited choice between having
health care or having a paycheck and no access to affordable health
insurance. The new Work Incentives Improvement Act builds on the
changes in the Balanced Budget Act of 1997. These initiatives have
the potential to improve health care options for persons with disabilities
wishing to return to work. However, depending on the assistive technology
needs of the individual and the state in which one lives, the measures
may be limited in improving access to AT.
The legislation creates new options for states to
allow working-age adults with disabilities to "buy into" Medicaid
coverage if they leave the Supplemental Security Income program
to return to work. States will first have to choose to expand this
option for Medicaid coverage for the "working disabled." In addition,
Medicaid coverage of AT varies from state to state, in large part
as a result of differences in "durable medical equipment" definitions
and provision of other optional services that can include AT. As
a result, state decision to allow Medicaid buy-in may not result
in improved access to AT needed by individuals who wish to enter
or return to the workforce.
Similar issues exist with respect to the Health Insurance
Portability and Accountability Act of 1996. One aim of the Act was
to assist persons with disabilities who wished to move from one
job to another, but who would lose health insurance coverage because
of a preexisting condition. Because of the limited AT coverage commonly
offered in employer health plans and the ability of insurers to
charge unaffordable premiums, the law has had very limited effect
on increasing AT access by potential workers with disabilities.
For those individuals eligible for services through
the Vocational Rehabilitation program, the Rehabilitation Act has
excellent provisions for the inclusion of assistive technology in
all facets of the rehabilitation process, from evaluation through
placement in employment. The only limitations to these provisions
are the limits of funding for vocational rehabilitation and implementation
difficulties related to these provisions, such as insufficient staff
expertise with assistive technology and lack of service providers
with this expertise.
However, the larger employment program implemented
through the new Workforce Investment Act appears to be poorly understood
in reference to service access for individuals with disabilities.
The one-stop employment centers created by the Workforce Investment
Act may not be providing services that are accessible to or meet
the needs of people with disabilities. It is unclear to what extent
Vocational Rehabilitation programs are responsible for ensuring
that the services at the One-Stop Centers are fully accessible and
appropriate for individuals with disabilities through direct resource
deployment at the centers or through other supports.
Assistive Technology Policy in Health Care
As policy makers, I think it's our obligation to
[dream things that never were and ask why not?]. To not only consider
the problems facing our states--and our nation--but to offer a vision
of what could be. A vision of America where every child has the
chance to grow up in good health. A vision of America where older
and disabled people live their lives to the fullest. In short, a
vision of America where every family is able to move ahead and where
no one is left behind."
--Health and Human Services Secretary
Donna Shalala, 1999
For persons with disabilities, health care coverage
of assistive technology remains an enigma. Public and private health
insurance programs pay for hundreds of pieces of medically necessary
assistive technology. Yet persons with disabilities find that health
care coverage does not provide access to hundreds of other devices
that improve or maintain functional abilities for rehabilitation
and that enhance productivity and independence.
The two primary public health insurance programs are
Medicaid and Medicare. The Medicaid program was created by Title
XIX of the Social Security Act in 1965 in order to provide medical
assistance to individuals in financial need. States implement the
Medicaid program and receive matching funds from the Federal Government.
The statute mandates that certain categories of services must be
provided, while a state can choose whether to provide other categories.
As a result, state programs vary greatly with respect
to the optional services provided. Assistive technology may be covered
to varying degrees depending on the categories of services a state
chooses to provide, such as durable medical equipment, prosthetic
devices, or, as with an augmentative communication device, speech
services. In some states, children up to age 21 will have access
to a wider range of AT thanks to the mandatory Early Periodic Screening,
Diagnosis, and Treatment (EPSDT) service requirement. For those
older than 21, the available benefits covering AT may be much more
restrictive, with some states not covering even traditional durable
medical equipment for adults. There can also be vast differences
among states as to what types of devices and equipment are covered
within a service category, and under what circumstances.
