N.H. Code Admin. R. He-E 801.17 - Environmental Accessibility Adaptations

Current through Register Vol. 41, No. 39, September 30, 2021

(a) Environmental accessibility adaptations (EAA) shall be a covered service when:
(1) A NH Medicaid-enrolled licensed practitioner or physical or occupational therapist has determined the need for one or more of the services in (b) below;
(2) The participant's case manager has requested prior authorization for the service in accordance with (d) below;
(3) BEAS has provided the prior authorization for the service; and
(4) The service is completed by a provider or contractor enrolled with the department in accordance with (e) below.
(b) The following environmental accessibility adaptations shall be covered:
(1) Installation of ramps;
(2) Installation of grab bars;
(3) Widening of doorways to accommodate the participant's wheelchair or other mobility access equipment; and
(4) Other adaptations authorized by BEAS that are necessary for the health and safety of a participant that are not otherwise covered under the Medicaid State Plan.
(c) The following environmental accessibility adaptations shall not be covered:
(1) Improvements that are of general utility and do not have direct or medical remedial benefit to the participant;
(2) Adaptations which add to the square footage of the home;
(3) Purchase of or modifications to a motor vehicle;
(4) Electrical or plumbing work that is beyond what is required to support the authorized adaptation;
(5) Electrical or plumbing work for which the proposed contractor is unable to state, in writing, that the proposed adaptation can be done within the current electrical or plumbing capacity of the home; and
(6) Adaptations to a residential care facility or other licensed facility, except for adaptations in an adult family care home when approved for a specific participant.
(d) The participant's case manager shall submit the following when requesting prior authorization for an EAA:
(1) A completed Form 3715, "Choices for Independence Prior Authorization Request Form" (4/2011) ;
(2) A copy of the evaluation in (a) (1) above that describes:
a. The medical or functional need for the adaptation;
b. The description and measurements required for the adaptation; and
c. The proposed training plan for the client and caregiver to ensure safe use of the adaptation;
(3) Proposals from at least 2 registered providers or contractors, except that one proposal may be submitted with a written explanation of why only one proposal is available or appropriate, including the following, as applicable to the project:
a. A list of supplies and materials;
b. Blueprints or scaled drawings;
c. The name(s) of any subcontractors that will be involved;
d. Written confirmation of whether or not a building permit is required;
e. If electrical or plumbing work is required to support the adaptation, then:
1. A statement signed by the provider or contractor stating that the requested adaptation can be done within the current electrical or plumbing capacity of the residence; and
2. A copy of the electrician or plumber's license;
f. A statement signed by the provider or contractor affirming knowledge of all applicable building codes and permitting requirements and affirming that any subcontractors involved in the work are appropriately licensed; and
g. An agreement signed by the provider or contractor stating that reimbursement for the authorized service through CFI will be payment in full;
(4) If a participant prefers one bid over the other(s) , then an explanation of the preference shall be submitted; and
(5) A notarized written statement from the property owner granting permission to complete the project if the participant is not the owner of the residence.
(e) Providers or contractors shall meet the following requirements in order to be enrolled to perform EAAs:
(1) Licensed if the work to be completed requires licensure, such as plumbing or electrical work;
(2) Registered with the NH secretary of state to do business in the state of NH;
(3) Insured with general liability insurance for person and property for a minimum amount of $50,000; and
(4) Have submitted documentation of (1) -(3) above to the department's fiscal agent.
(f) Payment for EAAs shall not be made until the department receives the following:
(1) A copy of any required building permit and written confirmation from the building inspector that the work was completed as allowed by the permit;
(2) A signed statement from the participant stating that the work has been completed according to the approved bid and plans and to the satisfaction of the participant; and
(3) A signed confirmation from the case manager stating that the work was completed.
(g) Payment for environmental accessibility adaptations shall not exceed the participant lifetime limit specified in the HCBC-CFI waiver approved by the Centers for Medicare and Medicaid Services.

Notes

N.H. Code Admin. R. He-E 801.17

(See Revision Note at part heading for He-E 801) #9969, eff 8-8-11

Amended by Volume XXXIX Number 32, Filed August 8, 2019, Proposed by #12830, Effective 8/7/2019, Expires 2/3/2020.

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