Compendium of Home Modification and Assistive Technology Policy and Practice Across the States

Volume II: State Profiles (continued)



TABLE OF CONTENTS

MONTANA
Medicaid State Plan Coverage
EPH
Mentally Retarded/Developmentally Disabled
Developmental Disabilities Aged 18 and Older
NEBRASKA
Medicaid State Plan Coverage
Aged and Disabled Waiver
NEVADA
Medicaid State Plan Coverage
Home and Community-Based Wavier for the Physically Disabled
Waiver for the Frail Elderly
NEW HAMPSHIRE
Medicaid State Plan Coverage
Home and Community-Based Care for Developmentally Disabled
Home and Community-Based Care for the Elderly and Chronically Ill
Home and Community-Based Care for Acquired Brain Disorders
NEW JERSEY
Medicaid State Plan Coverage
Traumatic Brain Injury Waiver
Community Resources for People with Disabilities Waiver
Personal Preference Program
Enhanced Community Options Waiver
Community Care Waiver
NEW MEXICO
Medicaid State Plan Coverage
Elderly and Disabled Waiver
Developmental Disabilities Home and Community-Based Waiver
NEW YORK
Medicaid State Plan Coverage
Aged and Disabled Waiver -- Long Term Home Health Care Program
Mental Retardation/Developmental Disability Waiver
Traumatic Brain Injury Waiver
NORTH CAROLINA
Medicaid State Plan Coverage
Community Alternatives Program for Disabled Adults
Community Alternatives Program for Persons with AIDS
Community Alternatives Program for Persons with Mental Retardation/Developmental Disability
1915(b)/(c) Consumer Directed Care for Behavioral Health-Innovations and Piedmont Cardinal Health Plan
NORTH DAKOTA
Medicaid State Plan Coverage
Aged and Disabled Waiver
Traumatic Brain Injury 18-64 Waiver
OHIO
Medicaid State Plan Coverage
Ohio Home Care Waiver
Transitions Waiver
PASSPORT Waiver
Choices Waiver
Independent Options Waiver
Level One Waiver
OKLAHOMA
Medicaid State Plan Coverage
Community Waiver
Advantage
In-Home Supports for Adults
Homeward Bound
OREGON
Medicaid State Plan Coverage
Waiver for Individuals with Developmental Disabilities
Seniors and People with Disabilities
Support Services Waiver for Adults
PENNSYLVANIA
Medicaid State Plan Coverage
Consolidated Waiver for Individuals with Mental Retardation
AIDS Waiver
OBRA Home and Community-Based Waiver
Attendant Care Waiver
Pennsylvania Department of Aging Waiver
Independence Home and Community-Based Waiver
Person/Family Directed Support Waiver
COMMCARE Waiver Program
Michael Dallas Waiver
Elwyn Waiver
RHODE ISLAND
Medicaid State Plan Coverage
Aged/Disabled Waiver
Department of Elderly Affairs Waiver
Mentally Retarded/Developmentally Disabled Waiver
People Actively Reaching Independence/Severely Handicapped Waiver
Assisted Living Waiver
Habilitation Waiver
SOUTH CAROLINA
Medicaid State Plan Coverage
Elderly and Disabled Waiver
Mental Retardation and Developmental Disabilities Waiver
Head and Spinal Cord Injury Waiver
Mechanical Ventilator Dependent Waiver
HIV/AIDS Waiver
South Carolina Choice Waiver
SOUTH DAKOTA
Medicaid State Plan Coverage
Elderly Waiver
Intermediate Care Facility for the Mentally Retarded Waiver
Family Support Program
TENNESSEE
Medicaid State Plan Coverage
Mental Retarded Waiver
Self-Determination Waiver Program
Mental Retardation Waiver
Elderly and Disabled Waiver
Adapt
Disabled Individuals over 21 Waiver
TEXAS
Medicaid State Plan Coverage
Consolidated Waiver Program
Home and Community-Based Waiver
Community Living Assistance and Supportive Services Program
Community-Based Alternatives
CBA-STAR+PLUS
Waiver for People with Deaf-Blindness and Multiple Disabilities
Consolidated Waiver Program
Texas Home Living Program
UTAH
Medicaid State Plan Coverage
Developmental Disabilities/Mental Retardation Waiver
Aged Waiver
Acquired Brain Injury Waiver
Nursing Facility Level of Care Waiver
VERMONT
Medicaid State Plan Coverage
1115 Vermont Global Commitment Waiver
1115 Choices for Care Medicaid Waiver
VIRGINIA
Medicaid State Plan Coverage
Mental Retardation Waiver
Elderly or Disabled with Consumer Direction Waiver Services
Individual and Family Developmental Disabilities Support Waiver
WASHINGTON
Medicaid State Plan Coverage
Medically Needy Residential Waiver
Medically Needy In-Home Waiver
Community Options Program Entry System Waiver
Basic Waiver
Basic Plus Waiver
Community Protection Waiver
Core Waiver
WEST VIRGINIA
Medicaid State Plan Coverage
Mentally Retarded/Developmentally Disabled Waiver
WISCONSIN
Medicaid State Plan Coverage
Community Options Waiver
Mentally Retarded/Developmentally Disabled Waiver
Aged and Disabled Waiver
Traumatic Brain Injury Waiver
Wisconsin Community Integration Program
WYOMING
Medicaid State Plan Coverage
Adult Developmental Disability Waiver
Acquired Brain Injury Waiver
Aged and Disabled Waiver


MONTANA

Overview Montana covers wheelchairs and power-operated vehicles through the Medicaid State Plan’s durable medical equipment benefit. In addition, Montana covers a range of assistive technologies and home modifications through three waivers.
Medicaid State Plan Coverage
Agency Name Department of Public Health and Human Services (DPHHS)
Phone 1-800-362-8312
Web site http://www.dphhs.mt.gov/
Summary of State Plan Coverage The Montana Medicaid State Plan follows Medicare’s coverage requirements for durable medical equipment. Home modifications, vehicle modifications, adaptive equipment, and environmental control items are specifically excluded by the Medicaid State Plan coverage guidelines.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME).
Examples of Covered HM and AT Services Wheelchairs, power-operated vehicles.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
  X N/A X X X
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


EPH (148)
Agency Name Department of Public Health and Human Services (DPHHS)
Phone 1-800-362-8312
Web site http://www.dphhs.mt.gov/
Summary of State Plan Coverage For elderly and disabled adults less than 65 years of age. To provide case management, homemaker services, personal care, respite care, adult day health care, habilitation (residential, day prevocational, supported employment, habilitation aide), environmental accessibility adaptations, transportation, specialized medical equipment and supplies, chore services, personal emergency response systems, private duty nursing, attendant care, adult residential care (adult foster, other personal care facility, other residential, hospice), therapies (including physical, occupational, speech, hearing, language, psychosocial, nutrition, and respiratory), behavior programming, chemical dependence counseling, cognitive rehabilitation, comprehensive day treatment, supported living, community residential rehabilitation, and specialized child care for children with AIDS.
Populations Served Elderly, disabled, adults less than 65 years of age.
Terminology for HM and AT Environmental accessibility adaptations (EAA), specialized medical equipment and supplies (SMES), personal emergency response systems (PERS).
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, porch lifts, construction services, electronic door openers, environmental control systems, installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.

SMES: Ramps, grab-bars, porch lifts, construction services, electronic door openers, augmentative communication devices, and sip-and-puff controls for wheelchairs.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A N/A N/A   X N/A
Benefit Limits Cost caps are determined by the overall budget. Each case management team is given an annual budget, covering a caseload of 60 beneficiaries.
Training on Use and Repairs Information N/A.


Mentally Retarded/Developmentally Disabled (208)
Agency Name Department of Public Health and Human Services (DPHHS)
Phone 1-800-362-8312
Web site http://www.dphhs.state.mt.us/dsd/govt_programs/ddp/BigWaiver/index.htm
Summary of State Plan Coverage To provide homemaker, personal care, respite care, habilitation (residential, day, prevocational, supported employment), environmental accessibility adaptations, environmental modification services, adaptive equipment, transportation, specialized medical equipment and supplies, private duty nursing, family supports coordination, therapies (including physical, occupational, speech, hearing, language, psychological, nutrition, and respiratory) and meals for mentally retarded/developmentally disabled individuals.
Populations Served Developmentally disabled, mentally retarded individuals.
Terminology for HM and AT Environmental accessibility adaptations (EAA), environmental modification services, adaptive equipment/specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services EAA: Physical adaptations to the home including the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, porch lifts, construction services, electronic door openers, environmental control systems, and installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.

Environmental modification services: Modifications to a recipient's home or vehicle for the purpose of increasing independent functioning and safety or to enable family members or other caregivers to provide the care required by the recipient.

Adaptive equipment/SMES: Items necessary to obtain and retain employment or to increase independent functioning. May include wheelchair lifts, wheelchair lock down devices, adapted driving controls, etc. A comprehensive list of covered services is not possible because items are sometimes created or invented to meet the unique needs of the individual.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Developmental Disabilities Aged 18 and Older (371)
Agency Name Department of Public Health and Human Services (DPHHS), Developmental Services Division, Developmental Disabilities Program
Phone 1-800-362-8312
Web site http://www.dphhs.state.mt.us/dsd/govt_programs/ddp/0371Waiver/index.htm
Summary of State Plan Coverage To provide homemaker services, personal care, respite care, habilitation (residential, day, prevocational, supported employment, and educational services), environmental accessibility adaptations, environmental modifications services, skilled nursing, transportation, specialized medical equipment and supplies, companion services, and private duty nursing to developmentally disabled aged 18 and older.
Populations Served Developmentally disabled individuals who are 18 and older.
Terminology for HM and AT Environmental accessibility adaptations (EAA), environmental modification services, adaptive equipment/specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, porch lifts, construction services, electronic door openers, environmental control systems, and installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.

Environmental modification services: Modifications to a recipient's home or vehicle for the purpose of increasing independent functioning and safety, or to enable family members or other caregivers to provide the care required by the recipient.

Adaptive equipment/SMES: Items necessary to obtain and retain employment or to increase independent functioning. May include wheelchair lifts, wheelchair lock down devices, adapted driving controls, etc. A comprehensive list of covered services is not possible because items are sometimes created or invented to meet the unique needs of the individual.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X  
Benefit Limits $7,800 yearly for all waiver services.
Training on Use and Repairs Training: yes.

Repairs: yes.


NEBRASKA

Overview Nebraska has one waiver (administered in close coordination with the state’s Assistive Technology Partnership) that covers assistive technology, home modifications, vehicle modifications, and personal emergency response systems, and the state plan covers selected items under the durable medical equipment benefit.
Medicaid State Plan Coverage
Agency Name Nebraska Health and Human Services System
Phone 402-471-9147
Web site http://www.hhs.state.ne.us/med/medindex.htm
Summary of State Plan Coverage The Nebraska Medicaid State Plan covers augmentative communication devices, wheelchairs, and other items that are medically necessary under the durable medical equipment benefit. Home and vehicle modifications are not covered under the state plan.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME).
Examples of Covered HM and AT Services Augmentative communicative devices, wheelchairs, grab-bars, seat lifts, chairs, walkers, bath benches, shower chairs, specialized beds. Bed baths and shower attachments (e.g., hand-held shower attachments, faucet adapters, etc.) are not covered.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
  X X X X  
Benefit Limits Information N/A.
Training on Use and Repairs Training: yes.

Repairs: yes.


Aged and Disabled Waiver (0187)
Agency Name Nebraska Health and Human Services System, Aging and Disability Services Division (Assistive Technology Partnership)
Phone 402-471-9147
Web site http://www.hhs.state.ne.us/med/medindex.htm
Summary of State Plan Coverage To provide assisted living, personal care, homemaker services, chore services, attendant care, companion services, medication oversight, medication administration, transportation, periodic nursing evaluations, assistive technology and supports, personal emergency response systems, and home modifications.
Populations Served Children and aged adults (over 65 years) who are disabled.
Terminology for HM and AT Assistive technology and supports (including vehicle modification), personal emergency response systems (PERS), home modifications (HM).
Examples of Covered HM and AT Services Assistive technology and supports: Assistive devices that aid daily living, such as sip-and-puff controls, environmental control units, electronic door openers, environmental control systems such as temperature control, lights, telephone, and security systems. Includes vehicle modifications such as hand controls, lifts, carriers, roll-in access, and tie down ramps.

PERS: An electronic device that enables a person to secure help in an emergency.

HM: Construction of an accessible entrance into the home; widening of doorways; roll-in showers; roll-under sinks; raised toilets; wheelchair lifts; stair glides; door levers; ramps; door openers; signaling devices; and environmental control units.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X X
Benefit Limits For home modifications and assistive technology, there is a $5,000 limit per year.