In 1998, the Health Care Financing Administration
(HCFA) aided recipients' efforts to obtain access to needed assistive
devices though a policy directive to state Medicaid programs. The
directive prohibited state Medicaid agencies from--
- Requiring equipment to be on a state's "exclusive
list" of covered equipment in order to be provided.
- Denying coverage if the equipment was not on the
exclusive list unless the claimant could show the equipment was
needed by the "Medicaid population as a whole," not just recipients
with disabilities.
While this policy directive prevents some states from
further narrowing Medicaid access to assistive technology, the issue
vividly demonstrates the inconsistencies in coverage of assistive
technology among states.
The Medicare program, created by Title XVIII of the
Social Security Act, is a federal health insurance program created
for persons over the age of 65. Individuals who have been disabled
for 24 months are also eligible for Medicare. Part B of Medicare
provides coverage for durable medical equipment. Part B is optional
and requires a monthly payment by the individual. Medicare coverage
of assistive technology reflects the acute care bias that existed
when the program was established in 1965. Assistive technology that
does not meet narrow definitions of durable medical equipment or
a prosthesis is generally considered to be a "comfort" or "convenience"
item. Items falling outside those definitions are not covered, even
when they are connected to the health or safety needs of the individual.
As the largest payer for durable medical equipment, Medicare's standards
are commonly followed for coverage of assistive technology in private
health insurance.
Private health insurance plans and employer-based
health benefits plans can be another source of payment for health
related assistive technology. Health insurance plans provided through
insurance companies are subject to state insurance laws. However,
the U.S. Supreme Court has held that employers with self-insured
health plans are exempt from treatment as insurance companies and
thus not regulated by state insurance law (see FMC Corporation
v. Holliday, 498 U.S. 52 (1990)). Self-insured plans are, however,
covered by the Employee Retirement Income Security Act of 1974 (ERISA).
ERISA regulates the administration of employee benefit plans, which
include health plans. ERISA does not mandate that an employer provide
health benefit plans, and if an employer does provide a plan, it
does not mandate that the employer provide particular benefits.
People with disabilities continue to identify lack
of access to health insurance as an obstacle to obtaining assistive
technology. About 15 percent of people with disabilities of working
age lack any health insurance (96 NCD Report/ McNeil 1993). Even
though the implementation of the Children's Health Insurance Program
has enrolled over 1 million children, there remain over 10 million
uninsured children in the United States.
Private health insurance, in addition to commonly
using narrow coverage standards where assistive technology is concerned,
frequently imposes modest dollar caps on coverage of durable medical
equipment. Thus, some of the assistive technology that can contribute
most to independence and to restoration or maintenance of functional
abilities is not covered.
Assistive Technology Policy in Telecommunications and
Information Technology
The new digital economy is dramatically changing
our world. This New Economy is being defined principally by its
power to unlock the potential of markets, to transform retailing
and to create unimaginable wealth for a privileged few in our society.
I believe that the New Economy must be defined, first and foremost,
by its power to unlock the potential of all of our people, by its
power to educate our poorest children, to empower people with disabilities,
to lift up people in rural and inner city communities and to repair
and revitalize the social fabric of our communities.
--FCC Chairman William E. Kennard, 1999
Americans rely on telecommunications every day for
routine activities such as making doctor appointments, communicating
with family and friends, participating in conference calls at work,
checking bank balances, and purchasing products or services. Telecommunications
are also relied upon for basic safety, making emergency calls, learning
of severe weather, and understanding actions to take in civil emergencies.
All of these telecommunications functions are of equal or greater
importance to persons with disabilities.
According to the 1999 National Telecommunications
and Information Administration (NTIA) report Falling Through
the Net: Defining the Digital Divide, although more Americans
than ever have access to information tools such as the personal
computer and the Internet, there is still a significant "digital
divide" separating American information "haves" and "have nots."
The digital divide persists between the information rich (such as
whites, Asians/Pacific Islanders, those with higher incomes, the
more highly educated, and dual-parent households) and the information
poor (such as those who are younger, those with lower incomes and
education levels, certain minorities, and those in rural areas or
central cities).
