1914 VEHICLE MODIFICATION SERVICES

1914.1 This section establishes the conditions for Medicaid providers of vehicle modification services enumerated in § 1914.7 (“Medicaid Providers”) to provide vehicle modification (VM) services to persons enrolled in the Home and Community-Based Services Waiver for Persons with Intellectual and Developmental Disabilities (ID/DD).

1914.2 VM services are physical adaptations or modifications to a vehicle, including the installation of a lift or other physical adaptations to make the vehicle accessible to the person, or to enable the person to drive the vehicle.

1914.3 In order to be eligible for reimbursement, each Medicaid provider must obtain prior authorization from the Department on Disability Services (DDS) before providing VM services. The request for prior authorization shall include a written justification demonstrating how the services will help the person to function with greater independence and increase his/her access to the community. The vehicle being serviced shall be owned by the person or the person’s family, guardian, or other primary caretaker who is not providing Residential Habilitation Services, Supported Living Services or Supported Living Services with Transportation.

1914.4 Medicaid reimbursable VM services shall consist of one of the following modifications or adjustments:

1. (a) Hydraulic lifts;
2. (b) Access ramps;
3. (c) Modified doors;
4. (d) Modified seating;
5. (e) Installation of equipment to secure a wheelchair or installing another assistive technology device; or
6. (f) Installation of equipment to make access, egress, or travel more comfortable, safe and secure.

1914.5 VM services shall include instruction in the use of the adapted vehicle.

1914.6 VM services shall be provided consistent with any stipulations or recommendations from the dealer of the vehicle's make and model.

1914.7 Each provider of Medicaid reimbursable VM services shall:

(a) Be an approved home and community based waiver services provider;

(b) Comply with Section 1904 (Provider Qualifications) and Section 1905 (Provider Enrollment Process) of Chapter 19 of Title 29 DCMR;

(c) Demonstrate knowledge in meeting applicable standards of installation, repair, and maintenance of vehicle adaptations and shall also be authorized by the manufacturer to install, repair, and maintain such systems where possible; and

(d) Have a current license, certification, or registration with the District of Columbia as appropriate for the services being purchased; and comply with all applicable business licensing requirements in the District of Columbia or in the jurisdiction where VM services are provided.

1914.8 Before receiving approval to deliver VM services, the provider of VM services shall perform an evaluation which:

(a) Confirms that the vehicle is structurally sound;

(b) Confirms that the vehicle can accommodate the proposed VM services;

(c) Recommends the installation process for delivering VM services; and

(d) Identifies the need for training after installation of the modification or physical adaptation.

1914.9 Before pre-authorization of any VM services, the vehicle owner shall submit at least two (2) written bids from providers for the service to the DDS service coordinator for comparison, in order to determine the most cost efficient use of Medicaid waiver funding for the service.

1914.10 Services shall only be authorized for reimbursement in accordance with the following provider requirements:

(a) The amount and cost of services to be received shall be documented in the ISP, Plan of Care and Summary of Supports and Services; and

(b) VM services shall not conflict with the service limitations described under Section 1914.17.

1914.11 Each provider of VM services shall maintain the following documents for monitoring and audit reviews:

1. (a) A written evaluation in accordance with the service requirements described under Section 1914.8;
2. (b) An itemized list describing the specific expenditures or purchases related to the physical adaptation or modification to the vehicle for which reimbursement is claimed;
3. (c) Receipts or copies of receipts verifying the specific expenditures or purchases for which reimbursement is claimed; and
4. (d) Any stipulation or recommendations from the dealer pertaining to the vehicle's make and model related to the provision of VM services.1914.12 Medicaid reimbursable VM services shall be available for modification of no more than two (2) vehicles over the course of five (5) years and shall not exceed a total of ten thousand dollars (\$10,000), unless the person receives service authorization from DDS through the exception process in § 1914.13.1914.13 Exceptions to the ten thousand dollars (\$10,000) limit and/or the two (2) vehicle limit over the course of five (5) years may be approved by DDS on a case-by-case basis by the DDS Medicaid Waiver Supervisor or a designated Developmental Disabilities Administration (DDA) staff member for persons who demonstrate need. The request for exception must be in writing and must specify the amount requested above the \$10,000 limit; describe the demonstrated need for the exception; and include supporting documentation.1914.14 In order to be eligible for Medicaid reimbursement, vehicle modifications shall not include the cost of the vehicle to be modified or the rental costs of vehicles with modifications or adaptations for use by the person.1914.15 The purchase or installation of car seats are not considered a vehicle modification and shall not be reimbursed by the Medicaid program.1914.16 Medicaid reimbursable VM services shall exclude any maintenance or repairs to the vehicle.1914.17 Medicaid reimbursable VM services shall not be provided to those persons receiving residential supports through Residential Habilitation, Supported Living, or Supported Living with Transportation.

SOURCE: Final Rulemaking published at 55 DCR 2290 (March 7, 2008); as amended by Final Rulemaking published at 61 DCR 2108 (March 14, 2014); as amended by Final Rulemaking published at 62 DCR 15321 (November 27, 2015).