FEDERAL POLICY BARRIERS TO ASSISTIVE
TECHNOLOGY

National Council on Disability
May 31, 2000

National Council on Disability
1331 F Street, NW, Suite 1050
Washington, DC 20004

202-272-2004 Voice
202-272-2074 TTY
202-272-2022 Fax

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.

Back to General News   |    National Congress on Disabilities   |   (ADA) Locations     |   (ADA) Assistive Technologies     |    Your Rights & Laws   |   Links-To-Other-Federal-Agencies    |    (ADA) Main Index   |
 
Planet Mobility Main Menu.!  -  Online Mall

Home

Veh.   Search

Finance

Join Us

Auctions

login

Travel

Free Email