Section 260. Environmental modifications

A. Service description. Environmental modifications shall be defined as those physical adaptations to the home or to a vehicle, included in the client's ISP, that are necessary to ensure the health, welfare, and safety of the client, or that enable the client to function with greater independence in the home and without which the client would require continued institutionalization. Such adaptations include items to ensure the safety of the client, family/caregiver and the community. Modifications can be made to an automotive vehicle only if it is the primary vehicle being used by the client.

B. Service units and service limitations. Environmental modifications shall be available to clients who are receiving at least one other waiver service. A maximum limit of $5,000 may be reimbursed per ISP year. Costs for environmental modifications shall not be carried over from ISP year to ISP year and must be pre-authorized by DMAS or the contracted preauthorization entity for each ISP year. Excluded from this service shall be those adaptations or improvements to the home that are of general utility and are not of direct medical or remedial benefit to the client, such as carpeting, roof repairs, central air conditioning, etc. Adaptations that add to the total square footage of the home are also excluded from this benefit. Modifications may not be used to bring a substandard dwelling up to minimum habitation standards. Also excluded are modifications that are reasonable accommodation requirements of the Americans with Disabilities Act, the Virginians with Disabilities Act, and the Rehabilitation Act. All services shall be provided in accordance with applicable state or local building codes.

C. Criteria. In order to qualify for these services, the client must have a demonstrated need for equipment or modifications of a remedial or medical benefit offered primarily in a client's primary home, primary vehicle used by the client or for the client by the family/caregiver, to specifically improve the client's personal functioning. This service shall encompass those items not otherwise covered in the State Plan for Medical Assistance or through another program.

D. Provider requirements. In addition to meeting the general conditions and requirements for home and community-based participating providers as specified in 12VAC30-135-120 and 12VAC30-135-160, environmental modifications must be provided in accordance with all applicable federal, state or local building codes and laws by providers who have a provider participation agreement with DMAS. The provider must submit information regarding environmental modifications to the case manager. The following are provider documentation requirements that must be included in the client's record:

1. Supporting documentation that documents the need for the service, the process to obtain the service, and the time frame during which the services are to be provided;

2. Documentation of the time frame involved to complete the modification and the amount of services and supplies;

3. Any other relevant information regarding the modification;

4. Documentation of notification by the client and family/caregiver of satisfactory completion of the service; and

5. Instructions regarding any warranty, repairs, complaints, and servicing that may be needed.

Historical Notes

Derived from Volume 24, Issue 02, eff. December 1, 2007.

Statutory Authority

§§ 32.1-324 and 32.1-325 of the Code of Virginia.