CHAPTER 2100 Environmental Accessibility Adaptation Services

CHAPTER 2100
SPECIFIC PROGRAM REQUIREMENTS
FOR
ENVIRONMENTAL ACCESSIBILITY ADAPTATION SERVICES
SCOPE OF SERVICES
2101 General
Environmental Accessibility Adaptation Services include adaptations and technical assistance to individually or family owned private residences which are designed to enable individuals to interact more independently with their environment thus enhancing their quality of life and reducing their dependence on physical support from others. These services include physical adaptations to the participant’s or family’s home which are necessary to ensure the health, welfare and safety of the individual, or enable the individual to function with greater independence in the home and without which, the participant would require institutionalization. Environmental Accessibility Adaptations consist of 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 necessary for the welfare of the participant and are of direct medical or remedial benefit to the participant.
Any item billed under Environmental Accessibility Adaptation Services must not be available under the State Medicaid Plan. These services must also be documented to be the payer of last resource. The COMP does not cover items that have been denied through the DME and other programs for lack of medical necessity.
2102 Special Requirements of Participation
2102.1 Individual Provider
In addition to those conditions of participation in the Medical Assistance Program as outlined in Part I, Policies and Procedures for Medicaid/PeachCare for Kids Manual applicable to all Medicaid providers, Section 106 (General Conditions of Participation), and Part II, Chapter 600 Policies and Procedures for the COMP Program, individual providers of Environmental Accessibility Adaptations must meet the following requirements:
a. Documentation Requirement: Providers, except for providers of participant-directed services, must document
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XXI-2
the following in the record of each participant receiving Environmental Accessibility Adaptation Services:
 The efforts of the participant’s Support Coordinator to substantiate payer of last resource, including available community, State Plan, or other resources.
 Verification of Environmental Accessibility Adaptation service delivery, including date, location, and specific environmental accessibility adaptations provided.
 Associated administration costs for Environmental Accessibility Adaptation service delivery that delineates line item sources of costs; billing of associated administration costs can not exceed eight to ten (8 to 10) percent of any billing for Environmental Accessibility Adaptation services.
b. Participant-Directed Services Documentation and other Requirements: Documentation and other requirements for individual providers of participant-directed services are
specified in Part II Policies and Procedures for COMP, Chapter 1200.
2102.2 Provider Agencies
In addition to those conditions of participation in the Medical Assistance Program as outlined in Part I, Policies and Procedures for Medicaid/PeachCare for Kids Manual applicable to all Medicaid providers, Section 106 (General Conditions of Participation), and Part II, Chapter 600 Policies and Procedures for the COMP Program, Environmental Accessibility Adaptation Services provider agencies must meet the following requirements:
1. Documentation Requirement: Providers, except for providers of participant-directed services, must document the following in the record of each participant receiving Environmental Accessibility Adaptation Services:
a. The efforts of the participant’s Support Coordinator to substantiate payer of last resource, including available community, State Plan, or other resources.
Rev. 07 2009
January 1, 2015 Comprehensive Supports Waiver Program (COMP) XXI-3
b. Verification of Environmental Accessibility Adaptation service delivery, including date, location, and specific environmental accessibility adaptations provided.
c. Associated administration costs for Environmental Accessibility Adaptation service delivery that delineates line item sources of costs; billing of associated administration costs can not exceed eight to ten (8 to 10) percent of any billing for Environmental Accessibility Adaptation services.
2. Participant-Directed Services Documentation and other Requirements: Documentation and other requirements for individual providers of participant-directed services are specified in Part II Policies and Procedures for COMP, Chapter 1200.
3. DBHDD Contract/LOA and DBHDD Community Service Standards: Providers must adhere to DBHDD Contract Standards, DBHDD Core Requirements for All Providers and all other applicable DBHDD Standards, including accreditation by a national organization (CARF, JCAHO, The Council, Council on Accreditation) or certification by DBHDD (see Part II Policies and Procedures for COMP, Chapter 603).
2103 Licensure
Environmental Accessibility Adaptations are made by building, plumbing or electrical contractors with applicable Georgia license (OCGA 43-14-2 or 43-41-2) or individual builders, plumbers or electricians with applicable Georgia business license as required by the local, city or county government in which the services are provided.
2104 Special Eligibility Conditions
1. The need for Environmental Accessibility Adaptation services must be related to the individual disability and specified in the Health and Safety Section of the Intake and Evaluation Team approved Individual Service Plan (ISP).
2. When a participant only receives specialized services, a specific goal must be in the ISP for any specialized services, which includes Environmental Accessibility Adaptation.
Rev. 04 2009
Rev. 10 2009
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January 1, 2015 Comprehensive Supports Waiver Program (COMP) XXI-4
3. Medical Necessity for Environmental Accessibility Adaptation Services must be documented through an order by the Georgia Licensed physician.
2105 Prior Approval
1. Environmental Accessibility Adaptation Services must relate to specific individual goals and must be required to meet the needs of the participant.
2. Environmental Accessibility Adaptation Services must be authorized prior to service delivery by the applicable DBHDD Regional Office at least annually in conjunction with the ISP development and any ISP revisions.
2106 Covered Services
Reimbursable Environmental Accessibility Adaptation Services include the following based on the assessed need of the participant and as specified in the approved ISP:
1. Environmental Accessibility Adaptation Services consist of physical adaptations to the participant’s or family’s home in which the participant resides and which are necessary to ensure the health, welfare and safety of the individual, or which enable the individual to function with greater independence in the home and without which, the participant would require institutionalization.
2. Environmental Accessibility Adaptations consist of 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 necessary for the welfare of the participant and are of direct medical or remedial benefit to the participant.
2107 Non-Covered Services
1. Environmental Accessibility Adaptation Services will not be approved for modifications made to homes that are licensed by the State as Personal Care Homes or Community Living Arrangements.
2. Adaptations that add to the total square footage of the home are excluded from this benefit except when necessary to complete an adaptation (e.g., in order to improve entrance/egress to a residence or to configure a bathroom to accommodate a wheelchair).
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January 1, 2015 Comprehensive Supports Waiver Program (COMP) XXI-5
3. Adaptations that are not of direct medical or remedial benefit to the participant, such as carpeting, roof repair, central air conditioning, etc.
4. Adaptations that are made to leased property.
5. Comfort, convenience, or recreational adaptations.
6. Installations or adaptations for alarm systems, chairlifts, elevators, burglar bars, security cameras, personal emergency response systems, deadbolt locks, fences, hot tubs, whirlpool tubs, portable pools and spas, lap pools, and indoor ceiling lift systems.
7. Participants cannot receive Environmental Accessibility Adaptation Services if receiving Community Residential Alternative Services.
8. Payment is not made, directly or indirectly, to members of the individual’s immediate family, except as approved as indicated in Part II Policies and Procedures for COMP, Chapter 900.
9. Payment is not made for those goods and services covered by the State Medicaid Plan except where a participant’s need exceeds State Plan coverage limits and exceptions to the coverage limits are not available.
2108 Basis for Reimbursement
A. Lifetime maximum is $10,400 per participant.
B. Reimbursement Rate:
Reimbursement rate for Environmental Accessibility Adaptation is the lower of three price quotes or the lifetime maximum. The reimbursement rates for all specialized services are found in Appendix A.
Limit: 1 Unit = $1.00
2109 Participant-Direction Options
A. Participants may choose the self-direction option with Environmental Accessibility Adaptation.
B. For details on participant-direction, see Part II Policies and Procedures for COMP, Chapter 1200.
Rev 01 2013

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