PERS: Information N/A.
Training on Use and Repairs Training: yes.

Repairs: yes.


NEVADA

Overview Nevada covers assistive technology and home modifications through the state plan and two waivers. Custom and power wheelchairs are covered through the Medicaid State Plan.
Medicaid State Plan Coverage
Agency Name Division of Health Care Financing and Policy (Nevada Medicaid)
Phone 775-684-3600
Web site http://dhcfp.state.nv.us/
Summary of State Plan Coverage The Nevada Medicaid State Plan covers wheelchairs under the durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME).
Examples of Covered HM and AT Services Wheelchairs including: standard, hemi, lightweight, heavy duty, extra heavy duty, reclining, custom, and power.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X X
Benefit Limits None.
Training on Use and Repairs Training: no.

Repairs: yes.


Home and Community-Based Waiver for the Physically Disabled (4150.90.R2)
Agency Name Division of Health Care Financing & Policy
Phone 775-688-2811
Web site http://dhcfp.state.nv.us/
Summary of State Plan Coverage To provide homemaker services, chore services, adult assisted living services, personal emergency response systems, home-delivered meals, home adaptations, extended state plan medical equipment, preventive dental care, independent living skills, and attendant care to individuals who are physically disabled.
Populations Served Physically disabled individuals who meet the nursing home level of care criteria.
Terminology for HM and AT Specialized medical equipment (SME)/extended state plan equipment, environmental accessibility adaptations/home adaptations, personal emergency response systems (PERS).
Examples of Covered HM and AT Services SME: Devices, controls, or appliances specified in the plan of care that enable recipients to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live. Specialized medical equipment includes vehicle adaptations and assistive technology.

Environmental accessibility adaptation/home adaptations: Environmental controls, installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems necessary to accommodate medical equipment and supplies.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X X
Benefit Limits SME: $565 per service item, per person.

Environmental accessibility adaptations: $3,230 per year, per individual.

PERS: $45 for installation; $40 monthly equipment rental.
Training on Use and Repairs Training: yes.

Repairs: yes.


Waiver for the Frail Elderly
Agency Name Division of Aging Services (DAS)
Phone 702-486-3545
Web site http://aging.state.nv.us/index.htm
Summary of State Plan Coverage To provide case management, homemaker services, personal care services, respite care services, chore services, personal emergency response systems, companion services, social model adult day care, and nutrition therapy to individuals aged 65 and over.
Populations Served Applicants or recipients must be 65 years of age or older and continue to meet the nursing facility level of care criteria.
Terminology for HM and AT Personal emergency response systems (PERS).
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X  
Benefit Limits $40 for monthly monitoring and $45 for the initial installation.
Training on Use and Repairs Training: no.

Repairs: yes.


NEW HAMPSHIRE

Overview New Hampshire covers certain types of assistive technology under the Medicaid State Plan durable medical equipment benefit. In addition, the state offers three waivers that cover a range of assistive technology services, environmental accessibility adaptations, and personal emergency response system services.
Medicaid State Plan Coverage
Agency Name New Hampshire Department of Health and Human Services, Office of Medicaid Business and Policy
Phone 603-271-4367
Web site http://www.dhhs.state.nh.us/DHHS/MEDICAIDPROGRAM/default.htm
Summary of State Plan Coverage Selected types of assistive technology are covered under the durable medical equipment benefit. The state plan does not provide coverage for home modifications.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME).
Examples of Covered HM and AT Services Augmentative alternative communication devices, power wheelchairs and medically required adaptations such as sip and puff switches to run the chairs, power scooters.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
  X   X X  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Home and Community-Based Care for Developmentally Disabled (0053E)
Agency Name New Hampshire Department of Health and Human Services, Bureau of Developmental Services
Phone 603-271-5034
Web site http://www.gencourt.state.nh.us/rules/he-m500.html
Summary of State Plan Coverage For individuals with developmental disabilities who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria. To provide supported employment, assistive technology, case management, specialty services, consolidated development services, personal care, respite care, environmental modifications, crisis response, community support, and habilitation.
Populations Served Medicaid recipients who are adults with developmental disabilities and who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Assistive technology support services, environmental modifications.
Examples of Covered HM and AT Services Assistive technology support services: Evaluation, consultation, and training in use, selection, and/or acquisition of assistive technology devices, as well as designing, fitting, and customizing of devices. This does not cover the actual cost of assistive technology devices. (Coverage for devices may be available through the state plan or Medicare.)

Environmental modifications: Modifications to the home and/or vehicle that enable the individual to function with greater independence in the home and community. Such adaptations may include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X N/A X X
Benefit Limits None.
Training on Use and Repairs Assistive technology support services: Training: yes. Repairs: information N/A.

Environmental modifications: Training: information N/A. Repairs: yes.


Home and Community-Based Care for the Elderly and Chronically Ill (0060)
Agency Name New Hampshire Department of Health and Human Services, Bureau of Elderly and Adult Services (BEAS)
Phone 603-271-4680
Web site http://www.dhhs.state.nh.us/DHHS/BEAS/LIBRARY/Policy-Guideline/hcbc-waiver.htm
Summary of State Plan Coverage To provide homemaker services, respite care, home health aide, community living services, personal care, adult group day care, environmental accessibility adaptations, assistive technology, specialized medical equipment and supplies, adult senior companion services, home-delivered meals, adult day health care, skilled nursing, personal emergency response systems, in-home day care, community transition services, chore services, adult social day services, and in-home mental health services to the elderly and chronically ill.
Populations Served Medicaid recipients who are over 18 years old and meet the nursing home level of care criteria.
Terminology for HM and AT Assistive technology support services, environmental accessibility adaptations (EAA), personal emergency response systems (PERS), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Assistive technology support services: Services to help individuals in the selection, acquisition, use, maintenance, and repair of assistive technology devices. Assistive technology support services are designed to provide individuals with evaluation, consultation, coordination, training, and technical assistance, as well as designing, fitting, and customizing of devices. However, this service does not cover the actual purchase and cost of assistive technology devices.

EAA: Installation of ramps, installation of grab-bars, and widening of doorways.

PERS: An electronic device that enables a person to secure help in an emergency.

SMES: Devices, controls, or appliances that enable individuals to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live (e.g., raised toilets, shower/bath seats, transfer benches, dressing aids, and non-slip grippers to pick up and reach items).
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X X
Benefit Limits Assistive technology support services: $15,000 per client.

EAA: $15,000 per client.

PERS: None.

SMES: $15,000 per client.
Training on Use and Repairs Training: yes.

Repairs: yes.


Home and Community-Based Care for Acquired Brain Disorders (40177)
Agency Name New Hampshire Department of Health and Human Services, Bureau of Developmental Services
Phone 603-271-5034
Web site http://www.dhhs.state.nh.us/DHHS/BDS/abd.htm
Summary of State Plan Coverage To provide service coordination, day services, employment services, personal care services, community support services, family support services including respite care, environmental modifications, crisis services, assistive technology support services, and specialty services to people with acquired brain disorders.
Populations Served Any state resident who has an acquired brain disorder, meets skilled nursing facility or long-term rehabilitation level of care criteria, and is eligible for Medicaid.
Terminology for HM and AT Assistive technology support services, environmental modifications.
Examples of Covered HM and AT Services Assistive technology support services: Evaluation, consultation, and training in use, selection, and/or acquisition of assistive technology devices, as well as designing, fitting, and customizing of devices. This does not cover the actual cost of assistive technology devices. (Coverage for devices may be available through the state plan or Medicare.)

Environmental modifications: Modifications to the home and/or vehicle that enable the individual to function with greater independence in the home and community. Such adaptations may include the installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X N/A X X
Benefit Limits None.
Training on Use and Repairs Assistive technology support services: Training: yes. Repairs: information N/A.

Environmental modifications: Training: information N/A. Repairs: yes.


NEW JERSEY

Overview New Jersey provides assistive technology and environmental modifications through the state plan’s durable medical equipment benefit, and through five waivers, including an 1115 waiver called the Personal Preference Program.
Medicaid State Plan Coverage
Agency Name Department of Human Services, Division of Medical Assistance and Health Services
Phone 609-588-2600
Web site http://www.state.nj.us/humanservices/dmahs/dhsmed.html
Summary of State Plan Coverage The New Jersey Medicaid State Plan covers augmentative/alternative communication systems under the durable medical equipment benefit. Although these are not specifically allowed under durable medical equipment, the state has received requests for environmental control units for individuals with high levels of paralysis (e.g., remote/voice activated mechanism to turn lights on and off, or unlock a door), and some persons may have received special approval to receive these services.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), augmentative/alternate communication systems.
Examples of Covered HM and AT Services DME: Augmentative/alternative communication systems, bathtub rails, floor bases, toilet rails, transfer tub rail attachments, power attachments to convert wheelchairs to motorized wheelchairs, motorized wheelchairs, and power-operated vehicles (three or four wheel non-highway).
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A X N/A X X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Training: yes.

Repairs: yes.


Traumatic Brain Injury Waiver (4174)
Agency Name Department of Human Services, Division of Disability Services
Phone 609-292-7800 or 888-285-3036
Web site http://www.state.nj.us/humanservices/dds/njwaiver.html
Summary of State Plan Coverage For individuals 18-65 who have acquired non-degenerative, structural brain damage after age 16. To provide case management; personal care; respite care; environmental accessibility adaptations; transportation; chore management; adult companion services; physical therapy; occupational therapy; speech, hearing, and language therapy; behavioral therapy; cognitive rehabilitation therapy; community residential services; counseling (behavioral and drug); night supervision; structured day program; and supported day program services.
Populations Served Individuals 18-65 who have acquired non-degenerative, structural brain damage after age 16.
Terminology for HM and AT Environmental modifications, vehicle modifications, and personal emergency response systems (PERS).
Examples of Covered HM and AT Services Environmental modifications: Installation of ramps and grabbers, widening of doorways, modification of bathrooms, or installation of specialized electric and plumbing systems necessary to accommodate medical equipment and supplies.

Vehicle modifications: Information N/A.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A X X N/A
Benefit Limits The individual cost cap is $7,790 per month for clients served at home, and $9,500 per month for clients served in a residential setting.

PERS: $45.00 for monitoring and $75 for installation.
Training on Use and Repairs Training: no.

Repairs: yes.


Community Resources for People with Disabilities Waiver (CRPD) (4133)
Agency Name Department of Human Services, Division of Disability Services
Phone 609-292-7800 or 888-285-3036
Web site http://www.state.nj.us/humanservices/dds/njwaiver.html
Summary of State Plan Coverage To provide case management, private duty nursing, environmental and vehicle modifications, personal emergency response systems, and community transitional services to blind or disabled children and adults.
Populations Served Blind or disabled children and adults.
Terminology for HM and AT Environmental and vehicle modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Environmental modifications: Installation of ramps and grabbers, widening of doorways, modification of bathrooms, or installation of specialized electric and plumbing systems necessary to accommodate medical equipment and supplies.

Vehicle modifications: Information N/A.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A X X N/A
Benefit Limits Environmental and vehicle modifications: Information N/A.

PERS: $45 for monitoring and $75 for installation.
Training on Use and Repairs Training: no.

Repairs: yes.


Personal Preference Program (CMS 1115 Research and Demonstration Waiver)
Agency Name Department of Human Services, Division of Disability Services
Phone 609-292-7800 or 888-285-3036
Web site http://www.state.nj.us/humanservices/dds/personal.html
Summary of State Plan Coverage The Personal Preference Program is a national research project implemented under a Centers for Medicare and Medicaid Services 1115 Research and Demonstration Waiver to study the effects of allowing eligible individuals to direct their own personal assistance services, as an alternative to accepting services arranged by an agency. The state has expanded the definition of personal assistance services under the waiver to include both human assistance and the purchase of goods and services--including environmental and vehicle modifications and personal emergency response systems and other assistive technology services--that reduce an individual’s need for human assistance.
Populations Served Individuals who are Medicaid-eligible, 18 years or older, and who qualify to receive personal assistance services for at least six months.
Terminology for HM and AT Environmental and vehicle modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Environmental modifications: Installation of ramps and grabbers, widening of doorways, modification of bathrooms, or installation of specialized electric and plumbing systems necessary to accommodate medical equipment and supplies.

Vehicle modifications: Information N/A.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X   N/A
Benefit Limits PERS: $45.00 for monitoring and $75 for installation.
Training on Use and Repairs Training: yes.

Repairs: yes.


