10 Colo. Code Regs. § 2505-10-8.7525

Current through Register Vol. 47, No. 24, December 25, 2024

Section 10 CCR 2505-10-8.7525 - Home Accessibility Modifications and Adaptations

8.7525.AHome Accessibility Modifications and Adaptations Eligibility

1. Home Accessibility Modifications and Adaptations is a covered benefit available to Members enrolled in one of the following HCBS waivers:

a. Brain Injury Waiver

b. Children's Extensive Support Waiver

c. Community Mental Health Supports Waiver

d. Complementary and Integrative Health Waiver

e. Elderly, Blind, and Disabled Waiver

f. Supported Living Services Waiver

8.7525.BHome Accessibility Modifications and Adaptations Definitions

1. The Division of Housing (DOH) is a State entity within the Department of Local Affairs that is responsible for approving Home Modification requests oversight on the quality of Home Modification projects, and inspecting Home Modification projects, as described in

2. Eligible Member means a Member who is enrolled in the following Home and Community-Based Services waivers: Brain Injury, Complementary and Integrative Health, Community Mental Health Supports, or Elderly, Blind and Disabled, Supported Living Services (SLS) and Children's Extensive Supports (CES).

3. Home Modification means specific modifications, adaptations or improvements in an eligible Member's existing home setting which, based on the Member's medical condition:

a. Are necessary to ensure the health, welfare and safety of the Member and

b. Enable the Member to function with greater independence in the home, and

c. Are required because of the Member's illness, impairment or disability, as documented on the Assessment and Person-Centered Support Plan; and

d. Prevents institutionalization or supports the deinstitutionalization of the Member.

8.7525.CHome Accessibility Modifications and Adaptations Inclusions

1. Home Modifications, adaptations, or improvements may include but are not limited to the following:

a. Installing or building ramps.

b. Installing grab-bars and installing other Durable Medical Equipment (DME) items if such installation shall not be performed by a DME supplier.

c. Widening doorways.

d. Modifying a bathroom facility for the purposes of accessibility, health and safety, and independence in Activities of Daily Living.

e. Modifying kitchen facilities.

f. Installing specialized electric and plumbing systems that are necessary to accommodate medically necessary equipment and supplies.

g. Installing stair lifts or vertical platform lifts.

h. Modifying an existing second exit or egress window for emergency purposes.

i. The modification of a second exit or egress window must be approved by the Department, or its agent as recommended by an occupational or physical therapist (OT/PT) for the health, safety, and welfare of the Member.

2. Previously completed home modifications, regardless of original funding source, shall be eligible for maintenance or repair within the remaining balance of the Member's lifetime cap for home modifications while remaining subject to Section 8.7525.C.

a. There shall be a lifetime cap as determined by the Department per Member. The Department may authorize funds in excess of the Member's lifetime cap if there is:

i. An immediate risk of the Member being institutionalized; or

ii. A significant change in the Member's needs since a previous home modification.

3. HCBS Supported Living Services (SLS) and Children's Extensive Services (CES) Waivers:

a. The combined cost of Home Accessibility Adaptations, Vehicle Modifications, and Assistive Technology shall not exceed the cap determined by the Department per Member.

b. Costs that exceed this cap may be approved by the Department or DOH to ensure the health, and safety of the Member, or enable the Member to function with greater independence in the home, if:

i. The adaptation decreases the need for paid assistance in another waiver service on a long-term basis, and

ii. Either:

1) There is an immediate risk to the Member's health or safety, or

2) There has been a significant change in the Member's needs since a previous Home Accessibility Adaptation.

8.7525.DHome Accessibility Modifications and Adaptations Exclusions and Limitations

1. Home Modifications must be a direct benefit to the Member and not for the benefit or convenience of caregivers or other residents of the home.

2. Duplicate adaptations, improvements, or modifications are not a benefit. This includes, but is not limited to, multiple bathrooms within the same home.

3. Adaptations, improvements, or modifications as a part of new construction costs are not a benefit.

a. Finishing unfinished areas in a home to add to or complete habitable square footage is prohibited.

b. Adaptations that add to the total square footage of the home are excluded from this benefit except when necessary to complete an adaptation to:

i. improve entrance or egress to a residence; or,

ii. configure a bathroom to accommodate a wheelchair.

c. Any request to add square footage to the home must be approved by the Department or DOH and shall be prior authorized in accordance with Department procedures.