The U.S. Department of Commerce Census Bureau data
from 1998 (Chart I-22) reveal significant disparities, including
the following:
- Whites are more likely to have access to the Internet
from home than blacks or Hispanics have from any location.
- Black and Hispanic households are approximately
one-third as likely to have home Internet access as households
of Asian/Pacific Islander descent, and roughly two-fifths as likely
as white households.
- Regardless of income level, Americans living in
rural areas are lagging behind in Internet access. Indeed, at
the lowest income levels, those in urban areas are more than twice
as likely to have Internet access as those earning the same income
in rural areas.
Several federal efforts aimed at bridging the digital
divide have, unintentionally, resulted in the continuation and development
of barriers for people with disabilities. The support and implementation
of such shortsighted initiatives are not isolated circumstances,
confined to one federal agency and easily ameliorated by a single
focused intervention.
For example, the U.S. Department of Education's Community
Technology Centers are designed to bring computers and the Internet,
with all its related information, to community centers, public housing,
libraries, and other community locations to reach those excluded
from the digital age. Under the Community Technology Centers initiative,
$9.9 million was awarded in 40 grants to organizations to help people
who do not have computers at home access computers for learning.
In a quick sampling of the awardees, those contacted were not aware
of the computer access needs of people with disabilities and had
made no plans in the application for providing input or output adaptations
so people with disabilities could utilize their offerings. Both
the 1998 census data and the NTIA report Falling Through the
Net emphasize the value of these community centers in schools,
libraries, and other public access points in providing computer
access for groups who lack access at home or at work. However, if
persons with disabilities cannot use the computers, they will not
help to bridge the digital divide at all.
In another example, the U.S. Department of Commerce
Telecommunications and Information Infrastructure Assistance Program
(TIIAP) has to date awarded more than 421 grants, in all 50 states,
the District of Columbia, and the U.S. Virgin Islands, totaling
$135. 8 million, to support community infrastructure development
for information technology access. One expected outcome of these
grants is to expand access and opportunity for all Americans, particularly
the underserved in communities across the nation, to use and benefit
from information technology. Many of the awards have been conferred
upon communities, schools, libraries, state governments, and community-based
organizations. As one of the TIIAP program goals, applicants are
clearly expected to implement efforts to "reduce disparities." Applications
are reviewed regarding their efforts and abilities to target underserved
communities or underserved groups within a broader community. While
a few of the TIIAP-funded programs have targeted their programs
to ensure access and benefit persons with disabilities as a special
initiative, the majority of the awardees using the grant program
to establish community access centers or services have not considered
the needs of persons with disabilities as a standard principle for
expenditure of federal funds.
Another example of a lost opportunity to ensure access
is the infusion of funds through the Federal Communications Commission
(FCC) E-Rate Discount Program. Many schools and libraries have benefitted
from this resource. Access for students, teachers, and school administrators
with disabilities and community members that access the schools
and local libraries is considered only when self-initiated. Unfortunately,
FCC has been silent regarding its expectations or delineation of
clear requirements of applicants to ensure access for people with
disabilities.
As telecommunications and information technology access
becomes a priority issue for all Americans, the many federal agencies
that support, monitor, and regulate such programs and distribute
supportive federal dollars should ensure that their policies and
programs do not unintentionally create new barriers for individuals
with disabilities.
Two recent laws are positive steps in the effort to
ensure telecommunications and information technology accessibility
for people with disabilities. Section 255 of the Telecommunications
Act of 1996 (P.L. 104-104) requires that telecommunications equipment
and services be accessible where readily achievable. If direct access
is not readily achievable, such equipment and services shall be
compatible with existing peripheral devices or specialized customer
premises equipment used to achieve access, again if such compatibility
is readily achievable. The intent of Section 255 is to ensure that
telecommunications manufacturers and service providers consider
including access features during the design and production of their
offerings to avoid needless development of new technologies with
access barriers.