Enhanced Community Options (ECO) Waiver (0285)
Agency Name New Jersey Department of Health and Senior Services, Division of Aging and Community Services
Phone 609-943-4060
Web site http://www.state.nj.us/health/consumer/cap.shtml
Summary of State Plan Coverage To provide case management, respite care, environmental accessibility adaptations, homemaker services, specialized medical equipment and supplies, chore services, personal emergency response systems, attendant care, home-based supportive care, home-delivered meals, caregiver/recipient training, social adult day care, alternate family care, and assisted living programs in subsidized housing to individuals who are aged or disabled.
Populations Served Individuals 65 and over, and individuals with disabilities aged 21 and over (individuals between the ages of 21 and 64 must be disabled) who meet the nursing facility level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (EAA), personal emergency response systems (PERS), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems to accommodate medical equipment and supplies. These items are not reimbursed for individuals who receive assisted living services in subsidized housing.

PERS: An electronic device that enables a person to secure help in an emergency.

SMES: Devices, controls or appliances, specified in the Plan of Care, that enable individuals to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live. Specialized medical equipment and supplies includes vehicle modifications, and augmentative/alternative communication systems. Vehicle modifications typically are used to install wheelchair lifts in vans that are operated by caregivers.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A X X N/A
Benefit Limits EAA and SMES: Can be restricted according to the available funds in the county’s spending authorization budget.

PERS: $45 for monitoring and $75 for installation.
Training on Use and Repairs Training: yes.

Repairs: yes.


Community Care Waiver (0031)
Agency Name New Jersey Department of Human Services, Division of Developmental Disabilities
Phone 609-987-0800
Web site http://www.state.nj.us/humanservices/dds/njwaiver.html
Summary of State Plan Coverage To provide case management, individual supports, habilitation (day and supported employment), respite, personal emergency response systems, environmental and vehicle modifications, integrated therapeutic network services, physical therapy, occupational therapy, speech therapy, and psychological and psychiatric services to mentally retarded and developmentally disabled individuals.
Populations Served Mentally retarded and developmentally disabled individuals.
Terminology for HM and AT Environmental/vehicle modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Environmental modifications: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A X X X
Benefit Limits There is cost cap of $11,000 per request.

PERS: $45 for monitoring and $75 for installation.
Training on Use and Repairs Training: yes.

Repairs: yes.


NEW MEXICO

Overview New Mexico covers augmentative and alternative communication devices, customized wheelchairs and seating systems, and hydraulic lifts in its Medicaid State Plan. In addition, the state offers two waivers that cover environmental modifications; one of these waivers also covers personal emergency response systems.
Medicaid State Plan Coverage
Agency Name New Mexico Human Services Department, Medical Assistance Division
Phone 505-827-3100
Web site http://www.state.nm.us/hsd/mad/Index.html
Summary of State Plan Coverage The New Mexico Medicaid State Plan covers augmentative and alternative communication devices, customized wheelchairs and seating systems, and hydraulic patient lifts under the durable medical equipment benefit. There is no coverage of home modifications under the state plan.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME).
Examples of Covered HM and AT Services Augmentative and alternative communication devices, customized wheelchairs and seating systems, hydraulic patient lifts.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
  X X X X  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Elderly and Disabled Waiver (0169)
Agency Name New Mexico Aging and Long-Term Services Department, Elderly and Disability Services Division
Phone 1-866-451-2901 or 505-476-4799
Web site http://www.nmaging.state.nm.us/Elderly_Disability_Services_Division.html
Summary of State Plan Coverage To provide adult day health care, assisted living services, bowel and bladder services, case management, emergency response service, environmental modifications, homemaker services, homemaker respite, occupational therapy, physical therapy, private duty nursing, respite care, and speech therapy for aged and disabled individuals.
Populations Served Medicaid recipients who are disabled or elderly (65 and older) and who meet the nursing facility level of care criteria.
Terminology for HM and AT Environmental modification services, personal emergency response service (PERS).
Examples of Covered HM and AT Services Environmental modification services: Installation of ramps, battery operated automatic door openers, voice activated electronic devices, modified switches, roll-in showers, sink or bathtub modifications, toilet modifications, turnaround space, grab-bars, widening of doorways, and lowering of counters.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A X N/A
Benefit Limits Environmental modification services: $7,500 lifetime maximum. After this cap is reached, there is a yearly maintenance fee of $300 that can be included in the Individualized Service Plan.

PERS: The waiver has established rates for installation and monthly fees.
Training on Use and Repairs Environmental modification services: Training: information N/A. Repairs: yes.

PERS: Training: yes. Repairs: yes.


Developmental Disabilities Home and Community-Based Waiver (0173)
Agency Name New Mexico Department of Health, Long Term Services Division
Phone 1-800-283-5548
Web site http://www.health.state.nm.us/ddsd/developmentaldisabilities/programddwaiverpg1.htm
Summary of State Plan Coverage For people with mental retardation and/or developmental disabilities. To provide case management, personal care, respite care, habilitation, environmental modifications, transportation, private duty nursing, adult residential care including supported living, assisted living, supervised living, home-based supports, physical and occupational therapy, speech-hearing-language services, and other services including nutritional counseling, behavior therapy, adaptation consultant, and children’s support services.
Populations Served Medicaid recipients of all ages who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (EAA), adaptation consultant.
Examples of Covered HM and AT Services EAA: Ramps, lifts/elevators, modifications/additions of bathroom facilities; roll-in showers; sink modifications; bathtub modifications/grab-bars; toilet modification/grab-bars; floor urinal and bidet adaptations and plumbing modifications; turnaround space adaptations; widening of doorways/hallways; handrails; door handle adaptations; trapeze and mobility tracks for home ceilings; automatic door opener/doorbells; voice activated, light activated, motion activated, and electronic devices; fire safety adaptations; glass substitutes for windows and doors.

Adaptation consultant: A licensed contractor who offers technical assistance and oversight to environmental accessibility adaptation projects in areas such as ensuring proper planning and design; reviewing construction plans and specifications; interpreting building codes and procedures; approving and amending building plans; reviewing costs; inspecting projects; recommending approval of completed projects for final payment. The adaptation consultant cannot perform the adaptation work or have any relationship with the contractor.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


NEW YORK

Overview New York covers assistive technologies and home modifications through the state plan and three waivers. In the waivers, covered services include home modifications, environmental modifications, and adaptive equipment.
Medicaid State Plan Coverage
Agency Name New York State Department of Health, Office of Medicaid Management
Phone 877-472-8411
Web site http://www.health.state.ny.us/health_care/medicaid/
Summary of State Plan Coverage The New York Medicaid State Plan covers selected items through the durable medical equipment benefit, including prosthetics, orthotics, medical supplies, and speech-generating/augmentative communication devices.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), augmentative communications devices.
Examples of Covered HM and AT Services Speech-generating devices.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A X X X X  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Aged and Disabled Waiver (0034) -- Long Term Home Health Care Program
Agency Name New York State Department of Health, Office of Medicaid Management
Phone 877-472-8411
Web site http://www.health.state.ny.us/health_care/medicaid/program/longterm/lthhc.htm
Summary of State Plan Coverage To provide case management, home-delivered or congregate meals, housing improvements, respiratory therapy, medical social services, and respite care to persons who are eligible for placement in a nursing home.
Populations Served This program is available to individuals who are medically eligible for placement in a nursing home and choose to receive services at home. These individuals must have care costs that are less than the nursing home cost in the county.
Terminology for HM and AT Housing improvements.
Examples of Covered HM and AT Services Housing improvements: Minor home modifications.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Mental Retardation/Developmental Disability Waiver (0238)
Agency Name Office of Mental Retardation and Developmental Disabilities (OMRDD)
Phone 518-473-9689
Web site http://www.omr.state.ny.us/index.jsp
Summary of State Plan Coverage To provide residential and day habilitation services, prevocational services, supported work services, residential respite care, environmental modifications, and adaptive equipment to persons with mental retardation/developmental disability who meet the Intermediate Care Facility for the Mentally Retarded or nursing facility level of care criteria.
Populations Served People with mental retardation and developmental disabilities who are eligible for Intermediate Care Facility for the Mentally Retarded or nursing facility level of care.
Terminology for HM and AT Environmental modifications, adaptive equipment.
Examples of Covered HM and AT Services Environmental modifications: Specialized equipment, or changes to the living or work environment including wheelchair ramps, lifts, handrails, and communication boards.

Adaptive equipment/technologies: Devices, aids, controls, appliances or supplies to enable the waiver participant to increase his or her ability to function in a home and community-based setting with independence and safety. The array of adaptive technologies to be provided is divided into two categories: communication aids and adaptive aids.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A X N/A
Benefit Limits Average per capita cost cannot exceed Intermediate Care Facility for the Mentally Retarded costs.

Threshold limits exist.
Training on Use and Repairs Training: yes.

Repairs: yes.


Traumatic Brain Injury Waiver (0269)
Agency Name New York State Department of Health
Phone 518-474-6580
Web site http://www.health.state.ny.us/health_care/medicaid/program/longterm/tbi.htm
Summary of State Plan Coverage For persons with traumatic brain injury, ages 18-64, who meet the nursing facility level of care criteria. To provide individualized care coordination, skills building, respite care, family support, intensive in-home services, crisis response, environmental modifications/vehicle modifications, assistive technology/special medical equipment and supplies, home mobility aids, adaptive and therapeutic equipment, and augmentative communication devices.
Populations Served Individuals who are 18-64, have traumatic brain injury or a related condition, and who meet the nursing facility level of care criteria.
Terminology for HM and AT Environmental modifications/vehicle modifications, assistive technology/special medical equipment and supplies (SMES), home mobility aids, adaptive and therapeutic equipment, augmentative communication devices.
Examples of Covered HM and AT Services Environmental modifications/vehicle modifications: Physical adaptations to the waiver participant's residence and primary vehicle to ensure the participant's health, safety, and welfare and increase the individual’s independence and integration in the community.

Assistive technology/SMES: Devices, controls, or appliances to increase the waiver participant's ability to perform activities of daily living or to perceive, control, or communicate with the environment. May include durable and non-durable medical equipment not usually funded under the Medicaid State Plan.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A N/A X
Benefit Limits Environmental modifications/vehicle modifications: $15,000 annual cap.

Assistive technology/SMES: $15,000 annual cap.
Training on Use and Repairs Information N/A.


NORTH CAROLINA

Overview North Carolina covers a range of assistive technologies and home modifications through the state plan and five waivers.
Medicaid State Plan Coverage
Agency Name North Carolina Department of Health and Human Services, Division of Medical Assistance
Phone 919-855-4111
Web site http://www.dhhs.state.nc.us/dma/
Summary of State Plan Coverage The North Carolina Medicaid State Plan covers durable medical equipment such as wheelchairs, hospital beds, orthotic appliances (braces), prosthetic devices (artificial limbs), etc., and disposable medical equipment ordered by an accepted prescriber that is medically necessary and suitable for use in the home.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME).
Examples of Covered HM and AT Services Wheelchairs, hospital beds, orthotic appliances (braces), prosthetic devices (artificial limbs), disposable medical equipment, specialized equipment and home mobility aids, commode chairs, transfer benches, grab-bars.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
  X X X X  
Benefit Limits The amount of service is limited to that which is medically necessary as determined by Medicaid policies. Capped rental items have restrictions on the length of rental.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.


Community Alternatives Program for Disabled Adults (Elderly/Disabled Waiver) (0132)
Agency Name North Carolina Department of Health and Human Services, Division of Medical Assistance
Phone 1-800-662-7030
Web site http://www.dhhs.state.nc.us/dma/commaltprog.htm
Summary of State Plan Coverage To provide a package of services to allow adults (age 18 and older) who qualify for nursing facility care to remain in their private residences. Services offered include: case management, Community Alternatives Program for Disabled Adults in-home aide, telephone alert, home mobility aids/home modifications, and medical supplies.
Populations Served Disabled persons aged 18 and older who meet the nursing facility level of care criteria.
Terminology for HM and AT Home mobility aids/home modifications, telephone alert service.
Examples of Covered HM and AT Services Home mobility aids/home modifications: Wheelchair ramps, safety rails, grab-bars, non-skid surfaces (rough-surfaced strips of adhesive material that adhere to non-carpeted areas such as concrete, linoleum, wood, tile, porcelain, or fiberglass), handheld showers, widening of doorways for wheelchair access.

Telephone alert service: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A X  
Benefit Limits Home mobility aids/home modifications: Up to $1,500 per year.

Telephone alert service: Medicaid does not cover the purchase and installation of equipment in the client’s home.
Training on Use and Repairs Information N/A.


