92-01-02-29.4. Home modifications.

1. An order is required from the primary health care provider with documentation of objective medical evidence that supports the necessity for home modifications directly due to the compensable work injury.

a. The order must be obtained and submitted to the organization prior to consideration of a home modification.

b. The order must include the date of an in-person office visit that coincides with the date of the order.

2. Prior to any home modifications, the organization shall complete a review to determine if the most appropriate assistive device is currently being utilized by an injured employee for the injured employee's functional needs. The review by the organization may require the following criteria:

a. A primary health care provider referral for a mobility assessment.

b. The mobility assessment must be performed by a licensed or certified occupational or physical therapist with specific training in rehabilitation mobility or functional evaluations.

c. The mobility assessment report must contain clear documentation of functional limits of standing and walking with an assistive device and have documentation to support how the other assistive devices were ruled out as not medically appropriate for functional needs.

3. If the appropriate assistive device is determined through the mobility assessment process, the organization may begin the review for home modification eligibility, if appropriate.

4. A primary health care provider shall make a referral for an in-home functional assessment to be completed in the home environment: a. The in-home functional assessment shall be performed by a licensed or certified occupational or physical therapist with specific training in rehabilitation mobility or functional evaluations. b. The in-home functional assessment must be completed in-person. Virtual assessments may be approved as determined by the organization. c. The in-home functional assessment report must contain documentation of the functional limitation the modification is addressing and the medical need for that modification.

5. The organization may request a minimum of two itemized cost quotes. The organization may decrease or add the number of cost quotes needed accordingly.

6. Actual construction or modification cannot occur until the organization reviews the request and issues recommendations or decisions as to eligibility for the benefit.

7. Payment by the organization may not occur until the modification work is completed, or at least, completed in documented phases or at the discretion of the organization.

8. The organization may request that the contractor for proposed home modification be in good standing (example: licensed in the state, bonded, etc.)

9. Real estate modifications to driveways, sidewalks, or passageways may be approved if evidence supports that those routes are needed to provide safe passageway for the injured employee.

10. Any appeal of a decision under this section must be adjudicated pursuant to North Dakota Century Code section 65-02-20.

11. Modifications will be considered upon receipt of documentation establishing injured employee's ownership of the residence to be permanently modified.

12. Modifications within new construction will be considered upon receipt of the original floor plan/specifications and cost estimate, as well as the modified floor plan and cost estimate.

History: Effective April 1, 2012; amended effective April 1, 2014; April 1, 2016; July 1, 2017; April 1, 2020; January 1, 2026.

Law Implemented: NDCC 65-05-07