Section 508 of the Rehabilitation Act (Workforce Investment
Act, P.L. 105-220) was substantially strengthened in 1998 in its
requirement for accessibility in electronic and information technology.
When federal departments or agencies develop, procure, maintain,
or use electronic and information technology, they shall ensure
that the information technology provides federal employees and members
of the public who have disabilities comparable access to the information
or data unless an undue burden is imposed. This requirement is very
different from an individual civil right protection such as found
under ADA. Section 508 requires accessibility of the information
technology itself, rather than the delivery of individual accommodations,
which might be assistive technology or might be other accommodation
methods.
Section 508 applies directly to the Federal Government;
however, the Assistive Technology Act of 1998 (preceded by the Technology-Related
Assistance for Individuals with Disabilities Act of 1988, P.L. 100-407,
as amended) requires states to provide assurance of compliance with
Section 508 as a condition for receipt of federal funding under
the Assistive Technology Act. Unfortunately, the Assistive Technology
Act provides no direction regarding the scope of application at
a state level, nor does it provide authority for rulemaking or standard
setting at a federal level to provide such direction. In addition,
at least six states have passed information technology access legislation
and many more have structured policies or executive orders in place
that direct their approach to ensuring information technology access.
To date, there has been no clear effort to coordinate these state
initiatives with federal proceedings.
Assistive Technology Policy in Alternative Financing
It is universally recognized that funding for AT
is an ongoing challenge and is often the barrier that precludes
or prevents individuals from acquiring the technology they require
for work, school, recreation, and everyday life in the community.
Micro-loans are an inclusive and dignified way to provide new opportunities
and expand the options for individuals with disabilities.
--National Institute on Disability and
Rehabilitative Research Director Katherine Seelman, 1999
An abundance of potential alternatives exist that
could help in reducing financial barriers to assistive technology
access. Included among them are a range of avenues related to equipment
and monetary loans, tax incentives, and equipment recycling. During
the past 10 years, many of these alternatives have been developed
to varying degrees, making some headway in increasing access to
assistive technology.
We are, however, far from taking advantage of the
innovative opportunities that can move us toward a world in which
assistive technology is readily available to all individuals with
disabilities. Implementation of many alternatives will require policy
innovations at the federal level. For the mechanisms that already
exist, a lack of information and supports hinders their use on a
wider scale.
Existing assistive technology cash loan programs,
frequently called micro-loans, have a demonstrated role in filling
gaps in access in states where they exist. In 1999, a total of 29
cash loan programs were operating nationally. These programs vary
widely in many aspects, such as lending terms, and in total loan
fund capacity. Testimony provided in a 1998 public hearing on outcomes
of state Tech Act projects cited the need for an adequate initial
financial base as the most important element of a successful assistive
technology loan program.
In another area, existing tax incentives help make
assistive technology more affordable to persons with disabilities
and enable businesses to become more accessible to employees and
members of the public with disabilities. One of these incentives
is the Disabled Access Credit (DAC). The Omnibus Budget Reconciliation
Act of 1990 created this tax incentive to encourage small businesses
to comply with ADA. DAC provides a credit for 50 percent of eligible
expenses up to $5,000 a year. Assistive technology is key among
the expenses to which the credit can be applied. Examples can include
purchasing screen-reading software and a scanner for an employee
who is blind; installing ramps for customers with mobility impairments;
providing a TTY for employees and customers who are deaf; and providing
visual fire alarms for employees who are deaf.
While the list of eligible assistive technology expenses
goes on and on, the use of DAC is sorely limited by a lack of knowledge
of its existence among small business owners. The Internal Revenue
Service reports that for the 1997 tax year, small businesses claimed
only $20.2 million in credits for incurring eligible expenses. Considering
the tremendous number of small businesses in the United States,
the $404,000 per state average of credits claimed illustrates DAC's
underutilization. The same can be said of the Architectural and
Transportation Barrier Removal Deduction, which may be claimed for
expenses incurred for assistive technology purchases.
