048-44 Wyo. Code R. § 44-6

Current through April 27, 2019

Section 44-6 - Environmental Modifications Approval Process

(a) The plan of care team may request environmental modifications during the six-month or annual plan of care meeting. Environmental modification requests submitted at other times during the plan of care year may be submitted if significant health, safety, or access concerns are identified.

(b) When the plan of care team identifies an environmental concern or need, the Case Manager shall submit the following information to the Division for the overall scope of the project:

(i) A description of the environmental concern or need;

(ii) Based on an assessment from an occupational or physical therapist, a description of how the environmental concern is related to the participant's diagnosed disability; and

(iii) How addressing the environmental concern will:
- (A) Contribute to the participant's ability to remain in, or return to, his or her home;
- (B) Increase the participant's independence;
- (C) Address the participant's accessibility concerns; and
- (D) Address health and safety needs of the participant.

(c) The Case Manager shall work with the participant or legally authorized representative to identify two certified environmental modification providers and contact the providers to obtain quotes. Quotes shall include:

(i) A detailed description of the work to be completed, including drawings or pictures when appropriate;

(ii) An estimate of the material and labor needed to complete the job, including costs of clean up;

(iii) An estimate for building permit, if needed;

(iv) An estimated timeline for completing the job;

(v) Name, address, and telephone number of the provider; and

(vi) Signature of the provider.

(d) The Case Manager shall submit the service authorization section of the individualized plan of care to the Division, including:

(i) The assessment completed by the professional team or the written approval from the Division to proceed with quotes; and

(ii) Two (2) quotes completed by certified environmental modification providers.
- (A) If two quotes cannot be obtained, the Case Manager shall include an explanation as to why only one quote was submitted.
- (B) The Division may review any request that does not include more than one quote.

(e) The Division may schedule an on-site assessment of the environmental concern including an evaluation of functional necessity with appropriate professionals under contract with the Division. To ensure cost effectiveness, the Division may use a third party to assess the proposed modification, and need for the modification. The assessment shall include:

(i) A statement verifying that the request meets at least two (2) of the criteria pursuant to Section 5(a) of this Chapter; and

(ii) A description of the modification that will address the environmental concern, including the minimum quality and quantity of material needed, and estimated cost range for modification.

(f) The Division shall notify the participant and Case Manager of the approval, including which quote was approved.

(i) Modifications shall be completed by the date stated in the individualized plan of care unless otherwise authorized by the Division.

(ii) If the cost of a modification increases due to a significant change in costs of material, the Case Manager shall submit a revised quote detailing the change in cost.

(iii) The Case Manager shall not give copies of the individualized plan of care to the environmental modification provider. The environmental modification provider shall receive a copy of the approved service authorization printout.

(g) Upon completion of the environmental modification, the provider shall have the homeowner sign the original quote verifying that the modification is complete.

(i) The environmental modification provider shall submit the signed quote to the participant's Case Manager.

(ii) If the homeowner has concerns with the modification, they shall contact the Case Manager. The Case Manager shall inform the Division of the concerns.

(iii) The Division or its representative agent shall complete an on-site review of the modification to determine if it is completed as described in the original quote.

(h) The Division or its representative agent may conduct on-site visits or any other investigations deemed necessary prior to approving or denying the request for an environmental modification.

(i) The Division reserves the right to deny requests for environmental modifications that are not within usual and customary charges or industry standards.

(j) Relative providers, including parents and stepparents, may also become certified to provide this service in accordance with Chapter 45 of the Department of Health's Medicaid Rules. If a relative provider quotes an environmental modification, the Case Manager shall always include one (1) other quote from a non-relative environmental modification provider.

(k) In accordance with Chapter 45 of the Department of Health's Medicaid Rules, provider agencies shall be certified by the Division to provide Environmental Modifications prior to providing the service.

(l) There is a lifetime cap of $20,000 for environmental modifications per family, regardless of waiver. Cap begins for purchases made after July 1, 2013 on previous Wyoming Waivers. Critical health or safety service requests that exceed the lifetime cap are subject to available funding and approval by the Extraordinary Care Committee.

048-44 Wyo. Code R. § 44-6

Amended, Eff. 6/21/2017.

Amended, Eff. 7/26/2018.