Community Alternatives Program for Persons with AIDS (AIDS Waiver) (0289)
Agency Name North Carolina Department of Health and Human Services, Division of Medical Assistance
Phone 1-800-662-7030
Web site http://www.dhhs.state.nc.us/dma/commaltprog.htm
Summary of State Plan Coverage To offer a home care alternative to nursing facility care for persons with AIDS as well as children who are HIV-positive with other qualifying conditions. Services offered under this waiver include: case management, Community Alternatives Program/AIDS in-home aides, waiver supplies, home mobility aids, and personal emergency response systems.
Populations Served Persons with AIDS and children who are HIV-positive who meet the nursing facility level of care criteria.
Terminology for HM and AT Home mobility aids, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Home mobility aids: Adaptations to the client’s home environment including wheelchair ramps; safety rails; grab-bars; non-skid surfaces (rough-surfaced strips of adhesive material that adhere to non-carpeted areas such as concrete, linoleum, wood, tile, porcelain, or fiberglass); handheld showers; and widening of doorways for wheelchair access for the Community Alternatives Program/AIDS client.

PERS: An electronic device to enable a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X N/A N/A X N/A
Benefit Limits Home mobility aids: Information N/A.

PERS: This service does not pay for the purchase or installation of equipment in the client’s home.
Training on Use and Repairs Information N/A.


Community Alternatives Program for Persons with Mental Retardation/ Developmental Disability (CAP/MR-DD Waiver) (0151)
Agency Name North Carolina Department of Health and Human Services, Division of Medical Assistance
Phone 1-800-662-7030
Web site http://www.dhhs.state.nc.us/dma/commaltprog.htm
Summary of State Plan Coverage To provide case management, supported living, respite care, personal care, personal habilitation, environmental accessibility adaptations, personal emergency response system, and specialized medical equipment and supplies to individuals of any age who qualify for care in an Intermediate Care Facility for the Mentally Retarded.
Populations Served Mentally retarded/developmentally disabled persons of any age who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (home/vehicle modifications) (EAA), augmentative communication devices (ACD), personal emergency response systems (PERS), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services EAA: Installation, maintenance, and repairs of ramps and grab-bars; widening of doorways/passageways; modification of bathroom facilities; bedroom modifications to accommodate hospital beds and/or wheelchairs and install thermostats, shelves, closets, sinks, counters, cabinets, and doorknobs; shatterproof windows; floor coverings for ease of ambulation; alarm systems/alert systems; fences; video cameras for a recipient who must be visually monitored while sleeping; porch or stair lifts, hydraulic, manual, or electronic lifts; stationary/built-in therapeutic tables; weather protective modifications; and fire safety adaptations.

ACD: Mounting kits and accessories for each component (computers, etc); overlay kits and accessories; switches/pointers/access equipment; keyboard/voice emulators/key guards; voice synthesizers; carry cases; supplies; artificial larynges.

PERS: An electronic device that enables a person to secure help in an emergency.

SMES: Adaptive positioning devices; mobility aids; customized/specialized wheelchairs, strollers, accessories and parts; protective helmets that are medically necessary; specialized adaptive tricycles; adaptive eating equipment; adaptive, assistive devices/aids; mobile and/or adjustable tables and trays; adaptive toothbrushes; adaptive toileting chairs and bath chairs, and items not on the state durable medical equipment list.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X N/A
Benefit Limits EAA: $15,000 over the duration of this waiver (three years). Home modifications can be provided only in a dwelling that is owned by the client or family, unless the modifications are portable.

ACD: $10,000 per year, per person.

PERS: Information N/A.

SMES: Information N/A.
Training on Use and Repairs Training: yes.

Repairs: yes.


1915(b)/(c) Consumer Directed Care for Behavioral Health-Innovations (1915(c)) and Piedmont Cardinal Health Plan (1915(b) Independence Plus Managed Behavioral Health Care Waiver) (0423-IP)
Agency Name North Carolina Department of Health and Human Services, Division of Medical Assistance
Phone 919-855-4290
Web site http://www.dhhs.state.nc.us/dma/Piedmont.htm
Summary of State Plan Coverage To provide health services, substance abuse services, and other services to persons with developmental disabilities and/or mental retardation.
Populations Served Individuals with developmental disabilities and/or mental retardation.
Terminology for HM and AT Augmentative communication devices (ACD).
Examples of Covered HM and AT Services ACD: Communication for assistive technology/alternative language.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


NORTH DAKOTA

Overview The North Dakota Medicaid State Plan covers some assistive technologies through its durable medical equipment benefit. In addition, North Dakota offers three waivers that cover assistive technology and home modification services such as emergency response systems, environmental modifications, and specialized equipment.
Medicaid State Plan Coverage
Agency Name Medical Services Division, North Dakota Department of Human Services
Phone 1-800-755-2604
Web site http://www.nd.gov/humanservices/services/medicalserv/medicaid/
Summary of State Plan Coverage The North Dakota Medicaid State Plan covers wheelchairs, wheelchair adaptations, and assistive communication devices through the durable medical equipment benefit.
Populations Served Medicaid-eligible Individuals.
Terminology for HM and AT Durable medical equipment (DME).
Examples of Covered HM and AT Services Adaptations to a wheelchair (e.g., a joy stick) that allow the individual to access his/her environment, manual or motorized wheelchair; speech-generating devices; assistive communication devices.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
  X X X X  
Benefit Limits None.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.


Aged and Disabled Waiver (0054)
Agency Name Medical Services Division, North Dakota Department of Human Services
Phone 1-800-755-2604
Web site http://www.nd.gov/humanservices/services/medicalserv/medicaid/waiver.html
Summary of State Plan Coverage This waiver allows physically disabled persons who meet the nursing facility level of care criteria to remain living at home and in the community. Services offered under the waiver include: case management, respite care, personal care service, chore service, homemaker services, and specialized medical equipment. The waiver allows North Dakota to pay for alternative services that permit these individuals to remain in their own homes or community settings.
Populations Served Individuals with disabilities or individuals over 65 years of age who are eligible for the Medicaid Program and have medical needs that would qualify them to enter a nursing facility.
Terminology for HM and AT Lifeline, environmental modifications (EM), specialized equipment and supplies.
Examples of Covered HM and AT Services Lifeline: An electronic device that enables a person to secure help in an emergency.

Environmental modifications: Safety rails, ramps, widening of doorways, bathroom/kitchen modifications.

Specialized equipment and supplies: Communication boards, specialized positioning devices, remote controls to operate electronic devices (e.g., kitchen appliances).
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A X X
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Traumatic Brain Injury 18-64 Waiver (0273)
Agency Name Medical Services Division, North Dakota Department of Human Services
Phone 1-800-451-8693
Web site http://www.nd.gov/humanservices/services/adultsaging/homecare4.html
Summary of State Plan Coverage This waiver allows persons aged 18 and above with traumatic brain injury who meet the nursing facility level of care criteria to remain living at home and in the community. Services include: case management, residential care, transitional living, and emergency response.
Populations Served Persons aged 18 and above with traumatic brain injury who meet the nursing facility level of care criteria.
Terminology for HM and AT Lifeline, environmental modifications (EM), specialized equipment and supplies.
Examples of Covered HM and AT Services Lifeline: An electronic device that enables a person to secure help in an emergency.

Environmental modifications: Safety rails, ramps, widening of doorways, bathroom/kitchen modifications.

Specialized equipment and supplies: Communication boards, specialized positioning devices, remote controls to operate electronic devices (e.g., kitchen appliances).
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A X X
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


OHIO

Overview Ohio covers selected adaptive and assistance equipment through its Medicaid State Plan. In addition, the state offers seven waivers that cover a range of environmental accessibility adaptations, specialized medical equipment, and assistive technologies.
Medicaid State Plan Coverage
Agency Name Ohio Department of Job and Family Services, Office of Health Plans (OHP)
Phone 614-644-0140
Web site http://jfs.ohio.gov/ohp/
Summary of State Plan Coverage The Ohio Medicaid State Plan covers speech-generating devices, wheelchairs, power-operated vehicles, and adaptive positioning devices under the durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME).
Examples of Covered HM and AT Services DME: Speech-generating devices (including application package, overlay/multiple location configuration, access device, mounting device, and adapted access software or speech synthesizer); adaptive positioning devices; power and custom wheelchairs; and power-operated vehicles.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
  X X X X  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Ohio Home Care Waiver (0337)
Agency Name Ohio Department of Job and Family Services, Office of Ohio Health Plans, Bureau of Home and Community Services
Phone 614-466-6742
Web site http://jfs.ohio.gov/ohp/ohc/bhcs.stm
Summary of State Plan Coverage To provide daily living services, adult day health care, environmental accessibility/ modifications, transportation, emergency response systems, adaptive/assistive devices, nursing, home-delivered meals, respite care (out-of-home respite care) to individuals who meet nursing facility level of care criteria.
Populations Served Medicaid recipients who meet nursing facility level of care criteria.
Terminology for HM and AT Personal emergency response systems (PERS), home modifications (also called environmental accessibility adaptations), supplemental adaptive/assistive devices.
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.

Home modifications: Wheelchair ramps, widening of doorways, installation of roll-in showers.

Supplemental adaptive/assistive devices: Appliances, equipment, and supplies that increase consumers’ functional ability and that are not otherwise covered by Medicaid. Includes vehicle modifications such as operating aids, raised and lowered floors, raised doors, raised roofs, portable ramps, scooter/wheelchair handling devices, transfer seats, lifts, etc. Other types of adaptive/assistive devices include in-home lifts, “reachers” and/or “grabbers”, special straps so an individual can hold utensils, etc.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X X
Benefit Limits A cost range is assigned to each consumer, based on need for services. The cost of services cannot exceed the upper end of the cost range without approval.
Training on Use and Repairs PERS: Training: yes. Repairs: yes.

Home modifications: Training: yes. Repairs: yes.

Supplemental adaptive/assistive devices: Training: Information N/A. Repairs: yes.


Transitions Waiver (0383)
Agency Name Ohio Department of Job and Family Services, Office of Ohio Health Plans, Bureau of Home and Community Services
Phone 614-466-6742
Web site http://jfs.ohio.gov/ohp/ohc/bhcs.stm
Summary of State Plan Coverage To provide services, providers, and administration identical to those specified in the Ohio Home Care Waiver (see previous page) to people who qualify for care in an Intermediate Care Facility for the Mentally Retarded. This waiver is for people who were originally enrolled in the Ohio Home Care Waiver; it is not available to new applicants.
Populations Served Medicaid recipients who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria who choose to remain at home.
Terminology for HM and AT See the description of the Ohio Home Care Waiver.
Examples of Covered HM and AT Services See the description of the Ohio Home Care Waiver.
Process to Access Benefit See the description of the Ohio Home Care Waiver.
Benefit Limits See the description of the Ohio Home Care Waiver.
Training on Use and Repairs See the description of the Ohio Home Care Waiver.


PASSPORT Waiver (0198)
Agency Name Ohio Department of Aging
Phone 614-466-5500
Web site http://goldenbuckeye.com/families/passport.html
Summary of State Plan Coverage To provide adult day care, personal care, environmental accessibility adaptations, adaptive and assistive equipment, chore services, counseling/social work, home-delivered meals, personal emergency response systems, homemaker services, independent living assistance, home medical equipment and supplies, home modifications, transportation, and nutritional consultation to people over 60 who meet the nursing home level of care criteria. Program services are administered through local Area Agencies on Aging.
Populations Served Medicaid recipients who are over 60 and meet the nursing home level of care criteria.
Terminology for HM and AT Adaptive and assistive equipment, environmental accessibility adaptations (EAA), home modifications, medical equipment and supplies, personal emergency response system (PERS).
Examples of Covered HM and AT Services Adaptive and assistive equipment (also called medical equipment and supplies): Appliances, equipment, and supplies that increase consumers’ functional ability and that are not otherwise covered by Medicaid. Examples include wheelchairs, grab-bars, and tub seats.

EAA: Plumbing and electrical services or repairs to accommodate medical equipment, installation of safety devices such as smoke alarms/carbon monoxide detectors, construction of exterior ramps, widening of doorways, and minor household repairs.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X N/A X X X
Benefit Limits Total care plan costs may not exceed 60 percent of the cost of nursing home care over a six-month period.
Training on Use and Repairs Training: yes.

Repairs: yes.


Choices Waiver (40196)
Agency Name Ohio Department of Aging
Phone 614-466-5500
Web site http://goldenbuckeye.com (Ohio Department of Aging)
http://www.ohioaging.org/pdf_files/Consumer_Directed_Care.pdf
Summary of State Plan Coverage A demonstration waiver to provide PASSPORT services to consumers who choose to self-direct their personal care.
Populations Served Medicaid recipients who are over 60 and meet the nursing home level of care criteria. In addition, recipients must be willing to employ and direct their personal care workers. This waiver is available only to residents of the regions served by the Columbus, Marietta, and Rio Grande Area Agencies on Aging.
Terminology for HM and AT See the description of the PASSPORT Waiver.
Examples of Covered HM and AT Services See the description of the PASSPORT Waiver.
Process to Access Benefit See the description of the PASSPORT Waiver.
Benefit Limits See the description of the PASSPORT Waiver.
Training on Use and Repairs See the description of the PASSPORT Waiver.


