Provider Requirements and Service Limitations
From The May 2010 Florida Medicaid Provider Handbook
Environmental - Requirements To Receive
Environmental accessibility adaptations (EAA) are those physical adaptations to the home that are required by the recipient’s support plan and are “medically necessary” to avoid institutional placement of the recipient and enable him to function with greater independence in the home. A Home Accessibility Assessment is an independent assessment by a professional rehabilitation engineer or other specially trained and certified professional to determine the most cost-beneficial and appropriate accessibility adaptations for a recipient’s home.
Home accessibility assessments may also include pre-inspection of up to three houses a recipient or family is considering for purchase, review of ceiling lift and track systems, van conversions, and oversight and final inspection of any approved EAA.
If the construction is not completed by the independent assessor, the assessor can still provide construction oversight and a final inspection. The assessment may also include pre-purchase inspection of up to three homes identified by a recipient or family to determine the best design to meet the recipient’s needs and any potential adaptations that may be required to make the home accessible.
Environmental accessibility adaptation services are limited to the amount, duration and scope of the adaptation project described on the recipient’s support plan and current approved cost plan. If multiple vendors are enrolled to provide this service, the recipient shall be encouraged to select from among the eligible vendors based on availability, quality of workmanship, and best price.
Environmental accessibility adaptations covered under this waiver includes the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities or installation of specialized electric and plumbing systems required to accommodate the medical equipment and supplies, which are necessary for the welfare of the recipient.
Excluded are those adaptations or improvements to the home, which are of general utility and are not of direct medical or remedial benefit to the recipient, such as carpeting, roof repair, central air conditioning, etc.
Environmental accessibility adaptations (EAA) are approved when they are medically necessary. APD must approve exceptions. To submit an exception request, the appropriate professional must complete an assessment documenting how the specific EAA is medically necessary, how it is directly related to the recipient’s developmental disability, how it is directly related to accessibility issues within the home; and how without the selected EAA, the recipient cannot continue to reside in his current residence. The request will be reviewed by an appropriate, qualified professional to determine whether the standards for medical necessity are met and to determine whether the requested item fairly meets the service definition.
Adaptations specifically excluded in this handbook will not be approved through exception.
Environmental accessibility adaptations include only adaptations to an existing structure, and must be provided in accordance with applicable state or local building codes. Adaptations that add to the total square footage of the home are excluded from this benefit.
Prior to the provider submitting the claim for payment, the recipient’s waiver support coordinator must document that the services were completed in accordance with the contract or agreement, either by conducting a site visit or by obtaining verbal verification from the recipient or family.
Reimbursement* and monitoring documentation to be maintained by the provider:
- *Copy of claims submitted for payment;
- *Copy of service log; and
- Original prescription for medical equipment.
Documentation to be submitted to the waiver support coordinator by the provider:
- Service log monthly, including documentation of waiver support coordinator’s verification that services were completed in accordance with the contract or agreement, prior to submission of claim for payment; and
- Copy of original prescription for medical equipment.
*Indicates reimbursement documentation.
Place of Service:
Environmental accessibility adaptations shall be made only to a recipient’s family home or recipient’s own home, including rented houses or apartments. Recipients living in foster homes, group homes, assisted living facilities, or homes for special services (any licensed residential facility) are not eligible to receive this service. The responsibility for EAA rests with the facility owner or operator.
Environmental accessibility adaptations shall be determined “medically necessary” before approved. This determination includes the following considerations:
- There are no less costly or conservative means to meet the recipient’s need for accessibility within the home;
- The environmental accessibility adaptation is individualized, specific and consistent with the recipient’s needs and not in excess of his needs; and,
- The environmental accessibility adaptation enables the recipient to function with greater independence in the home and without which, the recipient would require institutionalization.
Environmental accessibility adaptations that are required to support proper functioning of medical equipment, such as electrical upgrades, are limited to the requirements for the safe operation of the specified equipment and not intended to correct existing code violations in the recipient’s home.
Environmental accessibility adaptations shall be approved for a recipient’s own home or family home whether owned or leased, as needed, to make the home accessible to the recipient. No more than five units shall be billed per day. Once adaptations are made to a recipient’s residence, adaptation to another residence cannot be made until five years after the last adaptation to the first residence except for extenuating circumstances, such as total loss of residence. The waiver program does not cover routine repairs to the existing EAA or general repairs to the home or residence. The waiver program cannot be used to fund corrections to any existing code violation(s) to the home.
