Can the VA Medical Center provide Veterans with a Computer?

An excerpt from an article in the August 2008 PN Magazine

This guideline is contained in a June 4,2007 document signed by Michael J. Kussman, MD, MS, MACP, VA Under Secretary for the Health. Its title is, “VHA Prosthetic Clinical Management Program (PCMP) Clinical Practice Recommendations for the Prescription of Computers, Computer Components, Access Devices, and Software to Veterans with Disabilities”. Patients who may be issued a computer include (those who have) SCI/D, stroke, cognitive impairment, traumatic brain injury, progressive disease, upper-extremity amputation, and visual impairments. This list is not all inclusive, and a determination is made on a case-by-case basis. The following criteria must be met for veterans with disabilities to be evaluated and trained on computers (including laptops), computer components, access devices, and/or software:

1. Determined by the medical provider working with the patient following evaluation by the qualified clinician to have significant impairment(s) that would benefit from intervention with computer technology to include but not limited to desktop computers, laptops, computer components, access devices, and/or software as delineated under Section III Population Served.
2. A trained, qualified clinician (i.e. occupational therapist (OT), speech pathologist, physical therapist (PT), etc.) must complete the comprehensive assistive computerized technology evaluation.
3. The veteran requires the use of computer technology to facilitate functioning and assist in rehabilitation.
4. A comprehensive audiology evaluation should be completed for veterans requiring voice activation or speech output for access it is believed necessary during the evaluation process. This will ensure the veteran has maximized his or her ability to hear the speech output or his/her voice input.
5. Following training, the veteran demonstrates the ability to use the prescribed computer technology and software to effectively meet the documented stated goal(s).
6. Veterans determined by medical providers or clinicians to have difficulty using a standard input device (i.e. keyboard, pointing device, etc.) may be considered for voice or other specialized input options.

Medical necessity justification for physical, communicative, and cognitive deficits include but are not limited to:

• Access to Medicare: (1) Independent and private communication with healthcare providers, (2) independent decision-making, (3) prescription refill, (4) travel arrangements, (5) patient education.
• Attendant Care Management: (1) Interviewing, (2) care plan, (3) overall decreased attendant care needs/costs
• Access to Communication: Augmentative and alternative communication systems (AACs) that may have a laptop computer components or peripherals that are considered medically justified (additionally, e-mail and Internet access can be used for communication)
• Access to Basic Independent Living Skills: Including electronic aids to daily living (EADLs) or environmental controls that may be based on a laptop or have computer components incorporated.
• Self Care/Higher Level Living Skills: (1) Reading, (2) writing, (3) grocery shopping, (4) retail shopping, (5) child care, (6) banking, (7) balancing checkbook, (8) taxes, (9) time management, (10) leisure-time activity development.
• Psychosocial: (1) Relationships, (2) access to support/per groups, (3) counseling
• Restorative Rehabilitation: (1) Cognitive fx, (2) aphasia/stroke rehabilitation
• Other: (1) Telehealth systems, (2) education/schooling, (3) work, (4) virtual reality such as on-line training programs for mobility devices

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