Individual Options Waiver (0231)
Agency Name Ohio Department of Mental Retardation and Development Disabilities
Phone 614-466-0726
Web site http://odmrdd.state.oh.us/Includes/Waivers/Waivers.htm
Summary of State Plan Coverage For people with mental retardation or developmental disabilities who are 18 or older and meet the Intermediate Care Facility for the Mentally Retarded level of care criteria. To provide respite care, habilitation (supported employment), environmental accessibility adaptations, transportation, specialized medical equipment and supplies, homemaker/personal care, social work/counseling, interpreter, nutrition, and home-delivered meals.
Populations Served Medicaid recipients with mental retardation or developmental disabilities who are 18 or older who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (EAA), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services EAA: Installation of ramps, grab-bars, widening of doorways, modification of bathroom facilities, installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.

SMES: Devices, controls, or appliances that enable people to increase their ability to perform activities of daily living or to perceive, control, or communicate with their environment. Also includes equipment necessary for life support. Examples include wheelchair lift adaptation to vans, aid dogs or monkeys, adapted chairs, feeding dishes, adjustable pointer sticks, hand splints, controls, wedges.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X         X
Benefit Limits EAA: $7,500 per item.

SMES: $10,000 per item.
Training on Use and Repairs Training: yes.

Repairs: yes.


Level One Waiver (0380)
Agency Name Ohio Department of Mental Retardation and Development Disabilities
Phone 614-466-0726
Web site http://odmrdd.state.oh.us/Includes/Waivers/Waivers.htm
Summary of State Plan Coverage To provide respite care, environmental accessibility adaptations, transportation, specialized medical equipment and supplies, personal emergency response systems, and homemaker/personal care services for people with mental retardation or developmental delays who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Populations Served Medicaid recipients of any age with mental retardation or developmental disabilities who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (EAA), specialized medical equipment and supplies (SMES), personal emergency response systems (PERS).
Examples of Covered HM and AT Services EAA: Installation of ramps, grab-bars, widening of doorways, modification of bathroom facilities, installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.

SMES: Devices, controls, or appliances that enable people to increase their ability to perform activities of daily living or to perceive, control, or communicate with their environment. Also includes equipment necessary for life support. Examples include wheelchair lift adaptation to vans, aid dogs or monkeys, adapted chairs, feeding dishes, adjustable pointer sticks, hand splints, controls, wedges.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X         X
Benefit Limits $6,000 over three years for all three services.
Training on Use and Repairs Training: yes.

Repairs: yes.


OKLAHOMA

Overview Oklahoma’s Medicaid State Plan covers selected types of assistive technology. In addition, the state offers four waivers that cover a range of assistive technologies and home modification services.
Medicaid State Plan Coverage
Agency Name Oklahoma Health Care Authority
Phone 405-522-7300
Web site http://www.ohca.state.ok.us
Summary of State Plan Coverage The Oklahoma Medicaid State Plan covers selected types of assistive technology under the durable medical equipment, adaptive equipment, medical supplies, and prosthetic devices benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment, adaptive equipment, medical supplies, and prosthetic devices.
Examples of Covered HM and AT Services Durable medical equipment, adaptive equipment, medical supplies, and prosthetic devices: Hospital beds, wheelchairs, lift devices, adaptive equipment for individuals who reside in Intermediate Care Facilities for the Mentally Retarded.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Community Waiver (0179)
Agency Name Oklahoma Department of Human Services, Developmental Disabilities Services Division
Phone 405-522-3037 or local area office
Web site http://www.okdhs.org/programsandservices/dd/commsvcs/commwaiver/
Summary of State Plan Coverage To provide homemaker services, respite care, habilitation (prevocational, supported employment), intensive personal supports, habilitation training specialist, environmental accessibility adaptations, transportation, family training, residential care (agency companion services, daily living supports, group home supports), specialized foster care, physician, home health care, prescribed drugs, assistive technology, specialized medical equipment and supplies, dental, nutritional, psychological, audiology, and therapies (including occupational, physical, speech, hearing and language) to individuals aged three and older who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Populations Served Medicaid recipients who are three or older with mental retardation or related conditions and who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Architectural modifications, specialized medical equipment and supplies (SMES)/assistive technology.
Examples of Covered HM and AT Services Architectural modifications: Installation of ramps, lifts, grab-bars, widening of doorways, modification of bathroom or kitchen facilities, or installation of specialized electric or plumbing systems to accommodate medical equipment and supplies. Specialized safety adaptations may include scald protection devices, stove guards, installation of specialized equipment for people with vision or hearing impairments or behavioral challenges.

SMES/assistive technology: Bathtub rails, raised toilet seats, patient lifts (including hydraulic and electric), wheelchair accessories, specially constructed wheelchairs, speech-generating devices (including accessories and software). Vehicle modifications are covered under this benefit.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X N/A X X
Benefit Limits Architectural modifications: May be provided for no more than two residences within any five-year period. There are no cost caps.

SMES/assistive technology: Vehicle modifications for one vehicle per covered individual within in a five-year period.
Training on Use and Repairs Architectural modifications: Training: Information N/A. Repairs: yes.

SMES/assistive technology: Training: yes. Repairs: yes.


Advantage (0256)
Agency Name Oklahoma Department of Human Services, Aging Services Division
Phone 405-521-2281
Web site http://www.okdhs.org/programsandservices/aging/adw/
Summary of State Plan Coverage To provide case management, respite care, adult day health care, environmental accessibility adaptations, skilled nursing, specialized medical equipment and supplies, prescribed drugs, advanced restorative assistance, home-delivered meals, therapies (including physical, occupational, speech, language, and respiratory), comprehensive home care, and hospice care to adults (aged, disabled, and developmentally disabled with cognitive impairment) who require nursing facility level of care.
Populations Served Medicaid recipients who are 65 or older, adults 21 and older with physical disabilities, and adults 21 and older with developmental disabilities without mental retardation or cognitive impairments. All recipients must meet nursing home level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (EAA), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.

SMES: Information N/A.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X X
Benefit Limits EAA: None.

SMES: Information N/A.
Training on Use and Repairs EAA: Training: yes. Repairs: yes.

SMES: Information N/A.


In-Home Supports for Adults (0343)
Agency Name Oklahoma Department of Human Services, Developmental Disabilities Services Division
Phone 405-522-3037 or local area office
Web site http://www.okdhs.org/programsandservices/dd/commsvcs/inhsupp/default.htm
Summary of State Plan Coverage To provide homemaker services, respite care, habilitation (prevocational, supported employment, training specialist, self-directed support), environmental accessibility adaptations, transportation, family training, audiology, therapies (including occupational, physical, speech, hearing, and language), physician, home health skilled nursing, registered nursing, prescribed drugs, assistive technology, specialized medical equipment and supplies, dental services, nutritional services, adult day care, and psychological services to adults 18 and over with mental retardation. The benefits offered in this waiver are the same as those in the Community Waiver.
Populations Served Medicaid recipients who 18 or older with mental retardation who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Architectural modifications, specialized medical equipment and supplies (SMES)/assistive technology.
Examples of Covered HM and AT Services Architectural modifications: Installation of ramps, lifts, grab-bars, widening of doorways, modification of bathroom or kitchen facilities, or installation of specialized electric or plumbing systems to accommodate medical equipment and supplies. Specialized safety adaptations may include scald protection devices, stove guards, installation of specialized equipment for people with vision or hearing impairments or behavioral challenges.

SMES/assistive technology: Bathtub rails, raised toilet seats, patient lifts (including hydraulic and electric), wheelchair accessories, specially constructed wheelchairs, speech-generating devices (including accessories and software). Vehicle modifications are covered under this benefit.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X N/A X X
Benefit Limits The total cost of waiver services cannot exceed $18,540.
Training on Use and Repairs Architectural modifications: Training: Information N/A. Repairs: yes.

SMES/assistive technology: Training: yes. Repairs: yes.


Homeward Bound (0399)
Agency Name Oklahoma Department of Human Services, Developmental Disabilities Services Division
Phone 405-522-3037 or local area office
Web site http://www.okdhs.org/programsandservices/dd/docs/waiver.htm
Summary of State Plan Coverage For individuals who are 18 or older with mental retardation or related conditions who are certified by the U.S. District Court for the Northern District of Oklahoma as a member of the Plaintiff Class in Homeward Bound vs The Hissom Memorial Center. The benefits offered in this waiver are the same as those in the Community Waiver. To provide homemaker services, respite care, habilitation (prevocational, supported employment, intensive personal supports, habilitation training specialist), environmental accessibility adaptations (architectural modifications), transportation, family training, counseling, residential care, agency companion services, daily living supports, group home services, foster care, physician services, home health care, skilled nursing, registered nursing services, prescribed drugs, assistive technology, specialized medical equipment and supplies, dental services, nutritional services, psychological services, therapies (including physical, occupational, speech, hearing, and language), and audiology services.
Populations Served Medicaid recipients who are 18 or older who have mental retardation or a related condition and meet Intermediate Care Facility for the Mentally Retarded level of care criteria. In addition, recipients must have been certified by the U.S. District Court for the Northern District of Oklahoma as a member of the Plaintiff Class in Homeward Bound vs The Hissom Memorial Center.
Terminology for HM and AT Architectural modifications, specialized medical equipment and supplies (SMES)/assistive technology.
Examples of Covered HM and AT Services Architectural modifications: Installation of ramps, lifts, grab-bars, widening of doorways, modification of bathroom or kitchen facilities, or installation of specialized electric or plumbing systems to accommodate medical equipment and supplies. Specialized safety adaptations may include scald protection devices, stove guards, installation of specialized equipment for people with vision or hearing impairments or behavioral challenges.

SMES/assistive technology: Bathtub rails, raised toilet seats, patient lifts (including hydraulic and electric), wheelchair accessories, specially constructed wheelchairs, speech-generating devices (including accessories and software). Vehicle modifications are covered under this benefit.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X N/A X X
Benefit Limits The total cost of waiver services cannot exceed $18,540.
Training on Use and Repairs Architectural modifications: Training: Information N/A. Repairs: yes.

SMES/assistive technology: Training: yes. Repairs: yes.


OREGON

Overview Oregon covers speech-generating devices and selected assistive items through its Medicaid State Plan. In addition, the state offers three waivers that cover environmental accessibility adaptations, personal emergency response systems, and specialized medical equipment and supplies.
Medicaid State Plan Coverage
Agency Name Oregon Department of Human Services, Office of Medical Assistance Programs
Phone 503-945-5772
Web site http://oregon.gov/DHS/healthplan/index.shtml
Summary of State Plan Coverage The Oregon Medicaid State Plan covers selected items through the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies benefit and speech-generating/augmentative communication devices through the Speech-Language benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), speech-language pathology.
Examples of Covered HM and AT Services DMEPOS: Power wheelchairs and accessories, power-operated vehicles, client lifts, seats, or slings, and hydraulic bathtub lifts.

Speech-language pathology: Speech-generating/augmentative communication systems or devices.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X  
Benefit Limits DMEPOS: The program sets cost caps for different types of equipment. There is no cost cap per individual, per year.

Speech-language pathology: None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Waiver for Individuals with Developmental Disabilities (0117)
Agency Name Oregon Department of Human Services, Seniors and People with Disabilities
Phone 503-945-5811
Web site http://www.oregon.gov/DHS/dd/index.shtml
Summary of State Plan Coverage To provide respite, habilitation (residential and day), environmental accessibility adaptations, transportation, specialized medical equipment and supplies, family training, physical and occupational therapy, speech, hearing, and language services, in-home support services, and crisis/diversion services for individuals with developmental disabilities.
Populations Served Medicaid recipients of all ages with mental retardation/developmental disabilities who meet Intermediate Care Facilities for the Mentally Retarded level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (EAA), specialized medical equipment and supplies (SMES)
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, removing or widening of doorways, handrails, electric door openers, adaptations of kitchen cabinets/sinks, modifications of bathroom facilities, individual room air conditioners to maintain stable temperature as required by the individual’s medical condition, installation of non-skid surfaces, overhead track systems to assist with lifting or transferring of individuals, or installation of specialized electric and plumbing systems to accommodate medical equipment and supplies. Environmental modification consultation necessary to evaluate the home and make plans to modify the home is included.

SMES: Information N/A.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A   X X
Benefit Limits EAA: None.

SMES: Information N/A.
Training on Use and Repairs EAA: Training: yes. Repairs: no.

SMES: Information N/A.


