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Environmental Accessibility Modifications

Environmental Accessibility Modifications shall only mean the following modifications to the waiver participant’s place of residence:

a.   Physical modifications to the interior of a waiver participant’s place of residence to increase the waiver participant’s mobility and accessibility within the residence;

b.   Physical modifications to an existing exterior doorway of the waiver participant’s place of residence to increase the waiver participant’s mobility and accessibility for entrance into and exit from the residence;

c.   A wheelchair ramp and modifications directly related to, and specifically required for, the construction or installation of the ramp; or as an alternative to a wheelchair ramp, a platform lift (to lift wheelchairs) and modifications directly related to, and specifically required for, the installation of a platform lift for one entrance into the residence;

d.   Hand rails for exterior stairs or steps to increase the waiver participant’s mobility and accessibility for entrance into and exit from the residence; or

e.   Replacement of glass window panes with a shatterproof or break-resistant material when medically necessary based on a history of destructive behavior by the waiver participant.

The following are specifically excluded from coverage:

a.   Any adaptation or modification of the home which is of general utility and is not of direct medical or remedial benefit to the waiver participant;

b.   Any adaptation or modification which is considered to be general maintenance of the residence;

c.   Any physical modification to the exterior of the waiver participant’s place of residence or lot (e.g., driveways, sidewalks, fences, decks, patios, porches) that is not explicitly listed above as being covered;

d.   Any physical modification to garage doors for entry of vehicles;

e.   Any item that would be covered by the Medicaid State Plan/TennCare Program;

f.    Construction of an additional room or modification of an existing room which increases the total square footage of the residence;

g.   Construction of a new room within existing floor space (e.g., construction of an additional bathroom), including construction of new interior walls to subdivide existing rooms;

h.   A second or additional wheelchair ramp when there is a functional wheelchair ramp for one entrance into the waiver participant’s residence;

i.    A wheelchair ramp when there is a functional platform lift (to lift wheelchairs) for one entrance into the waiver participant’s residence; or a platform lift for entrance into the waiver participant’s residence when there is a functional wheelchair ramp for one entrance into the residence;

j.    Platform lifts for use inside the waiver participant’s place of residence;

k.   Stairway lifts, stair glides, or elevators or the installation, repair, or replacement of stairway lifts, stair glides, or elevators;

l.    Repair or replacement of roofing or siding;

m.  Installation, repair, replacement, or painting of ceiling, walls, or floors or installation, repair, or replacement of carpet or other flooring except:

(1)  When the need for such is directly related to and necessitated by another approved environmental accessibility modification (e.g., flooring or carpet repair when a doorway is widened); and

(2)  When the cost of such is included in the cost of the other approved environmental accessibility modification;

n.   Rugs and floor mats;

o.   Furniture, lamps, beds, mattresses, bedding, and overbed tables;

p.   Water purifiers, air purifiers, vaporizers, dehumidifiers, and humidifiers;

q.   Air conditioning or heating systems or units or the installation, repair, or replacement of air conditioning or heating systems or units;

r.    Electrical generators; emergency electrical backup systems; batteries, or battery chargers;

s.    Installation, repair, or replacement of electrical units or systems, except for the installation or replacement of electrical outlets which will be used for medical equipment;

t.    Lights or lighting systems or the installation, repair, or replacement of lights or lighting systems; except for the installation or replacement of lights when the need for such is directly related to and necessary in order to complete another approved environmental accessibility modification;

u.   Construction of additional exterior doorways or windows;

v.   Any item that meets the waiver service definition of Specialized Medical Equipment, Supplies, and Assistive Technology;

w.  Sprinklers and sprinkler systems; and

x.   Costs for removing an Environmental Accessibility Modification in order to convert or otherwise restore the place of residence to its pre-existing condition (i.e., the condition before the modification was made).

Environmental Accessibility Modifications shall be recommended by a qualified health care professional (e.g., physician, occupational therapist, physical therapist).

To facilitate community transition of a Medicaid eligible person residing in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) or other institutional setting who has been determined to qualify for HCBS waiver services upon discharge, Environmental Accessibility Modifications may be made to the waiver participant’s place of residence during the last 180 consecutive days of the person’s institutional stay prior to being discharged and enrolled in the waiver.  In such cases, the Environmental Accessibility Modification will not be considered complete until the date the person leaves the ICF/IID or other institutional setting and is enrolled in the waiver, and such date shall be the date of service for billing purposes.

Environmental Accessibility Modifications shall be available only for newly enrolled waiver participants, including (but not limited to) persons transitioning to the community from an institutional setting, and existing waiver participants who have recently experienced a significant loss of mobility function.

Environmental Accessibility Modifications shall be limited to a maximum of $15,000 per waiver participant per three (3) consecutive waiver program years.

Reimbursement shall be subject to approval of an itemized competitive bid as required in accordance with the department’s policy on submission of bids.  If the requirement for an itemized competitive bid is applicable, documentation of an approved bid must be submitted with the request for an Environmental Accessibility Modification or the request will be denied.

If the waiver participant does not own the place of residence, there must be written approval from the landlord for the Environmental Accessibility Modification to be approved.  Such written approval must acknowledge that the waiver participant will not be responsible for the costs of removing an Environmental Accessibility Modification in order to convert or otherwise restore the place of residence to its pre-existing condition.

Applicable limits, if any, on the amount, frequency, or duration of this service:

Environmental Accessibility Modifications shall be limited to a maximum of $15,000 per waiver participant per three (3) consecutive waiver program years

 

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