4. The purchase of items available through Durable Medical Equipment (DME) is not a benefit.

5. The following items are specifically excluded from Home Accessibility Adaptations and shall not be reimbursed:

a. Roof repair,

b. Central air conditioning,

c. Air duct cleaning,

d. Whole house humidifiers,

e. Whole house air purifiers,

f. Installation and repair of driveways and sidewalks, unless the most cost-effective means of meeting the identified need,

g. Monthly or ongoing home security monitoring fees,

h. Home furnishings of any type,

i. HOA fees,

j. Walk-In Tubs.

k. Adaptations or improvements to the home that are considered to be on-going home repair or maintenance and are not related to the Member's ability and needs are prohibited.

l. Upgrades beyond what is the most cost-effective means of meeting the Member's identified need, including, but not limited to, items or finishes required by a Homeowner Association's (HOA), items for caregiver convenience, or any items and finishes beyond the basic required to meet the need, are prohibited.

6. The Department may deny requests for Home Modification projects that exceed usual and customary charges or do not meet local building requirements, the Long-Term Services and Supports Home Modification Benefit Construction Specifications developed by the Division of Housing (DOH), or industry standards.

7. Home Modification projects are prohibited in any Provider -Owned or -Controlled setting.

8. Volunteer work on a Home Modification project approved by the Department shall be completed under the supervision of the Home Modification Provider Agency as stated on the bid.

a. Volunteer work performed by Department-approved organizations must be described according to Department prescribed processes and procedures. A list of these organizations may be found on the Department website.

b. Work performed by an unaffiliated party, such as, but not limited to, volunteer work performed by a friend or Family Member, or work performed by a private contractor hired by the Member or family, must be described and agreed upon, in writing, by the Provider Agency responsible for completing the home modification, according to Department prescribed processes and procedures and must be approved by the Department.

9. If a Member lives in a property where adaptations, improvements, or modifications as a reasonable accommodation through federally funded assisted housing are required by the Fair Housing Act, the Member's Home Modification funds may not be used unless reasonable accommodations have been denied.

8.7525.EHome Accessibility Modifications and Adaptations Case Management Agency Responsibilities

1. The Case Manager shall consider alternative funding sources to complete the Home Modification. These alternatives and the reason they are not available shall be documented in the case record.

a. The Case Manager must confirm that the Member is unable to receive the proposed adaptations, improvements, or modifications as a reasonable accommodation through federally funded assisted housing as required by the Fair Housing Act.

2. The Case Manager may approve Home Modification projects estimated at less than $2,500 without Department approval, contingent on Member authorization and confirmation of Home Modification fund availability.

3. The Case Manager shall obtain prior approval by submitting a prior request to the Department for Home Modification projects estimated to cost over $2500.

a. The Case Manager must submit the request and all supporting documentation according to Department prescribed processes and procedures. Home Modification requests submitted with improper documentation cannot be authorized.

b. The Case Manager and Case Management Agency are responsible for retaining and tracking all documentation related to a Member's previous home modification benefit lifetime use and communicating that information to the Member and Provider Agencies. The Case Manager may request confirmation of a Member's home modification use from the Department, its fiscal agent, or Division of Housing.

4. Home Modifications estimated to cost $2,500 or more shall be evaluated according to the following procedures:

a. An occupational or physical therapist (OT/PT) shall assess the Member's needs and the therapeutic value of the requested Home Modification. When an OT/PT with experience in Home Modification is not available, a Department-approved qualified individual may be substituted. An evaluation specifying how the Home Modification would contribute to a Member's ability to remain in or return to their home, and how the Home Modification would increase the individual's independence and decrease the need for other services, shall be completed before bids are solicited. This evaluation shall be submitted with the Home Modification request.

b. The evaluation services may be provided by a home health Agency or other qualified and approved OT/PT through the Medicaid Home Health benefit consistently with Home Health rules set forth in Section 8.520, including physician orders and plans of care.

i. A Case Manager may initiate the OT/PT evaluation process before the Member has been approved for Waiver Services, as long as the Member is Medicaid Eligible.

ii. A Case Manager may initiate the OT/PT evaluation process before the Member physically resides in the home to be modified, as long as the current property owner agrees to the evaluation.

c. The Case Manager and the OT/PT shall consider less expensive alternative methods of addressing the Member's needs.

