Environmental Modification 525-05-30-25

(Revised 2/1/17 ML #3490)

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Purpose

The purpose of Environmental Modification Service is to modify a recipient's or family member's home (the recipient must reside in the family home) to enhance the recipient's ability to function as independently as possible in the home or family member's home.

 

Service Eligibility, Criteria for

The individual receiving Environmental Modification Service must meet the following service eligibility criteria:

  1. Must be eligible for the programs of SPED, ExSPED, or Medicaid Waiver for Home and Community Based Services.
  2. The recipient or family member must own the home prior to application.  
  3. The individual has a need for a safer and/or adapted environment in which to live, such as the installation of grab bars in the individual's bathroom.
  4. The home modification must directly facilitate the applicant's/recipient's ability to complete his/her own cares independently or to receive care.  It must be evident that without the home modifications, adequate care or the ability to perform self or environmental care is not possible.
  5. The benefit outcome of the home modifications must be proportionate to the cost.  Factors to consider are:  the age of applicant/recipient, life expectancy, the value of the house, the applicant's/recipient's commitment to remain in the home including the family's commitment to assist.
  6. Documentation must be on file that alternative community programs or funding sources available to pay for the home modification costs were explored.  Examples are:  Office of Vocational Rehabilitation, Community Action (e.g. weatherization, rehab.), Community Development Grant (Housing) Funds, FmHA Loan and Grant Program.
  7. The informal network (family members, friends, or neighbors) are not available/willing/capable of completing or paying for the home modifications(s).
  8. Physical adaptations to the home required which are necessary and without which, the recipient would require institutionalization.

 

Limits

SPED and ExSPED tasks are limited to:  Labor and materials for installing safety rails.

 

For the Waiver programs see section Environmental Modification, Scope of which cannot exceed the amount budgeted (per person) for environmental modification in the federally approved Medicaid Waiver for the State of North Dakota.

 

Modifications are not for routine home maintenance, (such as carpeting and/or floor repair, plumbing repair, roof repair, central air conditioning, appliance repair, electrical repair, etc.) but are to promote independence. Adaptations, which add to the total square footage of the home, are not allowed. All services shall be provided in accordance with applicable state and local building codes.

 

For environmental modification the dollar limit is the lesser of the highest monthly rate for the highest cost skilled nursing facility or 20% of the tax evaluation of the home. The highest monthly rate for nursing facility is approximately $10,000 per month in some rural areas this amount may be more than the market value of the home thus the 20% limit. This cap may be increased as determined by legislative action. Exceptions to this service cap will not be made. If the client’s needs cannot be met within the allowed rate case management would explore other service options with the participant including nursing home placement. The case manager makes participants aware of the service cap.

 

Pre-Approval Service Eligibility Determination

Environmental Modification Service requires prior approval from HCBS Program Administration.  The following procedure is used in determining service eligibility:

  1. The individual must make application for services to the HCBS Case Management Agency in their county of physical residence using "Application for Services" (SFN 1047).
  2. The HCBS Case Management Agency will determine whether or not the need for home modification is related to the care needs of the applicant.  The comprehensive assessment is used to identify functional impairments.
  3. A visual inspection of the home is completed by the HCBS Case Manager and, whenever possible, a professional of another discipline with experience in evaluating home care needs of the elderly and disabled. They will determine if the applicant's/recipient's request for Environmental Modification Service will be of direct benefit to the applicant's self- care needs.  If it is found the requested/proposed modifications will not be of direct benefit to the applicant/recipient, the County Social Service Board must deny the service request following the service denial policy procedures.
  4. If the home is in poor condition and not structurally sound, Environmental Modification will not be approved.
  5. A summary of the applicant's/recipient's service request and the recommendation(s) resulting from the home inspection is documented in the case file records.  Included in the documentation must be an explanation of the proposed home modifications and how they will enable self-care or enhance care provided by others.
  6. Written construction bids must be obtained for any work funded under this service chapter.  When the estimated cost exceeds $500.00, bids must be obtained from at least two licensed general contractors if possible. Exceptions may be made to the two bid requirement if it can be demonstrated that there is a lack of available service providers in the area. All bids must include a breakdown of the labor AND material costs of the modifications. See section 525-05-45 for Contractor Standards.
  7. Upon receipt of the written bid(s), the following information is sent to the HCBS program administrator: written bids, narrative explanation of the proposed work and how it will assist the applicant/recipient to complete or receive self-care, a photocopy of the most recent Comprehensive Assessment, and the Individual Care Plan, SFN 1467, or Person Centered Plan of Care SNF 404 that lists Environmental Modification Service. If an exception is being requested to the two bid minimum include a written explanation of the facts supporting the request. HCBS Program Administration’s decision will be based on this information.
  8. If the proposed Environmental Modification Service is not approved, the Case Management Agency will issue a denial notice following the procedures of denying services.
  9. After the HCBS Case Management Agency is notified that the environmental modification project is approved, the Case Manager will assist the contractor (awarded the bid) to complete the forms required for enrollment as a Qualified Service Provider. The Authorization to Provide Service, SFN 1699, or Authorization to provide Waiver Services SFN 404 Section VII, is issued to the contractor awarded the bid once the successful bidder has met the requirements of a Qualified Service Provider. The service period dates entered on the Authorization to Provide Service, SFN 1699, or Authorization to Provide Waiver Services SFN 404 Section VII is the time span in which the contractor agrees to finish the project.
  1. Upon completion of the home modification, the HCBS Case Manager and the home care professional that participated in the initial home inspection and service recommendations, will inspect the job to determine if it was completed according to the bid.  If not, the HCBS program administrator must be contacted immediately.  Any cost overruns are the responsibility of the contractor.
  2. Upon completion of Environmental Modification Service, a new care plan must be completed, having deleted the reference to Environment Modification Service.

 

Environmental Modification, Scope of

The modifications to the home allowed within the scope of this service must be of direct and substantial benefit to the applicant's/recipient's need to perform self-care or receive care from others that cannot be met by the current physical characteristic of a part of the home.  

 

Examples of allowable home modifications include but may not be limited to the following:

  1. Labor and materials to widen doorways to accommodate wheelchair.
  2. Labor and materials to install a wheelchair ramp when structural changes to the house are required.  
  3. Labor and materials to install or relocate plumbing and/or electrical systems to accommodate specialized equipment.
  4. Labor and materials to modify a bathroom, including installation or relocation of fixtures to accommodate the individual's personal care needs.
  5. Labor and materials to modify a kitchen to enable accessibility for independent meal preparation.
  6. Adaptations may include the installation of ramps, and grab bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems, which are necessary to accommodate the medical equipment and supplies and necessary for the welfare of the recipient.

 

Materials Authorized for Purchase

The materials authorized for purchase must be directly related to the health and safety of the client.