Seniors and People with Disabilities (0185)
Agency Name Oregon Department of Human Services, Seniors and People with Disabilities
Phone 503-945-5811
Web site http://www.oregon.gov/DHS/spwpd/indexshtml
Summary of State Plan Coverage To provide respite, adult day health, environmental accessibility adaptations, transportation, chore, personal emergency response systems, attendant care, adult residential care, adult foster care, assisted living, home-delivered meals, adult day care, special living facilities, residential care facilities, and in-home care to persons with physical disabilities.
Populations Served Medicaid recipients who are either elderly or are 18 or older with a physical disability, and who meet nursing facility level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (EAA), personal emergency response systems (PERS)
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, and installation of specialized electric and plumbing systems that are necessary to accommodate medical equipment and supplies.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A   X X
Benefit Limits None.
Training on Use and Repairs EAA: Training: yes. Repairs: no.

PERS: Training: yes. Repairs: yes.


Support Services Waiver for Adults (0375)
Agency Name Department of Human Services, Seniors and People with Disabilities
Phone 503-945-5811
Web site http://www.oregon.gov/DHS/dd/index.shtml
Summary of State Plan Coverage To provide homemaker, respite, habilitation, environmental accessibility adaptations, transportation, specialized medical equipment and supplies, chores, personal emergency response systems, physical and occupational therapy, speech, hearing and language services, and specially prepared foods for individuals on special diets.
Populations Served Medicaid recipients with mental retardation/developmental disabilities who meet Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (EAA), personal emergency response systems (PERS), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services EAA: Shatter-proof windows; hardening of walls or doors; specialized, hardened, waterproof or padded flooring; an alarm system for doors or windows; protective coverings for smoke detectors, light fixtures, and appliances; sound and visual monitoring systems, and fencing. Other adaptations may include the installation of ramps and grab-bars, installation of electric door openers, adaptation of kitchen cabinets/sinks, widening of doorways, handrails, modification of bathroom facilities, individual room air conditioners for individuals whose temperature sensitivity issues create behaviors or medical conditions that put themselves or others at risk, or installation of non-skid surfaces, overhead track systems to assist with lifting or transferring, specialized electric and plumbing systems to accommodate medical equipment and supplies.

PERS: An electronic device that enables a person to secure help in an emergency. This may also include the cost to purchase and use cell phones and pagers.

SMES: Incontinence items; adaptive equipment to enable an individual to feed him/herself; adaptive beds; positioning devices; purchase of a manual wheelchair (when the power wheelchair will not fit in the house); specially designed clothes to meet the unique needs of the individual with the disability; assistive technology items, computer software, and augmentative communication devices; environmental adaptations to control lights, heat, stove, etc.; sensory and tactile stimulation equipment and supplies that help an individual calm him/herself; items necessary for life support; durable and non-durable medical equipment not available under the Medicaid State Plan.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X N/A X X  
Benefit Limits General: The cost of waiver services cannot exceed $20,000 per plan year unless prior authorized. Costs above $20,000 per plan year cannot exceed the cost of care in an Intermediate Care Facility for the Mentally Retarded facility.

EAA: If the cost of the environmental adaptation exceeds $5,000, the state will gain a security interest in the home.

PERS: Information N/A.

SMES: Information N/A.
Training on Use and Repairs EAA: Training: yes. Repairs: no.

PERS: Training: yes. Repairs: no.

SMES: Training: yes. Repairs: yes.


PENNSYLVANIA

Overview Pennsylvania covers power wheelchairs and accessories, power-operated devices, and augmentative communication devices through the Medicaid State Plan. In addition, the state offers eight waivers that cover a range of home modifications and assistive technology services.
Medicaid State Plan Coverage
Agency Name Pennsylvania Department of Public Welfare
Phone 717-787-1870
Web site http://www.dpw.state.pa.us/omap/dpwomap.asp
Summary of State Plan Coverage The Pennsylvania Medicaid State Plan covers power wheelchairs and accessories, power-operated devices, and augmentative communication devices through the medical supplies benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Medical supplies.
Examples of Covered HM and AT Services Medical supplies: Power wheelchairs and accessories, power-operated devices, and augmentative communication devices.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A X N/A X X  
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Consolidated Waiver for Individuals with Mental Retardation (0147)
Agency Name Pennsylvania Department of Public Welfare, Office of Mental Retardation
Phone 717-783-5764
Web site http://www.dpw.state.pa.us/Health/AccessHealthCare/SuppServWaivers/003671640.htm
Summary of State Plan Coverage To provide respite care; habilitation, including residential habilitation, day habilitation, home and community-based habilitation, prevocational services, and support employment services; environmental accessibility adaptations; transportation; chore services; visiting nurse services; specialized therapies; and permanency planning for children and youth.
Populations Served Individuals aged three and older with mental retardation who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (EAA), adaptive equipment.
Examples of Covered HM and AT Services EAA: Physical adaptations to vehicles, limited to: vehicular lifts, interior alterations of seats for proper positioning and safety of the individual, and other customized devices necessary for safe transportation of the individual. Physical adaptations to homes, limited to: ramps for egress to the home, rooms within the home, or vehicle; handrails and grab-bars in and around the home; adaptation of a smoke/fire alarm or detection system for individuals with sensory impairments; widening of doorways, landings, hallways, and sidewalks; modification of counters or work surfaces, major appliances, and furnishings; stair glider and elevating systems.

Adaptive equipment: Eating utensils such as scoop plates, spout cups, and silverware with modified handles; cooking and cleaning equipment; personal care items such as toothbrushes, soap holders, or washcloths; communication devices such as electronic language boards; switching devices; and reaching devices.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X   X N/A X N/A
Benefit Limits EAA: $20,000 per household. If the individual moves, a new $20,000 limit applies.

Adaptive equipment: None.
Training on Use and Repairs EAA: Training: Information N/A. Repairs: yes.

Adaptive equipment: Information N/A


AIDS Waiver (0192)
Agency Name Pennsylvania Department of Public Welfare, Office of Medical Assistance Programs, Waiver Implementation Unit
Phone 717-772-2525
Web site http://www.dpw.state.pa.us/Health/AccessHealthCare/SuppServWaivers/003671593.htm
Summary of State Plan Coverage To provide homemaker services, home health visits, home health aides, specialized medical equipment and supplies, nutritional consultations, and transition services to individuals over 21 with AIDS.
Populations Served Individuals who are 21 and older who have symptomatic HIV disease or AIDS and meet the level of care criteria for an acute, skilled nursing, or intermediate care facility.
Terminology for HM and AT Specialized medical equipment and supplies.
Examples of Covered HM and AT Services Information N/A.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


OBRA Home and Community-Based Waiver (0235)
Agency Name Pennsylvania Department of Public Welfare, Ofice of Social Programs
Phone 717-787-3438
Web site http://www.dpw.state.pa.us/Disable/HomeCommServices/003670916.htm
Summary of State Plan Coverage For individuals aged 18 or older with disabilities excluding mental retardation or a major mental disorder. To provide coordination/resource management, daily living, respite care, adult day health care, habilitation including prevocational education and supported employment, community integration, environmental accessibility adaptations, transportation, assistive technology, personal emergency response systems, physical therapy, occupational therapy, speech/language and visiting nurse services.
Populations Served Individuals with severe physical disabilities or severe developmental disabilities with onset prior to age 22, or who require an Intermediate Care Facility/Other Related Conditions level of care.
Terminology for HM and AT Environmental adaptations, personal emergency response systems (PERS), assistive technology/specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Information N/A.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Attendant Care Waiver (0277)
Agency Name Pennsylvania Department of Public Welfare
Phone 1-800-757-5042
Web site http://www.dpw.state.pa.us/Health/AccessHealthCare/SuppServWaivers/003670176.htm
Summary of State Plan Coverage To provide personal assistance, supports coordination, personal emergency response systems, and community transition services for individuals aged 18-59 with physical disabilities.
Populations Served Individuals between 18 and 59, with physical disabilities, who are mentally alert and who meet the nursing home level of care criteria.
Terminology for HM and AT Personal emergency response systems (PERS).
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Pennsylvania Department of Aging (PDA) Waiver (0279)
Agency Name Pennsylvania Department of Aging and Pennsylvania Department of Pubic Welfare, Office of Medical Assistance Programs, Waiver Implementation Unit
Phone 717-772-2525
Web site http://www.dpw.state.pa.us/Health/AccessHealthCare/SuppServWaivers/003671492.htm
Summary of State Plan Coverage To provide personal care services, companion services, counseling, environmental modifications, extended physician services, home-delivered meals, home health services, home support services, older adult daily living centers, personal emergency response systems, respite care, specialized durable medical equipment and supplies, and transportation to individuals who are 60 or older and meet the nursing home level of care criteria.
Populations Served Individuals age 60 or older who meet the nursing home level of care criteria. Income limit must be equal to or less than 300 percent of the Federal Benefit Rate, with resources of $2,000 or less.
Terminology for HM and AT Environmental modifications, personal emergency response systems (PERS), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Environmental modifications: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems that are necessary to accommodate medical equipment and supplies.

PERS: An electronic device that enables a person to secure help in an emergency.

SMES: Devices, controls, or appliances that enable recipients to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live. Also includes items necessary for life support and durable and non-durable medical equipment not available under the Medicaid State Plan.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Environmental modifications and

SMES: Information N/A.

PERS: Training: yes. Repairs: yes.


Independence Home and Community-Based Waiver (0319)
Agency Name Pennsylvania Department of Public Welfare, Office of Social Programs
Phone 717-787-3438
Web site http://www.dpw.state.pa.us/Disable/HomeCommServices/003670931.htm
Summary of State Plan Coverage To provide service coordination, daily living services, respite care, environmental adaptations, special medical equipment and supplies, personal emergency response systems, physical and occupational therapy, and speech, hearing and language services to disabled adults.
Populations Served Individuals who are 18 and older with severe physical disabilities and who meet the nursing facility level of care criteria. Primary diagnosis cannot be mental health or mental retardation.
Terminology for HM and AT Assistive technology/specialized medical equipment and supplies (SMES), environmental adaptations, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Information N/A.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Person/Family Directed Support Waiver (354)
Agency Name Pennsylvania Department of Public Welfare, Office of Mental Retardation
Phone 717-783-5764
Web site http://www.dpw.state.pa.us/Health/AccessHealthCare/SuppServWaivers/003671641.htm
Summary of State Plan Coverage To provide homemaker/chore services, respite care, habilitation (residential, day, prevocational and supported employment services) environmental accessibility adaptations, transportation, specialized therapies, visiting nurse services, adaptive appliances and equipment and personal support to mentally retarded individuals aged three and above.
Populations Served Individuals with mental retardation who are aged three and older. Does not require Office of Mental Retardation licensed community residential services.
Terminology for HM and AT Adaptive equipment, environmental accessibility adaptations (EAA).
Examples of Covered HM and AT Services Adaptive equipment: Eating utensils such as scoop plates, spout cups, and silverware with modified handles; cooking and cleaning equipment; personal care items such as toothbrushes, soap holders, or washcloths; communication devices such as electronic language boards, switching devices, and reaching devices.

EAA: Vehicular lifts, interior alterations of seats for proper positioning and safety of the individual, and other customized devices necessary for safe transportation of the individual. Physical adaptations to homes, limited to: ramps for egress to the home, rooms within the home, or vehicle; handrails and grab-bars in and around the home; adaptation of a smoke/fire alarm or detection system for individuals with sensory impairments; widening of doorways, landings, hallways, and sidewalks; modification of counters or work surfaces, major appliances, and furnishings; stair glider and elevating systems.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X   X N/A X N/A
Benefit Limits General: This waiver has an annual, per person cap of $22,083.

EAA: $20,000 per household. If the individual moves, a new $20,000 limit applies.
Training on Use and Repairs Adaptive equipment: Training: no. Repairs: no.

EAA: Training: Information N/A. Repairs: yes.


COMMCARE Waiver Program (386)
Agency Name Pennsylvania Department of Public Welfare, Office of Social Programs
Phone 717-787-3438
Web site http://www.dpw.state.pa.us/Disable/HomeCommServices/003670179.htm
Summary of State Plan Coverage To provide case management, personal care, respite care, habilitation (prevocational, supported employment, educational services), environmental adaptations, non-medical transportation, specialized medical equipment, supplies and assistive technology, chore services, personal emergency response systems, physical and occupational therapy, speech, coaching/cueing, night supervision, structured day program, behavioral specialist, cognitive therapy, counseling, and community integration for individuals 21 and older diagnosed with Traumatic Brain Injury.
Populations Served Individuals age 21 and older who experience a medically determinable diagnosis of traumatic brain injury and require a Special Rehabilitative Facility level of care.
Terminology for HM and AT Environmental adaptations; specialized medical equipment/supplies (SMES) and assistive technology; personal emergency response systems (PERS).
Examples of Covered HM and AT Services Environmental adaptations: Physical adaptations to the home, required by the consumer's plan of care, necessary to ensure consumer's health, safety, and well-being, or that enable consumers to function with greater independence in the home, and without which consumer would require institutionalization.