5. The Case Manager shall solicit bids according to the following procedures:

a. The Case Manager shall solicit bids from at least two Home Modification Provider Agencies.

i. The Case Manager must verify that the provider is an enrolled Home Modification Provider Agency.

ii. The bids must be submitted according to Department prescribed processes and procedures.

b. The bids shall include a breakdown of the costs of the project including:

i. Description of the work to be completed.

ii. Description and estimate of the materials and labor needed to complete the project. Material costs should include price per square foot for materials purchased by the square foot. Labor costs should include price per hour.

iii. Estimate for building permits, if needed.

iv. Estimated timeline for completing the project.

v. Name, address, and telephone number of the Home Modification Provider Agency.

vi. Signature, including option for digital signature, of the Home Modification Provider Agency.

vii. Signature, including option for digital signature, of the Member or Guardian or other indication of approval.

viii. Signature, including option for digital signature, of the homeowner or property manager if applicable.

c. Home Modification Provider Agencies have a maximum of 30 days to submit a bid for the Home Modification project after the Case Manager has solicited the bid.

i. If the Case Manager has made three attempts to obtain a written bid from a Home Modification Provider Agency and the Home Modification Provider Agency has not responded within 30 calendar days, the Case Manager may request approval of one bid. Documentation of the attempts shall be attached to the Home Modification request.

d. The Case Manager shall submit copies of the bid(s) and the OT/PT evaluation to the Department or its agent. The Department or its agent shall authorize the lowest bid that complies with the requirements of Section 8.7525 and the recommendations of the OT/PT evaluation.

i. If a Member or homeowner requests a bid that is not the lowest of the submitted bids, the Case Manager shall request approval by submitting a written explanation with the Home Modification request.

e. A revised bid and Change Order request shall be submitted according to the procedures described in this section for any changes from the original approved Prior Authorization Request (PAR) according to Department prescribed processes and procedures.

6. If a property to be modified is not owned by the Member, the Case Manager shall obtain signatures from the homeowner or property manager on the submitted bids authorizing the specific modifications described therein. Signatures may be completed using a digital signature based on preference of the individual signing the form.

a. Written consent of the homeowner or property manager, as evidenced by the above- mentioned signatures, is required for all projects that involve permanent installation within the Member's residence or installation or modification of any equipment in a common or exterior area.

b. If the Member vacates the property, these signatures can be used as evidence that the homeowner or property manager agrees to allow the Member to leave the modification in place or remove the modification as the Member chooses. If the Member chooses to remove the modification, the property must be left equivalent or better to its pre-modified condition. The homeowner or property manager may not hold any party responsible for removing all or part of a home modification project.

7. If the Case Management Agency does not comply with the process described above resulting in increased cost for a home modification, the Department may hold the Case Management Agency financially liable for the increased cost.

8. The Department or its agent may conduct on-site visits, or any other investigations deemed necessary prior to approving or denying the Home Modification request.

8.7525.FHome Accessibility Modifications and Adaptations Provider Agency Requirements

1. Home Modification Providers Agencies shall conform to Provider Agency regulations set forth in Section 8.7400.

2. Home Modification Provider Agencies shall be licensed in the city or county in which they propose to provide Home Modification services to perform the work proposed, if required by that city or county.

3. Home Modification Provider Agencies shall begin work within 60 days of signed approval from the Department. Upon request by Provider Agency, the the Division of Housing or the Department may grant an extension for circumstances outside of the Provider Agencies' control. Requests must be received prior to the expiration of the 60-day deadline and be supported by documentation, including Member notification. Reimbursement may be reduced for delays in accordance with Section 8.7525.F.6.

a. If any changes to the approved scope of work are made without Department authorization, the cost of those changes will not be reimbursed.

b. Projects shall be completed within 30 days of beginning work. Upon request by a Provider Agency, the Division of Housing or the Department may grant an extension for circumstances outside of the Provider Agencies' control. Requests must be received prior to the expiration of the 30-day deadline and be supported by documentation, including Member notification. Reimbursement may be reduced for delays..

4. The Home Modification Provider Agency shall provide a one-year written warranty on materials and labor from the date of final inspection on all completed work and perform work covered under that warranty at their expense.

5. The Home Modification Provider Agency shall comply with the Long Term Services and Supports Home Modification Benefit Construction Specifications developed by the Division of Housing, which may be found on the Department website, and with local, and state building codes.

