Ohio Admin. Code 5123-9-44 - [Effective 7/1/2025] Home and community-based services waivers - vehicle modification under the individual options, level one, and self-empowered life funding waivers
(A)
Purpose
This rule defines vehicle modification and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.
(B)
Definitions
For the purposes of this rule, the following definitions apply:
(1)
"Agency provider" means an entity that directly employs
at least one person in addition to a director of operations for the purpose of
providing services for which the entity is certified in accordance with rule
5123-2-08 of the Administrative
Code.
(2)
"County board" means a county board of developmental
disabilities.
(3)
"Department" means the Ohio department of developmental
disabilities.
(4)
"Individual" means a person with a developmental
disability or for purposes of giving, refusing to give, or withdrawing consent
for services, the person's guardian in accordance with section
5126.043 of the Revised Code or
other person authorized to give consent.
(5)
"Individual
service plan" means the written description of services, supports, and
activities to be provided to an individual.
(6)
"Service
documentation" means all records and information on one or more documents
that:
(a)
Are
created and maintained as services are delivered, and completed prior to
billing for services;
(b)
Are kept in a manner that fully discloses the extent of
services delivered;
(c)
Include the items delineated in paragraph (E) of this
rule; and
(d)
May be created or maintained in electronic software
programs.
(7)
"Vehicle modification" means adaptation or alteration
of an automobile or van that is an individual's primary means of
transportation, necessary to enable the individual to integrate more fully into
the community and ensure the individual's health, welfare, and safety.
(a)
Vehicle
modification includes:
(i)
Adaptation or alteration of an automobile or van that
meets an individual's assessed needs, including but not limited to,
installation of:
(a)
External handling devices or carriers.
(b)
Lifts.
(c)
Vehicle operating aids such as assistive equipment and
technologies.
(d)
Raised or lowered floors or roofs.
(e)
Remote
devices.
(f)
Scooter or wheelchair hoists, hitches, or
tie-downs.
(g)
Transferring seats or equipment.
(h)
Factory-installed
adaptations or alterations that are documented on a separate, itemized
invoice.
(ii)
Maintenance, repair, or replacement of a previously
approved vehicle modification funded by the individual's
waiver.
(b)
Vehicle modification does not include:
(i)
Adaptations or
alterations costing more than the lowest-cost alternative that meets the
individual's assessed needs.
(ii)
Adaptations or
alterations available through another funding source.
(iii)
Improvements of
general utility and not of direct medical or remedial benefit to the
individual.
(iv)
Repair or replacement of a previously approved vehicle
modification that was damaged as a result of apparent misuse, abuse, or
negligence.
(v)
Adaptations or alterations to a leased
vehicle.
(vi)
Removal of adaptations or alterations and return of a
vehicle to its prior condition when an individual no longer has a need for the
vehicle.
(vii)
Moving adaptations or alterations from one vehicle to
another.
(viii)
Installation of used parts.
(ix)
Purchase or
lease of a vehicle.
(x)
Purchase of extended warranties.
(xi)
Rental of an
alternative vehicle for use while a vehicle is being modified or repaired in
accordance with this rule.
(xii)
Maintenance,
repair, or replacement of a previously installed adaptation or alteration
funded by a source other than the individual's
waiver.
(8)
"Waiver
eligibility span" means the twelve-month period following either an
individual's initial waiver enrollment date or a subsequent eligibility
re-determination date.
(C)
Provider
qualifications
(1)
Vehicle modification will be provided by an agency
provider that:
(a)
Meets the requirements of this rule.
(b)
Has a medicaid
provider agreement with the Ohio department of medicaid.
(2)
An
agency provider of vehicle modification or its subcontractor will:
(a)
Be registered as
a motor vehicle repair business with the national highway traffic safety
administration in accordance with
49 C.F.R.
595.6.
(b)
Ensure the person
who installs a vehicle modification meets requirements and has successfully
completed all required training as specified by the manufacturer of the
adaptation or alternation being installed.
(3)
An agency
provider of vehicle modification that subcontracts any part of the
process:
(a)
Will maintain documentation demonstrating that its
subcontractor meets the requirements in paragraphs (C)(2)(a) and (C)(2)(b) of
this rule.
(b)
Is responsible for ensuring each vehicle modification
is completed in accordance with applicable federal, state, and local
regulations.
(4)
An applicant seeking approval to provide vehicle
modification will complete and submit an application and adhere to the
requirements of rule
5123-2-08 of the Administrative
Code except that:
(a)
The applicant is not required to pay an application fee
as specified in paragraph (R) of rule
5123-2-08 of the Administrative
Code.
(b)
Persons engaged by the applicant to install a vehicle
modification are not required to:
(i)
Hold first aid certification as specified in paragraph
(J)(2)(a) of rule
5123-2-08 of the Administrative
Code;
(ii)
Hold cardiopulmonary resuscitation certification as
specified in paragraph (J)(2)(b) of rule
5123-2-08 of the Administrative
Code; or
(iii)
Complete the training described in appendix C to rule
5123-2-08 of the Administrative
Code.
