DDRS Waiver Manual

The following service standards apply to Environmental Modifications:
Equipment and supplies must be for the direct medical or remedial benefit of the individual.
All items shall meet applicable standards of manufacture, design, and installation.
To ensure that environmental modifications meet the needs of the individual and abide by
established, federal, state, local, and FSSA standards, as well as Americans with Disabilities Act (ADA)
requirements, approved environmental modifications will reimburse for necessary
Assessment of the individual’s specific needs, conducted by an approved, qualified individual who is
independent of the entity providing the environmental modifications.
Independent inspections during the modification process and at completion of the modifications,
prior to authorization for reimbursement, based on the complexities of the requested modifications.
Equipment and supplies shall be reflected in the ISP.
Equipment and supplies must address needs identified in the person-centered planning process.
Documentation Standards
Documentation standards for Environmental Modifications include the following:
Documentation of the identified direct medical benefit for the individual
Documented prior authorization denial from Medicaid, if applicable
Receipts for purchases
Identified need in ISP
Documentation in compliance with 460 IAC 6, Supported Living Services and Supports requirements
Limitations
The following limitations apply to Environmental Modifications:
Reimbursement for Environmental Modification services has a lifetime cap of $15,000.
Service and repair up to $500 per year, outside this cap, is permitted for maintenance and repair of
prior modifications that were funded by a waiver service.
If the lifetime cap is fully utilized, and a need is identified, the Case Manager will work with other
available funding streams and community agencies to fulfill the need.
Activities Not Allowed
The following activities are not allowed under Environmental Modifications services:
Adaptations to the home that are of general utility
Adaptations that are not of direct medical or remedial benefit to the individual (such as carpeting,
roof repair, or central air conditioning)
Adaptations that add to the total square footage of the home
Adaptations that are not included in the comprehensive plan of care (POC)
Adaptations that have not been approved on a Request for Approval to Authorize Services form
108