DDRS Waiver Manual

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Section 11.3: Vehicle Modification Waiver Policy Notification Authority: 42 CFR §441.302 Policy Topic: Vehicle 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 (CIHW)– Division of Disability and Rehabilitative Services Family Supports (FSW) – Division of Disability and Rehabilitative Services Effective Date: December 1, 2007 and replaces all previous policies related to the authorization of Vehicle Modifications. Description Vehicle Modifications (VMOD) are the addition of adaptive equipment or structural changes to a motor vehicle that permit an individual with a disability to safely transport in a motor vehicle. Vehicle modifications, as specified in the Plan of Care/Cost Comparison Budget (POC/CCB), may be authorized when necessary to increase an individual’s ability to function in a home and community based setting to ensure accessibility of the individual with mobility impairments. These services must be necessary to prevent or delay institutionalization. The necessity of such items must be documented in the plan of care by a physician’s order. Vehicles necessary for an individual to attend post secondary education or job related services should be referred to Vocational Rehabilitation Services. A lifetime cap of $15,000 is available for vehicle modifications under the AD, CIH, and TBI waivers. Under the FS Waiver, a lifetime cap of $7,500 is available for Specialized Medical Equipment, which includes vehicle modifications. In addition to the applicable lifetime cap, $500 will be allowable annually for repair, replacement, or an adjustment to an existing modification that was funded by a Home and Community Based Services (HCBS) waiver. Vehicle Ownership The vehicle to be modified must meet all of the following: The individual or primary caregiver is the titled owner; The vehicle is registered and/or licensed under state law; The vehicle has appropriate insurance as required by state law; The vehicle is the individual’s sole or primary means of transportation; The vehicle is not registered to or titled by a Family and Social Services Administration (FSSA) approved provider agency. 180
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 strong written justification from the case manager detailing why a provider with a higher bid should be selected. Requirements All vehicle modifications must be approved by the waiver program prior to services being rendered. Vehicle modification requests must meet and abide by the following: The vehicle modification is based on, and designed to meet, the individual’s specific need(s); Only one vehicle per an individual’s household may be modified; The vehicle is less than ten (10) years old and has less than 100,000 miles on the odometer; If the vehicle is more than five years old, the individual must provide a signed statement from a qualified mechanic verifying that the vehicle is in sound condition. All vehicle modification shall be authorized only when it is determined to be medically necessary and/or 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 specific need(s); The modification is individualized, specific, and consistent with, but not in excess of, the individual’s need(s); Three (3) 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); All bids must be itemized to include the following: Example: Make: Model: Mileage: Year: Scope of work Materials Cost Related Labor Lift $$ $$ Tie down $$ $$ Total Cost: $$$$$ 181
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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
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o Small (4:1 or smaller) o Medium (
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The data may reside in multiple loc
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Providers must be able to indicate,
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programmed, constructive interactio
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The IBI Director will provide a nar
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As applicable, monthly/quarterly re
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participate in their communities, a
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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
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Page 143 and 144: o o o o o Individuals receiving RHS
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Page 153 and 154: Section 10.30: Speech/Language Ther
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Page 163 and 164: Service Standards The following ser
Page 165 and 166: Section 11: Request for Approval (R
Page 167 and 168: Choice of Provider The individual c
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: These requests should be extremely
Page 183 and 184: Completed by an approved Medicaid W
Page 185 and 186: The case management entity, working
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DDRS Waiver Manual

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