The personal income tax deductibility of medical expenses
is another tax incentive that some individuals can use to offset
out-of-pocket expenses for assistive technology. Among deductible
medical expenses on federal returns are expenses for assistive technology
used in making homes and vehicles accessible. For example, ramps,
railings, grab bars, stairway lifts, visual alarms, hand controls,
and wheelchair lifts for vehicles are all eligible medical expenses,
as is the cost of brailling books or magazines for a person with
a visual impairment. As with the business incentives, many persons
with disabilities are unaware of some of the expenses that can be
deducted from their individual income taxes.
A number of restrictions limit the benefit even to
those persons with disabilities who are aware of some of the assistive
technology-related equipment that can be claimed under the federal
deduction for medical expenses. First, an individual can only deduct
the amount of expenses that are more than 7.5 percent of adjusted
gross income. In addition, for home modifications, the amount of
the deduction must be reduced by any increase in the value of the
home.
In a number of states, assistive technology projects
are working to implement state tax incentives such as removing state
sales tax on many devices and pieces of equipment or providing tax
credits for out-of-pocket assistive technology expenditures. For
high-cost assistive technology, the savings to an individual with
a disability can amount to hundreds of dollars.
Individual development accounts (IDAs) are matched
savings accounts designed to help low-income families accumulate
funds to assist them in homeownership or improvement, job training,
or other areas. Low-income individuals save monthly, and their savings
are matched by funders such as financial institutions, nonprofit
organizations, or state and local governments. The match is sometimes
funded at greater than a one to one basis. IDAs are just beginning
to be explored as a potential financing mechanism for assistive
technology.
The market for recycled assistive technology, including
durable medical equipment, is expanding at an accelerated pace.
In recycled durable medical equipment alone, annual sales had reached
$300 million in the United States by 1997. Estimates on the amount
saved by consumers through the use of such programs are in the millions
of dollars. A national study of recycling programs cited several
key reasons for their growth:
- The growing number of persons who are elderly who
benefit from durable medical equipment and other assistive technology
to remain in their homes and communities.
- Cutbacks in federally funded programs that pay
for assistive technology devices, resulting in the increased need
for self-paying consumers to seek less expensive equipment alternatives.
- Growth of managed care organizations that seek
to cut costs.
Recycling programs vary greatly. Some are limited
primarily to durable medical equipment; others include a wider array
of assistive technology. Some programs involve equipment exchange
only. Such programs connect people who have equipment that is no
longer in use with people who are seeking the type of equipment.
All other arrangements in the transaction are handled by the individuals
in the transaction. Other programs actually take physical possession
of equipment, as well as storing, repairing, and transporting the
equipment.
Program capabilities of the latter type clearly offer
expanded opportunities for individuals with disabilities. Equipment
that cannot be included in a simple exchange program because of
the need for repairs or refurbishing may be suitable in a program
that includes repairing and refurbishing. The shortcoming of such
programs, however, is that they require considerably greater funding
to operate. In the national study of recycling programs, funding
was identified as the most problematic aspect of such programs.
In Conclusion
In the ideal climate, no person with a disability
should be denied the opportunity to obtain assistive technology
and transfer its inherent potential into viable, life fulfilling
endeavors. However, it is clear that the current patchwork of federal
policies has barriers and gaps, leaving many people with disabilities
without the benefits of assistive technology.
In 1998, Congress recognized that barriers and gaps
exist and directed NCD to prepare this report. The major barriers
and the 11 recommendations designed to reduce those barriers have
been identified and are presented with rationale in this report.
NCD calls on Congress to take a hard and fast look
at what people with disabilities need to make assistive technology
readily available.
Appendix
Mission of the National Council on Disability
Overview and Purpose
NCD is an independent federal agency with 15 members
appointed by the President of the United States and confirmed by
the U.S. Senate.
The overall purpose of NCD is to promote policies,
programs, practices, and procedures that guarantee equal opportunity
for all individuals with disabilities, regardless of the nature
or severity of the disability; and to empower individuals with disabilities
to achieve economic self-sufficiency, independent living, and inclusion
and integration into all aspects of society.
