La. Admin. Code tit. 50 § XXI-13919
Current through Register Vol. 50, No. 11, November 20, 2024
Section XXI-13919 - Environmental Accessibility AdaptationsA. 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;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; or5. 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;c. roofing, installation or repairs;d. smoke and carbon monoxide detectors, sprinklers, fire extinguishers, or hose; ore. furniture or appliances; orf. whole home generators.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.La. Admin. Code tit. 50, § XXI-13919
Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Community Supports and Services, LR 30:1206 (June 2004), amended by the Department of Health and Hospitals, Office of the Secretary, Office for Citizens with Developmental Disabilities, LR 33:1649 (August 2007), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 40:75 (January 2014), Amended by the Department of Health, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 4455 (1/1/2018), Amended LR 481552 (6/1/2022).AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.