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QUESTION: Does anyone have a policy they could share on the payment for medically necessary items not covered by either Medicare or Medicaid in group home settings? Do any agencies require clients to pay for any or all of the cost as their funds allow? How do you handle the situation if a client intentionally breaks items like glasses? If finances permit, clients will/do replace the item(s), if they do not have the funds we will look for alternative funds. It is my understanding that Group Home Providers do not necessary have to pay for the items, but are responsible for making sure these items are available to them. We help our customers pay for non covered items as their funds allow. If it is something they need and can't afford it, then our agency has a customer fund that they can request a donation from and if it is approved then it will be ordered for the customer. As far as breaking their things or other clients belonging, we have had them cover that cost. I would say this would be a case by case situation. If items are medically necessary I am not sure why insurance isn’t covering we would always get a prescription from the doctor/specialist to submit with the claim. We are having the same issue of uncertainty when it comes to who pays what. We don’t have a formal policy to share, but if the person requires the equipment, we are required to furnish, maintain the equipment in good condition. If they are breaking things, we have utilized repayment through their Behavior Plan. Our agency uses a special fund set up through donations called Client Emergency Fund which allows funds to be used for such things as broken glasses, special medical equipment not covered by Medicare/Medicaid, food if funds not available otherwise and so forth and the client does not pay back. We started an employee donation deduction from payroll as an opportunity for employees to donate to this client emergency fund. We also have an account set up for the agency to cover costs very a limited time and then an invoice created and charged back to the clients to pay as funds are available. This information is a compilation of suggestions, ideas, and opinions shared by INARF Members in response to the featured question. This information should not be considered official interpretation or guidance of State or Federal Policy. Additionally, statements within this document do not necessarily reflect an official position or opinion of INARF.