Specific Duties
The current statutory mandate of NCD includes the
following:
- Reviewing and evaluating, on a continuing basis,
policies, programs, practices, and procedures concerning individuals
with disabilities conducted or assisted by federal departments
and agencies, including programs established or assisted under
the Rehabilitation Act of 1973, as amended, or under the Developmental
Disabilities Assistance and Bill of Rights Act; as well as all
statutes and regulations pertaining to federal programs that assist
such individuals with disabilities, in order to assess the effectiveness
of such policies, programs, practices, procedures, statutes, and
regulations in meeting the needs of individuals with disabilities.
- Reviewing and evaluating, on a continuing basis,
new and emerging disability policy issues affecting individuals
with disabilities at the federal, state, and local levels and
in the private sector, including the need for and coordination
of adult services, access to personal assistance services, school
reform efforts and the impact of such efforts on individuals with
disabilities, access to health care, and policies that act as
disincentives for individuals to seek and retain employment.
- Making recommendations to the President, Congress,
the secretary of education, the director of the National Institute
on Disability and Rehabilitation Research, and other officials
of federal agencies about ways to better promote equal opportunity,
economic self-sufficiency, independent living, and inclusion and
integration into all aspects of society for Americans with disabilities.
- Providing Congress, on a continuing basis, with
advice, recommendations, legislative proposals, and any additional
information that NCD or Congress deems appropriate.
- Gathering information about the implementation,
effectiveness, and impact of the Americans with Disabilities Act
of 1990 (42 U.S.C. 12101 et seq.).
- Advising the President, Congress, the commissioner
of the Rehabilitation Services Administration, the assistant secretary
for Special Education and Rehabilitative Services within the Department
of Education, and the director of the National Institute on Disability
and Rehabilitation Research on the development of the programs
to be carried out under the Rehabilitation Act of 1973, as amended.
- Providing advice to the commissioner with respect
to the policies and conduct of the Rehabilitation Services Administration.
- Making recommendations to the director of the National
Institute on Disability and Rehabilitation Research on ways to
improve research; service; administration, and the collection,
dissemination, and implementation of research findings affecting
persons with disabilities.
- Providing advice regarding priorities for the activities
of the Interagency Disability Coordinating Council and reviewing
the recommendations of this council for legislative and administrative
changes to ensure that such recommendations are consistent with
NCD's purpose of promoting the full integration, independence,
and productivity of individuals with disabilities.
- Preparing and submitting to the President and Congress
an annual report titled National Disability Policy: A Progress
Report.
International
In 1995, NCD was designated by the Department of State
to be the U.S. government's official contact point for disability
issues. Specifically, NCD interacts with the special rapporteur
of the United Nations Commission for Social Development on disability
matters.
Consumers Served and Current Activities
While many government agencies deal with issues and
programs affecting people with disabilities, NCD is the only federal
agency charged with addressing, analyzing, and making recommendations
on issues of public policy that affect people with disabilities
regardless of age, disability type, perceived employment potential,
economic need, specific functional ability, status as a veteran,
or other individual circumstance. NCD recognizes its unique opportunity
to facilitate independent living, community integration, and employment
opportunities for people with disabilities by ensuring an informed
and coordinated approach to addressing the concerns of persons with
disabilities and eliminating barriers to their active participation
in community and family life.
NCD plays a major role in developing disability policy
in America. In fact, it was NCD that originally proposed what eventually
became the Americans with Disabilities Act (ADA). NCD's present
list of key issues includes improving personal assistance services,
promoting health care reform, including students with disabilities
in high-quality programs in typical neighborhood schools, promoting
equal employment and community housing opportunities, monitoring
the implementation of ADA, improving assistive technology, and ensuring
that persons with disabilities who are members of minority groups
fully participate in society.
Statutory History
NCD was initially established in 1978 as an advisory
board within the Department of Education (Public Law 95-602). The
Rehabilitation Act Amendments of 1984 (Public Law 98-221) transformed
NCD into an independent agency.
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