6. All Home Modification projects within a Department-established sampling threshold shall be inspected upon completion by Division Of Housing, a state, local or county building inspector or a licensed engineer, architect, contractor or any other person as designated by the Department. Home Modification projects may be inspected by Division Of Housing upon request by the Member at any time determined to be reasonable by DOH or the Department. Members must provide access for inspections.

a. Division Of Housing shall perform an inspection within 14 days of receipt of notification of project completion or receipt of a Member's reasonable request.

b. Division of Housing shall produce a written inspection report within three days of performing an inspection that notes the Member's specific Complaints. The inspection report shall be sent to the Member, Case Manager, and Provider Agency.

c. Home Modification Provider Agencies must repair or correct any noted deficiencies within 20 days, or the time required by the inspection, whichever is shorter. Upon request by the Provider Agency, the DOH or the Department may grant an extension for circumstances outside of the Provider Agencies' control. Requests must be received prior to the original deadline and be supported by documentation, including Member notification. Reimbursement may be reduced for delays in accordance.

7. Copies of building permits and inspection reports shall be submitted to Division of Housing. If a permit is not required, the Home Modification Provider Agency shall formally attest in their initial bid that a permit is not required. Incorrectly attesting that a permit is not required shall be justification for recovery of payment by the Department.

8.7525.GHome Accessibility Modifications and Adaptations Reimbursement

1. Payment for Home Modification services shall be the prior authorized amount, or the amount billed, whichever is lower. Reimbursement shall be made in two payments per Home Modification.

2. The Home Modification Provider Agency may submit a claim for an initial payment of no more than fifty percent of the project cost for materials, permits, and initial labor costs.

3. The Home Modification Provider Agency may submit a claim for final payment when the Home Modification project has been completed satisfactorily as shown by the submission of the documentation below to Division of Housing:

a. Signed lien waivers for all labor and materials, including lien waivers from subcontractors;

b. Required permits;

c. Photographs taken before and after the Home Modification has been completed;

d. One-year written warranty on materials and labor; and

e. Documentation in the Member's file that the Home Modification has been completed satisfactorily through:

i. Receipt of inspection report approving work from the building inspector or other inspector as referenced at Section 8.7525.F.6;

ii. Approval by the Member, Guardian, representative, or other designee;

iii. Approval by the homeowner or property manager; or

iv. By conducting an on-site inspection.

4. If Division of Housing notifies a Home Modification Provider Agency that an additional inspection is required, the Home Modification Provider Agency may not submit a claim for final payment until DOH has received documentation of a satisfactory inspection report for that additional inspection.

5. The Home Modification Provider Agency shall only be reimbursed for materials and labor for work that has been completed satisfactorily and as described on the approved Home Modification Provider Bid form or Home Modification Provider Change Order form.

a. All recommended repairs noted on inspections shall be completed before the Home Modification Provider Agency submits a final claim for reimbursement.

b. If a Home Modification Provider Agency has not completed work satisfactorily, Division of Housing shall determine the value of the work completed satisfactorily by the Provider Agency during an inspection. The Provider Agency shall only be reimbursed for the value of the work completed satisfactorily.

i. A Home Modification Provider Agency may request Division of Housing perform one redetermination of the value of the work completed satisfactorily. This request may be supported by an independent appraisal of the work, performed at the Provider Agency's expense.

6. Reimbursement may be reduced at a rate of 1% of the total project amount every 7 calendar days beyond the deadlines required for project completion, including correction of all noted deficiencies and inspection deficiencies.

a. Upon request by a Provider Agency, the Division of Housing or the Department may grant an extension for circumstances outside of the Provider Agency's control. Requests must be received within the original deadline period and be supported by documentation, including Member notification.

b. The Home Modification reimbursement reduced pursuant to this subsection shall be incorporated into the computation of the Member's remaining money.

7. The Home Modification Provider Agency shall not be reimbursed for the purchase of DME available as a Medicaid state plan benefit to the Member. The Home Modification Provider Agency may be reimbursed for the installation of Durable Medical Equipment if such installation is outside of the scope of the Member's Durable Medical Equipment benefit.

8. Work that was completed prior to Department approval is not eligible for reimbursement.

10 CCR 2505-10-8.7525

47 CR 03, February 10, 2024, effective 3/16/2024

47 CR 21, November 10, 2024, effective 11/30/2024