Physical Therapy (PT) incorporates purposeful, goal oriented activity in the evaluation, problem identification and/or treatment of persons whose function is impaired by physical injury or illness, congenital or developmental disability; in order to achieve maximum functioning, prevent progression of disability and maintain health.
Specific PT services at the New York State School for the Blind include:
- Education and training in sensory integration and sensorimotor activities
- Gross motor development
- Postural/balance control and gait training
- Use of massage
- Mobilization and therapeutic exercise
- Training and activities in Range of Motion (ROM)
- Scoliosis management
- Guidance in the selection, design and use of adaptive equipment
Major emphasis is placed on identification, screening, and assessment followed by the establishment of goals and objectives based on this evaluation. Intervention is directed toward aiding the student to overcome or adjust to his/her disability and achieve maximum ability within the educational setting and aiding the instructional and direct care staff to integrate these PT recommendations into everyday programming.
The Physical Therapy (PT) staff attempts to complete weekly inspections of all student wheelchairs and adaptive equipment utilized within the programs. Frequently problems with wheelchairs are noted during these inspections. Notification can also be received from direct care staff or parents.
For Repairs or Adjustments to Wheelchairs:
- Repairs requiring the minor adjustment in placement of support pieces or tightening of straps and or hardware will be completed by the PT staff prior to end of business on the same day that notification is received.
- Repairs requiring replacement or modification of hardware (screws, bolts) on either the insert or wheelchair frame will be completed by maintenance staff generally within 24 hours of notification.
For Replacement of Broken Parts or Accessories:
- The wheelchair frame, excluding armrests, footrests and anti-tippers, usually carry a lifetime warranty. If a repair to the wheelchair frame is required, the PT contacts the vendor that ordered the wheelchair and arranges for reordering/replacement of the frame. This does not require insurance prior approval and receipt of the equipment should take 4-6 weeks.
- If the faulty part is identical to that which was initially approved by insurance, the PT contacts the vendor that ordered the wheelchair. Replacements of this type require contact with the insurance company for approval, however, this approval is often granted over the telephone. Approval for re-ordering of replacement parts is completed by the vendor. Parts are generally received within 2-4 weeks after the vendor receives approval.
For Obtainment of Different Adaptations to the Current Wheelchair:
- Occasionally, it is determined that insert adaptations initially ordered with the wheelchair do not adequately meet the positioning needs of the student, or the physical status of the child changes so that a different type of insert or support system must be obtained. This process requires insurance prior approval complete with physician signature and justification via letter of medical necessity. In this instance, the process is the same as the "Guidelines for: Obtaining Durable Medical Equipment". Depending on the type of insurance coverage, parts are generally obtained within 3-6 months.
Parents are notified of repairs or adjustments completed by NYSSB staff through the "going home" communication books. If replacement parts or different adaptations need to be obtained, the parent will be contacted by the PT for consent to proceed with the vendor. As with the ordering of new equipment, it is the sole responsibility of the parent to verify that the vendor and insurance companies are acting in a timely manner to obtain replacement parts or different adaptations for a student's wheelchair.
This process can be very lengthy, complicated and frustrating. We are here to help! The following is a summary of the steps to securing such equipment for your child, once the need is identified:
- The Physical Therapist (PT) consults with the parent/legal guardian to determine how the equipment will be utilized and verifies essential insurance and physician information.
- The PT contacts the insurance carrier to determine the required "participating vendor. If no "participating vendor" is required by private insurance, a list of vendors is provided to the parent.
- The PT contacts the selected vendor to schedule an appointment to determine the specifications for the equipment and to provide insurance and physician information. This appointment is scheduled during school hours and the parent is requested to attend. Preliminary measurements are taken - height, weight, and various body part lengths (e.g., seat depth).
- The PT writes a letter of medical necessity for the equipment to the vendor and copies the parent.
- The vendor provides a detailed list of the equipment to be ordered, price list, and other required documentation to the primary physician for review and signature. Once the physician has signed, the letter of medical necessity and the detailed inventory of equipment to be ordered are forwarded by the vendor to the insurance carrier for prior approval.
- Prior approval from private insurance carriers must be obtained before:
- Submitting to Medicaid for review
- Actually ordering the equipment
This is generally the lengthiest part of the ordering process. Insurance carriers have three options:
- Approve of the order
- Disapprove the order
- Request additional information
Private insurance carriers generally approve or deny
the order within 3-6 months. Medicaid or State Aid rulings may take
as long as 12 months to receive.
The parent/legal guardian and the medical equipment vendor are the only participants in this process who receive notification of approval, denial, or request for more information. The PT does not receive this information. It is your responsibility to contact the PT department once you have received this notification. Your notification to us of approval will allow the PT to take final measurements which the vendor then sends to the manufacturer(s) of the various components (frame, insert) of your child's wheelchair.
- Usually a wheelchair will be received from the manufacturer(s) within 6-8 weeks.
Once the letter of medical necessity has been written and submitted to the vendor by the PT, it becomes the sole responsibility of the parent to verify that the vendor and insurance companies are acting in a timely manner to gain approval for the equipment to be ordered.
If you have any questions regarding this process, feel free
to contact Michele Stamp, our Senior PT. The best time to reach her is
in the afternoon from 2:30 - 3:30 PM
Local number: (585)343-5384, ext.221
Toll free: (877) 697-7382, ext. 221