Thank you for participating in this reporting system established by the National Coalition for Assistive and Rehab Technology (NCART). The purpose is to gather information on situations where a Medicaid beneficiary is not able to access needed Complex Rehab Technology (CRT) because their Medicaid Managed Care Organization (under contract with the state) either: (a) has inappropriately DENIED COVERAGE of the item or (b) has established an INADEQUATE PAYMENT AMOUNT for the item. These are two different reasons and we ask you to provide that detail below. NOTE: If you have multiple examples of problems, please supply details on the most significant one and then indicate in the Additional Comments section below that you have others and we will follow up with you. For questions, please contact Mickae Lee at mlee@ncart.us.

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* 1. Reporting Organization:

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* 2. Person Completing Survey:

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* 3. Medicaid Managed Care Organization:

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