If a recipient or family builds a home while the recipient is receiving waiver services, major or structural changes will not be covered. Environmental accessibility adaptations covered under these circumstances are the difference in the cost, if any, between a handicapped-accessible bathroom and a standard bathroom. However, the cost difference for each item and adaptation must be documented, with total cost not exceeding $3,500.
Rental property is limited to minor adaptations as defined below. Prior to any adaptation to a rental property, a determination should be made as to what, if anything, the landlord will cover. The landlord, prior to service, shall approve all proposed environmental accessibility adaptations in writing. The written agreement between the recipient or family and the landlord must specify any requirements for restoration of the property to its original condition if the occupants move and must indicate that the Department of Children and Families and waiver funding are not obligated for any restoration costs. Waiver funds cannot be placed in escrow to undo any accessibility adaptations when the recipient moves out. Recipients or families requesting EAA are expected to apply for all other assistance that may be available to assist in meeting the recipient’s needs. This includes local housing authorities, county, and local and community funding, etc.
Environmental accessibility adaptations shall be separated into two categories. Minor adaptations shall be defined as those EAA costing under $3,500 for all adaptations in the home. Major adaptations shall include those adaptations to a home when the total cost is $3,500 and over. Total EAA cannot exceed $20,000 during a five-year period. Major environmental accessibility adaptations require the assessment of a rehabilitation engineer or other professional qualified to make a home accessibility assessment. This home accessibility assessment shall include evaluation of the current home and describe the most cost-beneficial manner to permit accessibility of the home for the recipient on the waiver.
The report must demonstrate that the environmental accessibility adaptation recommended is a “prudent purchase.” Prudent purchase is a combination of quality and cost, where quality is measured by the ability to meet the recipient’s accessibility need and cost is measured by being the most reasonable and economical approach necessary to meet that need. Each environmental accessibility adaptation must be the most reasonable alternative based on the results of the review of all options, including a change in the use of rooms within the home or alternative housing.
Environmental accessibility adaptations must be cost-beneficial. Once the most reasonable alternative has been identified and specifications been developed, three competitive bids must be obtained for all EAA to a home costing $3,500 and over to determine the most economical option.
If three bids cannot be obtained, it must be documented to show what efforts were made to secure the three bids and explain why less was obtained. For EAA to a home costing between $1,000 and $3,499 at least two competitive bids must be obtained. If two bids cannot be obtained, it must be documented to show what efforts were made to secure the two bids and explain why only two were obtained. For EAA to a home costing under $1,000 only one bid is required, as long as it can be demonstrated that the bid is consistent with local market value. Environmental accessibility adaptations do not include those adaptations or improvements to the home that are of general utility, are considered to be standard housing obligations of the owner or tenant, are considered to be experimental, or are not of direct medical or remedial benefit to the recipient on the waiver. Routine maintenance of the adaptations and general repair and maintenance to the home is the responsibility of the owner or landlord and not a covered waiver service.
Examples of items not covered include replacement of carpeting and other floor coverings; roof repair; driveways; decks; patios; fences; swimming pools; spas or hot tubs; sheds; sidewalks; central heating and air conditioning; raised garage doors; storage (i.e., cabinets, shelving, closets); standard home fixtures (i.e., sinks, commodes, tub, stove, refrigerator, microwave, dishwasher, clothes washer and dryer, wall, window and door coverings, etc.); furnishings (i.e., furniture, appliances, bedding); and other noncustom items which may routinely be found in a home. Also, specifically excluded are any adaptations that will add square footage to the home.
Environmental Accessibility Adaptation
Providers of environmental accessibility adaptation (EAA) services include licensed general or independent licensed contractors, electricians, plumbers, carpenters, architects and engineers.
Any enrolled EAA provider who provides construction work must present a qualified business number, as required in section 489.119, F.S. In accordance with section 489.113, F.S., subcontractors of a qualified business shall hold the required state certificate or registration in that trade category.
Engineers shall be licensed in accordance with Chapter 471, F.S., and must have one year of experience in environmental adaptation assessment and remodeling or be Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) certified.
Architects shall be licensed in accordance with Chapter 481, F.S., and must have one year of experience in environmental adaptation assessment and remodeling or be Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) certified.
Contractors and electricians shall be licensed in accordance with Chapter 489, F.S.
Plumbers shall be licensed in accordance with Chapter 489, F.S.
Carpenters and other vendors shall hold local occupational licenses or permits, in accordance with Chapter 205, F.S. Other professionals who may provide environmental accessibility adaptations assessments include providers with experience in the field of environmental accessibility adaptation assessment, with Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) certification, and an occupational license.