N.H. Admin. Code § He-E 801.17

Current through Register No. 50, December 12, 2024

Section He-E 801.17 - Environmental Accessibility Services

(a) EAS, for a participant's home or vehicle, as defined in He-E 801.02(r) shall be a covered service when:

(1) A NH medicaid-enrolled licensed practitioner has determined the need for one or more of the services in (b) below;

(2) The participant's case manager has requested prior authorization for the service in accordance with (d) below;

(3) The department has provided the prior authorization for the service;

(4) The service is completed by an EAS provider who is enrolled with the department in accordance with (e) below; and

(5) The services are prior authorized.

(b) The following EAS shall be covered:

(1) Installation of ramps;

(2) Installation of grab bars;

(3) Widening of doorways to accommodate the participant's wheelchair or other mobility access equipment;

(4) Electronic aids to daily living; and

(5) Other adaptations authorized by the department that are necessary for the health and safety of a participant that are not otherwise covered under the medicaid state plan.

(c) The following EAS shall not be covered:

(1) Improvements that are of general utility and do not have direct medical or remedial benefit to the participant;

(2) Adaptations which add to the square footage of the home except when necessary to complete an adaptation such as to improve the entrance or egress to the residence or to configure a bathroom to accommodate the participant's wheelchair;

(3) Purchase of a motor vehicle;

(4) Electrical or plumbing work that is beyond what is required to support the authorized adaptation;

(5) Electrical or plumbing work, unless the EAS provider states, in writing, that the proposed adaptation can be done within the current electrical or plumbing capacity of the home; and

(6) Adaptations to a residential care facility or other licensed facility, except for adaptations in an adult family care home when approved for a specific participant.

(d) The participant's case manager shall submit the following when requesting prior authorization for an EAS:

(1) A completed Form 3715, "Choices for Independence Prior Authorization Request Form" (January 2022);

(2) A copy of the evaluation in (a)(1) above that describes:

a. The medical or functional need for the adaptation;

b. The description and measurements required for the adaptation; and

c. The proposed training plan for the participant and as applicable, the caregiver, to ensure safe use of the adaptation;

(3) Proposals from at least 2 EAS providers for proposals that have a total cost more than $5,000, except that one proposal may be submitted with a written explanation of why only one proposal is available or appropriate or when a proposal indicates the total cost is $5,000 or less, including the following, as applicable to the project:

a. A list of supplies and materials;

b. Blueprints or scaled drawings;

c. The name(s) of any subcontractors that will be involved;

d. Written confirmation of whether or not a state or local building permit is required;

e. If electrical or plumbing work is required to support the adaptation, then:

1. A statement signed by the EAS provider stating that the requested adaptation can be done within the current electrical or plumbing capacity of the residence; and

2. A copy of the electrician or plumber's license;

f. A statement signed by the EAS provider affirming knowledge of all applicable building codes and permit requirements, affirming that the work will meet the requirements of RSA 155-A:2, and affirming that any subcontractors involved in the work are appropriately licensed; and

g. An agreement signed by the EAS provider stating that reimbursement for the authorized service through the CFI waiver program shall be considered as payment in full;

(4) If a participant prefers one bid over the other(s), then an explanation of the preference shall be submitted to the case manager; and

(5) A notarized written statement from the property owner granting permission to complete the project if the participant is not the owner of the residence.

(e) In order to be enrolled to perform EAS, the EAS provider shall:

(1) Be licensed if the work to be completed requires licensure, such as plumbing or electrical work;

(2) Be registered with the NH secretary of state to do business in the state of NH;

(3) Be insured with general liability insurance for person and property for a minimum amount of $50,000; and

(4) Have submitted documentation of (1)-(3) above to the department's fiscal agent.

(f) When there is a discrepancy between the recommended specifications pursuant to (a)(1) above, and the EAS provider's quote, the case manager shall not request an authorization for the service, and the department shall not authorize the service until the discrepancy is resolved to the recommended specifications.

(g) An initial authorization shall be made for the first 50% of the expense for the modification.

(h) Final authorization for payment for EAS shall not be made until the department receives the following:

(1) A copy of any required state or local building permit(s) and written confirmation from the building inspector that the work was completed as allowed by the permit(s);

(2) A signed statement from the participant, and if the participant is not the owner of the residence, the property owner, stating that the work has been completed according to the approved bid and plans to the satisfaction of the participant and, if applicable, the property owner;

(3) A signed confirmation from the case manager stating that the work was completed; and

(4) A signed confirmation from the participant that he or she was trained as described in the training plan to ensure safe use of the adaption.

(i) Payment for EAS shall not exceed the limit specified in the HCBS-CFI waiver approved by CMS.

(j) If, within 90 days of an EAS installation:

(1) There is a discrepancy between the EAS provider's quote and the delivered or installed materials for a participant, the EAS provider shall replace the equipment or modification;

(2) The replacement includes a restocking fee that the EAS provider will incur as a result of the needed modification or replacement, the EAS provider may provide a revised quote for the replacement at the same cost and add a restocking fee, and the case manager shall submit the revised quote that includes the restocking fee for authorization to the department. Any restocking fee shall be limited to the actual restocking fee incurred by the EAS provider; and

(3) There is a need to modify the EAS because it did not meet the local or state codes or the EAS provider's quote, the repair, replacement, or modification shall be made at the EAS provider's expense.

N.H. Admin. Code § He-E 801.17

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11

Amended by Volume XXXIX Number 32, Filed August 8, 2019, Proposed by #12830, Effective 8/7/2019, Expires 2/3/2020.

Amended by Volume XLII Number 6, Filed February 10, 2022, Proposed by #13340, Effective 1/29/2022, Expires 1/29/2032 (formerly He-E 801.17).