Current through Register Vol. 50, No. 9, September 20, 2024
A. Environmental accessibility adaptations
are physical adaptations to the beneficiary's home or vehicle which are
necessary to ensure health, welfare, and safety of the beneficiary, or which
enable the beneficiary to function with greater independence, without which the
beneficiary would require additional supports or institutionalization.
Environmental adaptations must be specified in the beneficiary's plan of care.
1. Reimbursement shall not be paid until
receipt of written documentation that the job has been completed to the
satisfaction of the beneficiary.
B. Environmental adaptation services to the
home and vehicle include the following:
1.
performance of necessary assessments to determine the type(s) of modifications
that are needed;
2. training the
beneficiary and the provider in the use and maintenance of the environmental
adaptation(s);
3. repair of
equipment and/or devices, including battery purchases for vehicle lifts and
other reoccurring replacement items that contribute to the ongoing maintenance
of the approved adaptation(s); and
4. standard manufacturer provided service
contracts and warranties.
C. Home adaptations which pertain to
modifications that are made to a beneficiary's primary residence. Such
adaptations to the home may include bathroom modifications, ramps, or other
adaptations to make the home accessible to the beneficiary.
1. The service must be for a specific
approved adaptation.
2. The service
may include the installation of ramps and grab-bars, widening of doorways,
modification of bathroom facilities, or installation of specialized electric
and plumbing systems which are necessary to accommodate the medical equipment
and supplies which are necessary for the welfare of the beneficiary.
D. Modifications may be applied to
rental or leased property only with the written approval of the landlord and
approval of OCDD.
1. - 2. Repealed.
E. All environmental accessibility
adaptations to home and to a vehicle must meet all applicable standards of
manufacture, design, and installation.
F. Service Exclusions for Home Adaptations
1. Home modification funds are not intended
to cover basic construction cost. Waiver funds may only be used to pay the cost
of purchasing specific approved adaptations for the home, not for the
construction costs of additions to the home.
2. Home modifications shall not be furnished
to adapt living arrangements that are owned or leased by paid caregivers or
providers of waiver services.
3.
Home modifications may not include modifications which add to the total square
footage of the home, except when the additional square footage is necessary to
make the required adaptions function appropriately.
EXAMPLE: if a bathroom is very small and a modification
cannot be done without increasing the total square footage, this would be
considered as an approvable cost.
a.
When new construction or remodeling is a component of the service, payment for
the service is to only cover the difference between the cost of typical
construction and the cost of specialized construction.
4. Home modifications may not include
modifications to the home which are of general utility and not of direct
medical or remedial benefit to the beneficiary, including, but not limited to:
a. flooring;
b. roof repair;
c. central air conditioning;
d. hot tubs;
e. swimming pools;
f. exterior fencing; or
g. general home repair and
maintenance.
5. Home
modification funds may not be used for service warranties and contracts above
those provided by the manufacturer at the time of purchase (e.g., extended
warranties, extended service contracts).
G. Vehicle adaptations pertain to
modifications to a vehicle that is the waiver beneficiary's primary means of
transportation in order to accommodate his/her special needs.
1. Such adaptations to the vehicle may
include a lift, or other adaptations, to make the vehicle accessible to the
participant or for the beneficiary to drive.
2. The service must be for a specific
approved adaptation.
H.
Service Exclusions for Vehicle Adaptations
1.
Payment will not be made to:
a. adapt
vehicles that are owned or leased by paid caregivers or providers of waiver
services, or
b. purchase or lease
of a vehicle.
2. Vehicle
Adaptations. 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.
3. Vehicle modification funds may not be used
for regularly scheduled upkeep and maintenance of a vehicle, except upkeep and
maintenance of the modifications.
4. Car seats are not considered a vehicle
adaptation.
5. Vehicle modification
funds may not be used for service warranties and contracts above those provided
by the manufacturer at the time of purchase (e.g., extended warranties,
extended service contracts).
I. Provider Responsibilities
1. The environmental accessibility
adaptation(s) must be delivered, installed, operational and reimbursed in the
POC year in which it was approved.
a. - b.
Repealed.
2. A written
itemized detailed bid, including drawings with the dimensions of the existing
and proposed floor plans relating to the modifications, must be obtained and
submitted for prior authorization.
a.
Repealed.
3. Vehicle
modifications must meet all of the applicable standards of manufacture, design
and installation for all adaptations to the vehicle.
4. 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.
J.
Provider Qualifications. In order to participate in the Medicaid Program,
providers must meet the following qualifications.
1. Home Adaptations. Providers of
environmental accessibility adaptations for the home must:
a. be registered through the State Licensing
Board for Contractors as a home improvement contractor. The provider must have
a current license from the State Licensing Board for Contractors for any of the
following building trade classifications:
i.
general contractor;
ii. home
improvement; or
iii. residential
building; or
b. If a
current Louisiana Medicaid provider of durable medical equipment, have
documentation from the manufacturing company (on its letterhead) that confirms
that the provider is an authorized distributor of a specific product that
attaches to a building. The letter must specify the product and state that the
provider has been trained on its installation.
2.
3. All environmental adaptations providers
must comply with all applicable local (city or parish) occupational
license(s).
4. All environmental
adaptation providers, as well as the person performing the service (i.e.,
building contractors, plumbers, electricians, engineers, etc.), must meet any
state or local requirements for licensure or certification. When state and
local building or housing code standards are applicable, modifications to the
home shall meet such standards, and all services shall be provided in
accordance with applicable State or local requirements.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
