NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Environmental Modifications/Adaptive Equipment
PAGE: 1 of 2
MANUAL: Clinical
SECTION: Miscellaneous
ORIGINAL EFFECTIVE DATE: 8/17/01
BOARD APPROVAL DATE: 9/26/13
REVIEWED/REVISED ON DATE: 4/16/15
CURRENT EFFECTIVE DATE: 5/1/13
REVISIONS TO POLICY STATEMENT:
YES
NO
OTHER REVISIONS:
YES
NO
APPLIES TO:
This policy applies to all eligible service recipients of Northpointe.
POLICY:
Northpointe Behavioral Healthcare Systems recognizes that physical adaptations to an individual’s home may be
required to ensure the health, welfare and safety of the individual while promoting greater independence.
PURPOSE:
All eligible service recipients of Northpointe Behavioral Healthcare Systems will be afforded the covered
service/support of environmental modifications that are within reason and are necessary to ensure the health,
welfare and safety of the individual, in the least restrictive environment.
DEFINITIONS:
1)
Eligible individual: An open NBHS service recipient who has Medicaid as their payor source.
2)
Environmental Modifications: Physical adaptations to the home and/or work place, required by the
individual’s support plan, that are necessary to ensure the health, safety and welfare of the individual,
or enabling him/her to function with greater independence within the environment(s).
PROCEDURES:
1.
Physical adaptations will be identified and supported through the person-centered planning
process and the appropriate specialized assessments. A physician’s order is required for all
modifications and for each adaptive equipment/service.
2.
The Care Manager or Specialty Discipline must complete Admin 180 Individual
prescription/Purchase Request form. The clinician then researches alternative funding sources
and forwards the form to their Supervisor. Once the Supervisor approves the form is
forwarded to the Finance Dept. The CFO will then approve and forward to the Contract
manager who will ensure the authorization is in ELMER and obtain the physician prescription.
3.
The Care Manager will document all other avenues for payment of the modifications; have
been exhausted (i.e. DHS, local service groups).
4.
Adaptations may include:
- The installation of ramps and grab bars.
- Widening of doorways
- Modification of bathroom facilities
- Installation of specialized electric and plumbing systems that are necessary to accommodate
the medical equipment and supplies necessary for the welfare of the individual.
Adaptations or improvements to the home that are not of direct medical or habilitative benefit
to the individual (e.g. carpeting and room repair) are not included. Adaptations or
improvements will be completed “once in a lifetime”. Central air conditioning is included
only when prescribed by a physician and specified with extensive documentation in the
support plan as to how it is essential in the treatment of the individual’s illness or condition.
This supporting documentation must demonstrate the cost effectiveness of central air
compared to the cost of window units in all rooms that participant must use.
Environmental modifications for licensed settings includes only the remaining balance of
previous environmental modification costs that accommodate the specific needs of current Hab
NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: Environmental Modifications/Adaptive Equipment
PAGE: 2 of 2
MANUAL: Clinical
SECTION: Miscellaneous
ORIGINAL EFFECTIVE DATE: 8/17/01
BOARD APPROVAL DATE: 9/26/13
REVIEWED/REVISED ON DATE: 4/16/15
CURRENT EFFECTIVE DATE: 5/1/13
Waiver participants, and will be limited to the documented portion being amortized in the
mortgage, or the lease cost per bed. Environmental modifications exclude the cost of
modifications required for basic foster care licensure or to meet local building codes.
Adaptations to the work environment are limited to those necessary to accommodate the
person’s individualized needs, and cannot be used to supplant the requirements of Section 504
of the Rehabilitation Act or the Americans with Disabilities Act.
All services must be provided in accordance with applicable state or local building codes.
Adaptations cannot result in valuation of the structure significantly above comparable
neighborhood real estate values.
Assessments and specialized training needed in conjunction with the use of such
environmental modifications are included as a part of the cost of the service.
5.
NBHS may opt to place a lien against the home when costly modifications are constructed.
6.
All adaptive equipment purchased by NBHS, will be property of NBHS and must be returned
when it is no longer necessary.
7.
Any modification costing over $5000 must go through the competitive bidding process as
outlined in NBHS policy.
8.
If a modification to an individual’s dwelling costs more than $5000, and the owner sells the
home within 5 years or the useful life of the modification, a prorated payment back to NBHS
will be enforced as follows:
0 – 1 year = 80% return
2 – 3 years = 60% return
3 – 5 years = 40% return
9.
Individual/guardian agrees to these terms by signing NBHS Form Cl.150.
10.
Routine maintenance or repair and/or cost of operating environmental modifications/adaptive
equipment (i.e. electricity to operate air conditioning) are the responsibility of the
individual/guardian.
CROSS REFERENCE:
NBHS Form Admin 180 Individual prescription/Purchase Request form
NBHS Form Cl.150 Adaptive Equipment/ Environmental Modifications Agreement form
MDCH/CMHSP Managed Mental Health Supports and Services contract
Medicaid Provider Manual
NBHS Policy: Procurement