SMES and assistive technology: Devices, controls, or appliances that enable consumers to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with their environment; items necessary for life support.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A X N/A
Benefit Limits Environmental adaptations: $20,000 per consumer, per lifetime.

SMES and assistive technology: $10,000 lifetime maximum.

PERS: Information N/A
Training on Use and Repairs Information N/A.


Michael Dallas Waiver (4144)
Agency Name Pennsylvania Department of Public Welfare, Office of Medical Assistance Programs, Waiver Implementation Unit
Phone 717-772-2525
Web site http://www.dpw.state.pa.us/Health/AccessHealthCare/SuppServWaivers/003671490.htm
Summary of State Plan Coverage To provide attendant care, case management, specialized medical equipment and supplies, private duty nursing, respite care, and transition services to individuals of any age who are technology dependent.
Populations Served Recipients of any age who are technology dependent (i.e., requiring technology to sustain life or replace a vital body function and avert immediate threat to life). Income must be equal or less than 300 percent of the Federal Benefit Rate and resources must be less than $2000.
Terminology for HM and AT Specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Information N/A.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Elwyn Waiver (0313)
Agency Name Pennsylvania Department of Public Welfare, Office of Medical Assistance Programs, Waiver Implementation Unit
Phone 717-772-2525
Web site http://www.dpw.state.pa.us/Health/AccessHealthCare/SuppServWaivers/003671491.htm
Summary of State Plan Coverage To provide personal care services, counseling services, home health services, therapeutic social and recreational programming, and special medical equipment and supplies to people over 40 who are deaf and/or blind.
Populations Served Individuals over 40 who are deaf and/or blind and meet skilled nursing facility care criteria. Income must be less than 300 percent of the Federal Benefit Rate and resources must be less than $2,000.
Terminology for HM and AT Special medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Information N/A.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


RHODE ISLAND

Overview Rhode Island provides coverage for home modifications and assistive technology through six waivers; the Medicaid State Plan covers power-operated vehicles.
Medicaid State Plan Coverage
Agency Name Department of Human Services, Medical Assistance (MA) Program
Phone 1-800-964-6211
Web site http://www.dhs.state.ri.us/dhs/adults/dmadult.htm
Summary of State Plan Coverage The Rhode Island Medicaid State Plan covers durable medical equipment such as power-operated vehicles and portable showerheads.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME).
Examples of Covered HM and AT Services DME: Raised toilet seats, versa frames, grab-bars, portable showerheads, power-operated vehicles, patient lifts, roll-abouts, and mobile geriatric chairs.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A X X  
Benefit Limits None.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.


Aged/Disabled Waiver (0040)
Agency Name Department of Human Services
Phone 401-725-6211
Web site http://www.dhs.state.ri.us/dhs/heacre/provsvcs/manuals/waiver/agedisab.htm#cov
Summary of State Plan Coverage To provide homemaker services, personal care, environmental accessibility adaptations, skilled nursing, specialized medical equipment and supplies, personal emergency response systems, senior companion services, and meals on wheels to individuals who are aged and disabled.
Populations Served People who are 65 years of age or older and are homebound.
Terminology for HM and AT Specialized medical equipment and supplies (SMES)/minor assistive devices; minor home modifications (known as environmental accessibility adaptations (EAA)); personal emergency response systems (PERS).
Examples of Covered HM and AT Services SMES/minor assistive devices: Grooming, cooking and eating aids.

Minor home modifications: Ramps, grab-bars, toilet modifications.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X  
Benefit Limits None.
Training on Use and Repairs Training: yes for all services (except for personal emergency response system).

Repairs: yes.


Department of Elderly Affairs Waiver (0176)
Agency Name Department of Elderly Affairs
Phone 401-462-4000
Web site http://www.dhs.state.ri.us/dhs/heacre/provsvcs/manuals/waiver/dea.htm
Summary of State Plan Coverage To provide case management, homemaker services, home health aide, personal care, special medical equipment and supplies, personal emergency response systems, assisted living, senior companion services, meals on wheels, minor assistive devices, and minor modifications to the home for individuals 65 and over.
Populations Served People who are 65 years of age or older and are homebound. Recipients can be either categorically eligible or medically needy.
Terminology for HM and AT Specialized medical equipment (SMES)/minor assistive devices, minor home modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services SMES/minor assistive devices: Grooming, cooking and eating aids.

Minor home modifications: Ramps, grab-bars, toilet modifications.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X  
Benefit Limits None.
Training on Use and Repairs Training: yes for all services (except for personal emergency response system).

Repairs: yes.


Mentally Retarded/Developmentally Disabled Waiver (0162)
Agency Name Department of Mental Health, Retardation and Hospitals (MHRH), Division of Developmental Disabilities
Phone 401-462-3234
Web site http://www.dhs.state.ri.us/dhs/heacre/provsvcs/manuals/waiver/mrdd.htm
Summary of State Plan Coverage To provide case management, homemaker services, respite care, residential habilitation, day habilitation, supported employment, environmental modifications, specialized medical equipment and supplies, personal emergency response systems, adult foster care and special homemaker services to individuals between 22 and 64 who are at risk for placement in an Intermediate Care Facility for the Mentally Retarded.
Populations Served Individuals between 22 and 64 who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Specialized medical equipment and supplies (SMES)/minor assistive devices, minor home modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services SMES/minor assistive devices: Grooming, cooking and eating aids.

Minor home modifications: Ramps, grab-bars, toilet modifications.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X  
Benefit Limits None.
Training on Use and Repairs Training: yes for all services (except for personal emergency response system).

Repairs: yes.


People Actively Reaching Independence (PARI)/Severely Handicapped Waiver (40126)
Agency Name Department of Human Services, in conjunction with People Actively Reaching Independence (PARI)
Phone 401-725-1966
Web site http://www.dhs.state.ri.us/dhs/heacre/provsvcs/manuals/waiver/sevhand.htm
Summary of State Plan Coverage To provide case management and personal care services, consumer preparation, diaper, underpads and linings, minor assistive devices, minor modifications to the home, and training to severely disabled adults. Medicaid recipients hire and supervise their own personal care attendants with training assistance from the People Actively Reaching Independence’s Independent Living Center.
Populations Served Quadriplegic individuals living in the community who are 18 years of age or older and have demonstrated the ability and competence to direct their own care.
Terminology for HM and AT Minor assistive devices, minor home modifications.
Examples of Covered HM and AT Services Minor assistive devices: Grooming, cooking and eating aids.

Minor home modifications: Ramps, grab-bars, toilet modifications.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X  
Benefit Limits None.
Training on Use and Repairs Training: yes for all services (except for personal emergency response system).

Repairs: yes.


Assisted Living Waiver
Agency Name Department of Human Services
Phone 401-725-1966
Web site http://www.dhs.state.ri.us/dhs/dhcbwser.htm
Summary of State Plan Coverage To provide assistive technology to individuals of any age who require 24-7 nursing care in their home.
Populations Served Individuals of any age who require 24-7 nursing care in their home.
Terminology for HM and AT Minor assistive devices.
Examples of Covered HM and AT Services Minor assistive devices: Grooming, cooking and eating aids.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A X X  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Habilitation Waiver
Agency Name Department of Human Services
Phone 401-725-1966
Web site http://adrc.ohhs.ri.gov/paying/Habilitation_%20HCBP.php
Summary of State Plan Coverage Provides assistive technology, home modification, and personal emergency response systems to individuals with an adult onset cognitive disability, such as a brain injury.
Populations Served Individuals who are 18 and older and who are severely and permanently disabled. Most participants in this program are people who have had brain injuries.
Terminology for HM and AT Minor assistive devices, minor home modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Minor assistive devices: Grooming, cooking and eating aids.

Minor home modifications: Ramps, grab-bars, toilet modifications.

PERS: An electronic device that enables a person to obtain help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X  
Benefit Limits None.
Training on Use and Repairs Training: yes for all services (except for personal emergency response system).

Repairs: yes.


SOUTH CAROLINA

Overview South Carolina covers assistive technology through the Medicaid State Plan and home modifications and assistive technology through six waivers.
Medicaid State Plan Coverage
Agency Name Department of Health and Human Services
Phone 803-898-2500
Web site http://www.dhhs.state.sc.us/dhhsnew/index.asp
Summary of State Plan Coverage The South Carolina Medicaid State Plan covers augmentative communication devices, power wheelchairs, patient lifts, speech-generating devices, walkers, and gait trainers under the durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), speech-generating devices.
Examples of Covered HM and AT Services DME: Power wheelchairs and accessories, patient lifts, speech-generating devices, walkers, and gait trainers.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X  
Benefit Limits Information N/A.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.


Elderly and Disabled Waiver (0104)
Agency Name Department of Health and Human Services, Community Long Term Care Division
Phone 803-898-2590
Web site http://www.dhhs.state.sc.us/dhhsnew/insidedhhs/bureaus/BureauofLongTermCareServices/CLTCOverview.ASP
Summary of State Plan Coverage To provide case management, personal care, respite care, adult day health care, environmental modifications, personal emergency response systems, nursing home transition services, companion services, attendant care, and limited incontinence supplies to elderly and disabled individuals who are 18 and over.
Populations Served Elderly and disabled individuals, aged 18 and over, who meet the nursing facility level of care criteria.
Terminology for HM and AT Environmental modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Environmental modifications: Pest control, ramps, minor physical adaptations to the home.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Mental Retardation and Developmental Disabilities Waiver (0237)
Agency Name Department of Health and Human Services, Community Long Term Care Division
Phone 803-898-2590
Web site http://www.dhhs.state.sc.us/dhhsnew/insidedhhs/bureaus/BureauofLongTermCareServices/CLTCOverview.ASP
Summary of State Plan Coverage To provide personal care, respite care, adult day health care, habilitation (residential, day, prevocational, and supported employment), environmental modifications, specialized medical equipment and supplies, assistive technology, adult companion services, psychological services, nursing, private vehicle modifications, behavior supports, physical therapy, occupational therapy, prescribed drugs, speech-language pathology, audiology services, and adult dental and vision services to persons with mental retardation and related conditions.
Populations Served Persons with mental retardation and related conditions who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Environmental modifications, vehicle modifications, specialized medical equipment and supplies (SMES), personal emergency response systems (PERS).
Examples of Covered HM and AT Services Environmental modifications: Physical adaptations made to the client’s home to ensure health, safety, and welfare and greater independence.

Vehicle modifications: Modifications made to privately owned vehicles driven or used to transport mental retardation waiver recipients to enhance independence in the community.

SMES: Equipment provided to mental retardation waiver clients to ensure health, safety and welfare and/or increase independence in the home and community.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Head and Spinal Cord Injury Waiver (0284)
Agency Name Department of Health and Human Services, Community Long Term Care Division
Phone 803-898-2590
Web site http://www.dhhs.state.sc.us/dhhsnew/insidedhhs/bureaus/BureauofLongTermCareServices/CLTCOverview.ASP
Summary of State Plan Coverage To provide respite care, habilitation (residential, day, prevocational, and supported employment), environmental modifications, nursing, specialized medical equipment and supplies, personal emergency response systems, attendant care/personal assistance services, psychological services, behavioral support, private vehicle modifications, physical therapy, occupational therapy, other therapies (including speech, hearing and language), health education and peer guidance for consumer directed care, and prescribed drugs to individuals with head and spinal cord injuries.
Populations Served Individuals aged 0-65 with head and/or spinal cord injuries who meet the nursing facility or Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Environmental modifications, specialized medical equipment and supplies (SMES), equipment, personal emergency response systems (PERS), private vehicle modifications.
Examples of Covered HM and AT Services Environmental modifications: Ramps, bathroom modifications, and floor surface modifications.

SMES: Special wheelchairs and other items not covered under the state plan; communication devices.

PERS: An electronic device that enables a person to secure help in an emergency.

Private vehicle modifications: Modifications to a privately owned vehicle to be driven by or routinely used to transport the participant, including any equipment necessary to make the vehicle accessible to the participant. Examples include special steering wheel adaptations, electric lifts, and tie-downs.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Mechanical Ventilator Dependent Waiver
Agency Name Department of Health and Human Services, Community Long Term Care Division
Phone 803-898-2590
Web site http://www.dhhs.state.sc.us/dhhsnew/insidedhhs/bureaus/BureauofLongTermCareServices/CLTCOverview.ASP
Summary of State Plan Coverage To provide environmental modifications, nursing services, personal care, respite care, and specialized medical equipment and supplies to clients who are dependent on mechanical ventilation and have long-term care needs.
Populations Served Medicaid recipients, age 21 years or older, who meet the skilled or intermediate level of care criteria and who require mechanical ventilation.
Terminology for HM and AT Personal emergency response systems (PERS), environmental modifications, specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.

