Current through Register Vol. 50, No. 9, September 20, 2024
A. Environmental accessibility adaptations
are physical adaptations to the home or a vehicle that are necessary to ensure
the health, welfare, and safety of the beneficiary or that enable him/her to
function with greater independence in the home and/or community. Without these
services, the beneficiary would require additional supports or
institutionalization.
B. Such
adaptations may include:
1. installation of
ramps and/or grab-bars;
2. widening
of doorways;
3. modification of
bathroom facilities;
4.
installation of specialized electric and plumbing systems which are necessary
to accommodate the medical equipment and supplies for the welfare of the
beneficiary; or
5. adaptations to
the vehicle, which may include a lift or other adaptations, to make the vehicle
accessible to the beneficiary or for the beneficiary to drive.
C. Requirements for Authorization.
Items reimbursed through NOW funds shall be supplemental to any adaptations
furnished under the Medicaid state plan.
1.
Any service covered under the Medicaid state plan shall not be authorized by
NOW. The environmental accessibility adaptation(s) must be delivered,
installed, operational and accepted by the beneficiary/authorized
representative in the CPOC year for which it was approved. The environmental
accessibility adaptation(s) must be billed and reimbursed according to the
Medicaid billing guidelines established by LDH policy. A written itemized
detailed bid, including drawings with the dimensions of the existing and
proposed floor plans relating to the modification, must be obtained and
submitted for prior authorization. Modifications may be applied to rental or
leased property with the written approval of the landlord and approval of the
human services authority or district. Reimbursement shall not be paid until
receipt of written documentation that the job has been completed to the
satisfaction of the beneficiary.
2.
Upon completion of the work and prior to payment, the provider shall give the
beneficiary a certificate of warranty for all labor and installation and all
warranty certificates from manufacturers.
3. Excluded are those adaptations or
improvements to the residence that are of general utility or maintenance and
are not of direct medical or remedial benefit to the beneficiary, including,
but not limited to:
a. air conditioning or
heating;
b. flooring;
c. roofing, installation or
repairs;
d. smoke and carbon
monoxide detectors, sprinklers, fire extinguishers, or hose; or
e. furniture or appliances; or
f. whole home generators.
4. ...
5. Home modification funds are not intended
to cover basic construction cost. For example, funds may be used to cover the
difference between constructing a bathroom and building an accessible or
modified bathroom, but in any situation funds must be used to pay for a
specific approved adaptation.
6.
Excluded are those vehicle adaptations which are of general utility or for
maintenance of the vehicle. Car seats are not considered a vehicle
adaptation.
D. Service
Limits. There is a cap of $7,000 per three-year period for a beneficiary for
environmental accessibility adaptations. On a case-by-case basis, with
supporting documentation and based on need, a beneficiary may be able to exceed
this cap with the prior approval of OCDD central office.
E. Provider Qualifications. The provider must
be an enrolled Medicaid provider and comply with applicable state and local
laws governing licensure and/or certification.
1. All providers of environmental
accessibility adaptations must be registered through the Louisiana State
Licensing Board for Contractors as a home improvement contractor, with the
exception of providers of vehicle adaptations.
2. Providers of environmental accessibility
adaptations to vehicles must be licensed by the Louisiana Motor Vehicle
Commission as a specialty vehicle dealer and accredited by the National
Mobility Equipment Dealers Association under the Structural Vehicle Modifier
category.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
