La. Admin. Code tit. 50 § XXI-16311
Current through Register Vol. 50, No. 11, November 20, 2024
Section XXI-16311 - Environmental Accessibility AdaptationsA. 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); and4. 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.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: c. central air conditioning;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, orb. 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. 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. 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:iii. residential building; orb. 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.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.La. Admin. Code tit. 50, § XXI-16311
Promulgated by the Department of Health and Hospitals, Office for Citizens with Developmental Disabilities, LR 33:2446 (November 2007), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 422159 (10/1/2015), Amended by the Department of Health, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 471513 (10/1/2021), Amended LR 481563 (6/1/2022).AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.