10 Colo. Code Regs. § 2505-10-8.7554

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

Section 10 CCR 2505-10-8.7554 - Vehicle Modifications

8.7554.AVehicle Modifications Eligibility

1. Vehicle Modifications is a covered benefit available to Members enrolled in one of the following HCBS waivers:

a. Children's Extensive Support Waiver

b. Supported Living Services Waiver

8.7554.BVehicle Modifications Definition

1. Vehicle Modifications means adaptations or alterations to an automobile that are:

a. The Member's primary means of transportation.

b. To accommodate the needs of the Member, as a result of the Member's disability and shall not be approved if the need is a typical age-related need.

c. Are necessary to enable the Member to integrate more fully into the community and to ensure the health and safety of the Member.

8.7554.CVehicle Modifications Inclusions

1. Vehicle Modifications is authorized for Organized Health Care Delivery System (OHCDS).

2. Upkeep and maintenance of the modifications to the vehicle are allowable services.

8.7554.DVehicle Modifications Exclusions and Limitations

1. Items and services specifically excluded from reimbursement under the HCBS waivers include:

a. Adaptations or improvements to the vehicle that are not of direct medical or remedial benefit to the Member;

b. Purchase or lease of a vehicle; and

c. Typical and regularly scheduled upkeep and maintenance of a vehicle.

8.7554.EVehicle Modifications Case Management Agencies Responsibilities

1. The total cost of Home Accessibility Adaptations, Vehicle Modifications, and Assistive Technology shall not exceed 10,000 dollars over the five (5) year life of the HCBS waiver without an exception granted by the Department:

a. The Case Manager may approve Vehicle Modifications when the total cumulative cost is under $10,000 for the cost of Home Modifications, Vehicle Modifications and Assistive Technology.

b. For modifications with a cumulative total over $10,000, the Case Manager shall obtain approval by submitting a request to the Department.

i. The Case Manager shall obtain all supporting documentation according to department prescribed processes and procedures.

ii. An occupational or physical therapist (OT/PT) shall assess the Member's needs and the therapeutic value of the requested Vehicle Modification. When an OT/PT with experience in Vehicle Modification is not available, a qualified individual may be substituted, with Department approval.

iii. The Case Manager shall obtain at least two bids for the necessary work. If the Case Manager has made three attempts to obtain a written bid from a Provider Agency and the Provider Agency has not responded within thirty (30) calendar days, the Case Manager may request approval of one bid.

2. Requests for costs that exceed a Member's cumulative allotment of $10,000 over the five-year life of the HCBS waiver may be approved by the Department if it:

a. Ensures the health and safety of the Member;

b. Enables the Member to function with greater independence within the community; or

c. Decreases the need for paid assistance in another HCBS waiver service on a long-term basis.

3. Case Management Agency approval for a higher amount shall include a thorough review of the current request as well as past expenditures to ensure cost effectiveness, prudent purchases and no unnecessary duplication.

8.7554.FVehicle Modifications Provider Agency Reimbursement

1. The total cost of Home Accessibility Adaptations, Vehicle Modifications, and Assistive Technology shall not exceed $10,000 dollars over the five year life of the HCBS waiver without an exception granted by the Department.

2. Vehicle Modifications that have been completed prior to approval will not be reimbursed.

10 CCR 2505-10-8.7554

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

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