(D)
Requirements for
service delivery
(1)
Vehicle modification will be provided pursuant to an
individual service plan that conforms to the requirements of rule
5123-4-02 of the Administrative
Code.
(2)
The vehicle that is being modified must be owned
by:
(a)
The
individual;
(b)
The individual's family member with whom the individual
lives or has consistent and ongoing contact who may or may not be a paid
provider of home and community-based services to the individual;
or
(c)
A person who is neither the individual's family member
nor a paid provider of home and community-based services to the individual but
is a primary ongoing caregiver to the individual.
(3)
Prior to
authorizing a vehicle modification, an individual's service and support
administrator will:
(a)
Request an assessment to determine the individual's
and/or caregiver's capacity to use a vehicle modification and identify the
appropriate vehicle modification and the suitability of the vehicle to be
modified.
(i)
The assessment will address:
(a)
The individual's
physical characteristics (e.g., height and weight) and mobility support needs
(e.g., transferring or turning).
(b)
Whether the
individual travels independently or relies on caregivers during
transportation.
(c)
Whether the individual uses a scooter or wheelchair,
including:
(i)
Whether the individual uses a scooter or wheelchair
independently or relies on caregivers when using a scooter or
wheelchair;
(ii)
Whether the individual uses a scooter or wheelchair all
the time;
(iii)
Whether the individual travels in a scooter or
wheelchair or transfers into the vehicle; and
(iv)
Characteristics
of the scooter or wheelchair (i.e., manual or powered, weight, height, width,
and length).
(d)
Identification of the lowest cost alternative that
meets the individual's needs.
(ii)
The assessment
will be conducted by:
(a)
An occupational therapist or a physical therapist
licensed pursuant to Chapter 4755. of the Revised Code; or
(b)
A person holding
a certified driver rehabilitation specialist credential issued by the
association for driver rehabilitation specialists.
(b)
Establish ownership of the vehicle to be modified and obtain
the vehicle owner's written consent to modify the vehicle.
(c)
Secure a written
attestation from the individual or the individual's parent or guardian, as
applicable, that the vehicle to be modified is the individual's primary means
of transportation.
(d)
When the vehicle to be modified is used, obtain a
written statement from an automotive service excellence-certified professional
that the vehicle is in good operating condition.
(e)
Secure
documentation necessary to establish the vehicle owner has liability insurance
and collision insurance for the vehicle to be modified.
(f)
Obtain at least
two quotes from department-certified providers of vehicle modification that
meet the individual's needs as identified in the assessment described in
paragraph (D)(3)(a) of this rule and include an itemized list of materials and
labor with associated costs.
(4)
A provider of
vehicle modification will:
(a)
Comply with all federal, state, and local regulations
that apply to vehicle modification or operation of the provider's business or
trade.
(b)
Provide a written warranty against defective
workmanship lasting at least one year from the date of final acceptance of the
work.
(c)
Provide a written statement that all materials
furnished and installed perform their advertised function.
(5)
A
provider of vehicle modification may not be the owner of the vehicle being
modified.
(E)
Documentation of services
Service documentation for vehicle modification will include each of the following to validate payment for medicaid services:
(1)
Type of service.
(2)
Date of
service.
(3)
Name of individual receiving service.
(4)
Medicaid
identification number of individual receiving service.
(5)
Name of
provider.
(6)
Provider identifier/contract number.
(7)
Year, make,
model, and vehicle identification number of the vehicle
modified.
(8)
A description of the work performed including a drawing
or diagram of the adaptation or alteration made and an itemized list of
materials and labor with associated costs.
(9)
Written or
electronic signature of the person delivering the
service.
(F)
Payment standards
(1)
The billing unit,
service codes, and payment rate for vehicle modification are contained in the
appendix to this rule.
(2)
The department will process payment for vehicle
modification following verification by the county board that the vehicle
modification meets the requirements specified in the approved individual
service plan, the vehicle modification is satisfactorily completed, and the
vehicle modification complies with applicable federal, state, and local
regulations.
(3)
Payment for vehicle modification will not exceed ten
thousand dollars per waiver eligibility span unless the county board documents
the need for an exception in accordance with paragraph (F)(4) of this
rule.
(4)
When the cost of needed vehicle modification exceeds
ten thousand dollars per waiver eligibility span, the department and the county
board will collaborate with the individual and the individual's team to ensure
the individual's health and welfare needs are met either through waiver funding
or non-medicaid funds. When waiver funding is necessary, the county board will
submit documentation to the department establishing how the vehicle
modification will ensure the individual's health and welfare.
Notes
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.049, 5123.1611
Rule Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
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