CHAPTER 3200 Vehicle Adaptation Services

CHAPTER 3200
SPECIFIC PROGRAM REQUIREMENTS
FOR
VEHICLE ADAPTATION SERVICES
SCOPE OF SERVICES
3201 General
Vehicle Adaptation Services include various adaptations and technical assistance to individually or family owned vehicles 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. Vehicle Adaptations are limited to a participant’s or his or her family’s privately owned vehicle and include such things as a hydraulic lift, ramps, special seats and other interior modifications to allow for access into and out of the vehicle as well as safety while moving. The adapted or to be adapted vehicle must be the participant’s primary means of transportation.
Any item billed under Vehicle 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.
3202 Special Requirements of Participation
A. 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 vendors and dealers in Vehicle Adaptations 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 Vehicle 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.
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b. Verification of Vehicle Adaptation service delivery, including date, location, and specific vehicle adaptations provided.
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.
3202.1 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, Vehicle 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 Vehicle 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.
b. Verification of Vehicle Adaptation service delivery, including date, location, and specific vehicle adaptations provided.
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 MHDDD 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 the DBHDD (see Part II Policies and Procedures for COMP, Chapter 603)).
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3203 Licensure
Vehicle Adaptations are made by vendors with the applicable Georgia business license as required by the local, city or county government in which the services are provided.
3204 Special Eligibility Conditions
1. The need for Vehicle 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 goal must be in the ISP for any specialized services, which includes Vehicle Adaptation.
3. Medical necessity for Vehicle Adaptation Services must be documented through and order by a Georgia licensed physician.
3205 Prior Approval
1. Vehicle Adaptation Services must relate to specific individual goals and must be required to meet the needs of the participant.
2. Vehicle 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.
3206 Covered Services
Reimbursable Vehicle Adaptation Services include the following based on the assessed need of the participant and as specified in the approved ISP:
1. Vehicle Adaptations are limited to a participant’s or his or her family’s privately owned vehicle.
2. Vehicle Adaptations include such things as a hydraulic lift, ramps, special seats and other interior modifications to allow for access into and out of the vehicle as well as safety while moving.
3. Vehicle Adaptation to the participant’s primary means of transportation.
4. Repair of a prior existing vehicle adaptation provided the repair is less that replacement.
Rev. 10 2009
Rev. 10 2009
Rev. 10 2009
Rev. 10 2009
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5. Replacement of a prior existing vehicle adaptation if replacement is less than a repair.
3207 Non-Covered Services
1. Adaptation, repair or replacement costs for adaptations to provider-owned vehicles.
2. Adaptation, repair or replacement costs for adaptations to leased vehicles.
3. Vehicle adaptations will not be replaced in less than three years except in extenuating circumstances and authorized by the Division of Medicaid, Department of Community Health.
4. Vehicle backup sensor and alarm systems.
5. Comfort, convenience, or recreational adaptation.
6. Adaptation, replacement or repair that is necessitated by participant’s neglect, wrongful disposition, intentional misuse or abuse. Adaptations will not be replaced due to the participant’s negligence and/or abuse (e.g., before its normal life expectancy has been attained unless supporting medical documentation and change I the physical or developmental condition of the participant).
7. Regularly scheduled upkeep and maintenance of the vehicle or its modifications.
8. Adaptations of general utility that are not of direct medical or remedial benefit to the individual.
9. Purchase or lease of vehicles.
10. Extended warranties and/or maintenance agreements.
11. Participants cannot receive Vehicle Adaptation Services if receiving Community Residential Alternative Services.
12. 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.
13. 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.
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3208 Basis for Reimbursement
A. Lifetime maximum is $6,240.00 per participant.
B. Reimbursement Rate
Reimbursement rate for Vehicle Adaptation is the lower of three price quotes or the lifetime maximum. The reimbursement rates for all specialized services are found in Appendix A.
3209 Participant-Direction Options
A. Participants may choose the self-direction option with Vehicle Adaptation.
B. For details on participant-direction, see Part II Policies and Procedures for COMP, Chapter 1200.

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