DDRS Waiver Manual

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Authority: 42 CFR §441.302 Section 11.1: Environmental Modification Policy Waiver Policy Notification Policy Topic: Environmental Modification Policy Clarification Impacts the following Home and Community-Based Services (HCBS) Waivers: Aged and Disabled (AD) – Division of Aging Traumatic Brain Injury (TBI) – Division of Aging Community Integration and Habilitation Waiver (CIH) – Division of Disability and Rehabilitative Services Note: Not a covered service for the Family Supports Waiver – Division of Disability and Rehabilitative Services Effective Date: December 1, 2007 and replaces all previous policies related to the authorization of Environmental Modifications. Description Environmental modifications are minor physical adaptations to the home, as required by the individual’s Plan of Care/Cost Comparison Budget (POC/CCB), which are necessary to ensure the health, welfare and safety of the individual, which enable the individual to function with greater independence in the home, and without which the individual would require institutionalization. A lifetime cap of $15,000 is available for environmental modifications. The cap represents a cost for basic modification of an individual’s home for accessibility and safety and accommodates the individual’s needs for housing modifications. The cost of an environmental modification includes all materials, equipment, labor, and permits to complete the project. No parts of an environmental modification may be billed separately as part of any other service category (e.g. Specialized Medical Equipment). In addition to the $15,000 lifetime cap, $500 is allowable annually for the repair, replacement, or an adjustment to an existing environmental modification that was funded by a Home and Community Based Services (HCBS) waiver. Home Ownership Environmental modifications shall be approved for the individual’s own home or family owned home. Rented homes or apartments are allowed to be modified only when a signed agreement from the landlord is obtained. The signed agreement must be submitted along with all other required waiver documentation. 166
Choice of Provider The individual chooses which approved/certified providers will submit bids or estimates for this service. The provider with the lowest bid will be chosen, unless there is a strong written justification from the case manager detailing why a provider with a higher bid should be selected. Requirements All environmental modifications must be approved by the waiver program prior to services being rendered. Environmental modification requests must be provided in accordance with applicable State and/or local building codes and should be guided by Americans with Disability Act (ADA) or ADA Accessibility Guidelines (ADAAG) requirements when in the best interest of the individual and his/her specific situation. Environmental modifications shall be authorized only when it is determined to be medically necessary and shall have direct medical or remedial benefit for the waiver individual. This determination includes the following considerations: The modification is the most cost effective or conservative means to meet the individual’s need(s) for accessibility within the home; The environmental modification is individualized, specific, and consistent with, but not in excess of, the individual’s need(s); Three (3) home modification bids must be obtained for all modifications over $1,000; If three (3) bids cannot be obtained, it must be documented to show what efforts were made to secure the three (3) bids and explain why fewer than three (3) bids were obtained (e.g. provider name, dates of contact, response received); For modifications under $1,000, one (1) bid is required and pricing must be consistent with the fair market price for such modification(s); Bids must be itemized to include the following: Example: Scope of work Material Related Labor Ramp 15’ long $$ $$ Widen front door to 36” $$ $$ Widen bathroom door to 36” $$ $$ Install ADA toilet $$ $$ Building permits (specify) $$ $$ Total Cost $$$$ $$$$ 167
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2016 DDRS Waiver Manual Our Mission
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Section 1: Roles and Responsibiliti
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Section 7.5: State Authorization of
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Section 10.23: Psychological Therap
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Section 1.1: The Centers for Medica
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ules or standards that may affect t
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Information Sharing The Individual
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Here are some tips on what to discu
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6. Does each person have his or her
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Section 3: Additional Medicaid Prog
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HCBS waiver services. HCBS waiver p
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Section 4.1: Medicaid Waiver Overvi
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Section 4.4: Coordination with Medi
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personal beliefs and customs, ensur
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Section 5.1: Request for Applicatio
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Internet access, call toll free 1-8
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understanding and use of language,
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If an individual declines the offer
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waiver slot when it appears that th
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Five calendar days to interview and
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The individual or guardian has sign
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Section 6: Objective Based Allocati
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adjustments to the allocation amoun
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BMAN Reserve $0 $0 $2,620.80 $5,241
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An individual’s behavioral condit
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An individual or the individual’s
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Your Appeal Right as an Applicant f
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Section 7.1: Level of Care Re-Evalu
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RN/LPN, who must be actively involv
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o Children receiving adoption assis
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including the DDRS Case Management
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When the individual “Re-Enters”
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(RHS) under the Community Integrati
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Section 8.1: Appeal Request The fol
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Objective-based allocation (OBA): T
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administrative hearing must still b
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The person testifying should be the
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In all cases, the decision of the A
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Section 9.1: Overview The Family an
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Structural or environmental issues
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implemented in order to ensure that
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conducted by the ombudsman must als
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Section 10.24: Recreational Therapy
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Medicaid Waiver Services, Codes, an
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FSW CIH MFP- CIH INsite Code Servic
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The Case Manager should give the co
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Aversive techniques - any technique
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Services delivered to persons who d
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where services are not rendered wit
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Section 10.7: Community Based Habil
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Activities that do not foster the a
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The system to be installed must be
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The monitoring base staff must have
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Electronic Monitoring may not be us
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Adaptations to service provider-own
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independence and are consistent wit
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Group supports delivered to individ
Page 115 and 116: o Small (4:1 or smaller) o Medium (
Page 117 and 118: The data may reside in multiple loc
Page 119 and 120: Providers must be able to indicate,
Page 121 and 122: programmed, constructive interactio
Page 123 and 124: The IBI Director will provide a nar
Page 125 and 126: As applicable, monthly/quarterly re
Page 127 and 128: participate in their communities, a
Page 129 and 130: Homeschooling, special education, a
Page 131 and 132: or before the fifteenth day of the
Page 133 and 134: o Medium (5:1 to 10:1) o Larger (la
Page 135 and 136: Services must address needs identif
Page 137 and 138: The following activities are not al
Page 139 and 140: maintaining natural supports, physi
Page 141 and 142: tool for individual assessment. The
Page 143 and 144: o o o o o Individuals receiving RHS
Page 145 and 146: (C) requires minimal residential ha
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Page 149 and 150: Available only under the Community
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Page 153 and 154: Section 10.30: Speech/Language Ther
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Page 159 and 160: Bus passes or alternate methods of
Page 161 and 162: The participant requires assistance
Page 163 and 164: Service Standards The following ser
Page 165: Section 11: Request for Approval (R
Page 169 and 170: Reimbursement Reimbursement is avai
Page 171 and 172: Modifications/Items - Non-Covered E
Page 173 and 174: Authority: 42 CFR §441.302 Section
Page 175 and 176: Total Cost $$$$$ 175
Page 177 and 178: Items - Covered Justification and d
Page 179 and 180: These requests should be extremely
Page 181 and 182: Choice of Provider The individual c
Page 183 and 184: Completed by an approved Medicaid W
Page 185 and 186: The case management entity, working
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