Environmental modifications: Pest control, minor modifications to the home.

SMES: Medical supplies to assist with care at home.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


HIV/AIDS Waiver
Agency Name Department of Health and Human Services, Community Long Term Care Division
Phone 803-898-2590
Web site http://www.dhhs.state.sc.us/dhhsnew/insidedhhs/bureaus/BureauofLongTermCareServices/CLTCOverview.ASP
Summary of State Plan Coverage To provide case management, attendant care, companion care, environmental modifications, foster care, home-delivered meals, personal care, and nursing services to HIV/AIDS clients.
Populations Served Medicaid recipients of any age who are diagnosed with HIV/AIDS and are at risk for hospitalization.
Terminology for HM and AT Environmental modifications.
Examples of Covered HM and AT Services Environmental modifications: Pest control and minor physical adaptations to the home.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


South Carolina Choice Waiver
Agency Name Department of Health and Human Services, Community Long Term Care Division
Phone 803-898-2590
Web site http://www.dhhs.state.sc.us/dhhsnew/insidedhhs/bureaus/BureauofLongTermCareServices/CLTCOverview.ASP
Summary of State Plan Coverage To provide consumer-directed care advice, personal care, companion service, environmental modifications, home-delivered meals, adult day health care, nursing services, respite care, personal emergency response systems, limited incontinence supplies, and appliances to people with long-term care needs who choose to live at home.
Populations Served Individuals who are 21 years of age and older who want to have greater say in their care, and who are unable to perform their own activities of daily living due to illness or disability.
Terminology for HM and AT Environmental modifications, personal emergency response systems (PERS), appliances/assistive technology.
Examples of Covered HM and AT Services Environmental modifications: Pest control services and minor physical adaptations to the home.

PERS: An electronic device that enables a person to secure help in an emergency.

Appliances: Devices, controls, or household appliances that enable the individual to perform activities of daily living.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


SOUTH DAKOTA

Overview South Dakota covers a range of assistive technologies and home modifications through three waivers, and selected adaptive and assistive equipment through the Medicaid State Plan.
Medicaid State Plan Coverage
Agency Name Department of Social Services, Division of Adult Services and Aging
Phone 605-773-4678
Web site http://dss.sd.gov/medicalservices/
Summary of State Plan Coverage The South Dakota Medicaid State Plan covers assistive technology through the durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), augmentative communication devices.
Examples of Covered HM and AT Services DME: Bed rails; manually or electrically operated hospital beds, including regular mattresses and side rails; motorized wheelchairs with seats that also serve as a commode; wheelchair seat or back cushions, including accessories and drop seat; augmentative communication devices.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A X N/A X N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.


Elderly Waiver (Aged Waiver) (0189)
Agency Name South Dakota Department of Social Services, Division of Adult Services and Aging
Phone 605-773-3656
Web site http://dss.sd.gov/medicaleligibility/longtermcare/elderly.asp
Summary of State Plan Coverage To provide assisted living services, homemaker services, nursing, home-delivered meals, emergency response, and adult day care to seniors.
Populations Served Medicaid recipients who are 65 years of age and older and meet the nursing home level of care criteria.
Terminology for HM and AT Assistive devices, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Assistive devices: Items, such as medication management devices, that can increase an individual's independence.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X N/A N/A N/A N/A
Benefit Limits May not exceed 85 percent of a monthly nursing home cost.
Training on Use and Repairs Training: yes.

Repairs: yes.


Intermediate Care Facility for the Mentally Retarded Waiver (0044)
Agency Name South Dakota Department of Human Services, Division of Developmental Disabilities
Phone 605-773-3438
Web site http://dss.sd.gov/medicaleligibility/longtermcare/developmentallydisabled.asp
Summary of State Plan Coverage To provide service coordination; residential and day habilitation; supported employment; specialized medical equipment and supplies; and nursing to people with mental retardation/developmental disability.
Populations Served Medicaid recipients with mental retardation and/or developmental disability who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Specialized medical equipment.
Examples of Covered HM and AT Services Specialized medical equipment: items that enable individuals to increase their ability to perform activities of daily living or are necessary for life support. Services are limited to devices not available under the Medicaid State Plan.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Training: yes.

Repairs: yes.


Family Support Program (ICF/MR Waiver) (0338)
Agency Name South Dakota Department of Human Services, Division of Developmental Disabilities
Phone 605-773-3438
Web site http://www.state.sd.us/dhs/dd/family/index.htm
Summary of State Plan Coverage To provide service coordination, specialized medical equipment, and respite care, personal care services, environmental accessibility adaptations, and companion services to people under 22 with mental retardation/developmental disabilities.
Populations Served Individuals who are under 22, meet the Intermediate Care Facility for the Mentally Retarded level of care criteria, and live with their families.
Terminology for HM and AT Adaptive equipment and supplies, environmental access adaptations (housing modifications and vehicle modifications), specialized medical equipment.
Examples of Covered HM and AT Services Adaptive equipment and supplies: Information N/A.

Environmental access adaptations: Housing and vehicle modifications including van lifts, wheelchair ramps, fences, widening of doorways, modification of bathroom facilities, and installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.

Specialized medical equipment: Information N/A.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X N/A N/A X N/A
Benefit Limits Monthly caps exist, but there are no lifetime benefits caps.
Training on Use and Repairs Training: yes.

Repairs: yes.


TENNESSEE

Overview Tennessee provides coverage of assistive technology and home modifications through six waivers. Some waivers provide service in specific counties, and the three Mental Retardation waivers provide the most extensive coverage of home modifications and assistive technologies.
Medicaid State Plan Coverage
Agency Name Tennessee Department of Finance and Administration
Phone Information N/A
Web site http://www.state.tn.us/sos/rules/1200/1200-13/1200-13-13.pdf
http://www.tennessee.gov/tenncare/
Summary of State Plan Coverage The Tennessee Medicaid State Plan covers assistive technology through the durable medical equipment and medical supplies benefit. Nearly the entire TennCare program operates under a Section 1115(a) waiver.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME) and medical supplies.
Examples of Covered HM and AT Services Wheelchairs.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A N/A N/A X N/A N/A
Benefit Limits Information N/A
Training on Use and Repairs Information N/A


Mental Retardation Waiver (0128)
Agency Name Tennessee Department of Finance and Administration, Division of Mental Retardation Services (DMRS)
Phone 615-231-5049 (Middle Tennessee)
901-213-1980 (West Tennessee)
865-588-0508 ext. 163 (East Tennessee)
Web site http://tennessee.gov/tenncare/ltcare/ltcdd_waiver2.htm
Summary of State Plan Coverage To provide adult dental services, personal assistance, behavioral respite services, personal emergency response systems, behavior services, physical therapy services, day services, residential habilitation, environmental accessibility modifications, respite care, family model residential support, specialized medical equipment supplies, assistive technology, individual transportation services, medical residential services, speech, language, and hearing services, nursing services, support coordination, nutrition services, supported independence services, occupational therapy services, supported living, orientation and mobility training, and vehicle accessibility modifications.
Populations Served Mentally retarded and developmentally disabled individuals.
Terminology for HM and AT Environmental accessibility modifications, specialized medical equipment, supplies (SMES), and assistive technology, personal emergency response systems (PERS), vehicle accessibility modifications.
Examples of Covered HM and AT Services Environmental accessibility modifications: Wheelchair ramps, widening of doorways, modifications of bathroom and kitchen facilities, and installation of specialized electrical or plumbing systems to accommodate necessary medical equipment and supplies.

SMES and assistive technology: Communication devices; hearing devices; specialized lifts (excluding Hoyer lifts); positioning equipment; and wheelchairs and seating devices.

PERS: An electronic device that enables a person to secure help in an emergency.

Vehicle accessibility modifications: Lifts that allow access to the vehicle and interior modifications such as grab-bars, head/leg rests, devices to secure wheelchairs in a stationary position, roof modifications, and safety belts.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X X
Benefit Limits Environmental accessibility modifications: $15,000 per enrollee, per two-year period.

SMES and assistive technology: $10,000 per enrollee, per two-year period.

PERS: Information N/A.

Vehicle accessibility modifications: $20,000 per enrollee, per 5-year period.
Training on Use and Repairs Environmental accessibility modifications: Training: yes. Repairs: information N/A.

SMES and assistive technology: Training: yes. Repairs: information N/A.

PERS: Training: Information N/A. Repairs: yes.

Vehicle accessibility modifications: Training: yes. Repairs: yes.


Self-Determination Waiver Program (0427)
Agency Name Tennessee Department of Finance and Administration, Division of Mental Retardation Services (DMRS)
Phone 615-231-5289 (MTRO)
901-213-1800 (WTRO)
865-588-0508 ext. 163 (ETRO)
800-535-9725 Statewide Mental Retardation Hotline
Web site http://tennessee.gov/tenncare/ltcare/ltcdd_waiver1.htm
Summary of State Plan Coverage Provides adult dental services, behavioral respite services, behavior services, day services, environmental accessibility modifications, financial administration, individual transportation services, nutrition services, nursing services, occupational therapy services, orientation and mobility training, personal assistance, personal emergency response systems, physical therapy services, respite care, specialized medical equipment, supplies, and assistive technology, speech, language and hearing services, supports brokerage, and vehicle accessibility modifications. This program allows the individual to self-direct services, including services such as personal assistance.
Populations Served Individuals of any age diagnosed with mental retardation before age 18, or who have a medical diagnosis of developmental disability and are aged four or younger.
Terminology for HM and AT Environmental accessibility modifications, specialized medical equipment and supplies (SMES) and assistive technology, personal emergency response systems (PERS), vehicle accessibility modifications.
Examples of Covered HM and AT Services Environmental accessibility modifications: Wheelchair ramps, widening of doorways, modifications of bathroom and kitchen facilities, and installation of specialized electrical or plumbing systems to accommodate necessary medical equipment and supplies.

SMES and assistive technology: Communication devices; hearing devices; specialized lifts (excluding Hoyer lifts); positioning equipment; and wheelchairs and seating devices.

PERS: An electronic device that enables a person to obtain help in an emergency.

Vehicle accessibility modifications: Lifts that allow access to the vehicle and interior modifications such as grab-bars, head/leg rests devices to secure wheelchairs in a stationary position, roof modifications and safety belts.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X  
Benefit Limits The total budget for all waiver services, including emergency assistance services, shall not exceed $36,000 per year, per participant ($30,000 without emergency assistance services).
Training on Use and Repairs Environmental accessibility modifications: Training: yes. Repairs: information N/A.

SMES and assistive technology: Training: yes. Repairs: yes.

PERS: Training: Information N/A. Repairs: yes.

Vehicle accessibility modifications: Training: yes. Repairs: yes.


Mental Retardation Waiver (Arlington Waiver) (0357)
Agency Name Tennessee Department of Finance and Administration, Division of Mental Retardation Services (DMRS)
Phone 901-213-1800
Web site http://tennessee.gov/tenncare/ltcare/ltcdd_waiver3.htm
Summary of State Plan Coverage To provide personal assistance; behavioral respite services; personal emergency response systems; behavior services; physical therapy services; day services; residential habilitation; environmental accessibility modifications; respite care; family model residential support; specialized medical equipment, supplies, and assistive technology; individual transportation services; medical residential services; speech, language, and hearing services; nursing services; support coordination; nutrition services; supported independence services; occupational therapy services; supported living; orientation and mobility training; vehicle accessibility modifications; and vision services.
Populations Served Individuals with mental retardation who are class members certified in United States vs. Tennessee, et. al. (Arlington Developmental Center) and who would otherwise require the level of care provided in an Intermediate Care Facility for the Mentally Retarded.
Terminology for HM and AT Environmental accessibility modifications, specialized medical equipment, supplies (SMES) and assistive technology, personal emergency response systems (PERS), vehicle accessibility modifications
Examples of Covered HM and AT Services Environmental accessibility modifications: Wheelchair ramps, widening of doorways, modifications of bathroom and kitchen facilities, and installation of specialized electrical or plumbing systems to accommodate necessary medical equipment and supplies.

SMES and assistive technology: Communication devices; hearing devices; specialized lifts (excluding Hoyer lifts); positioning equipment; and wheelchairs and seating devices.

PERS: An electronic device that enables a person to secure help in an emergency.

Vehicle accessibility modifications: Lifts that allow access to the vehicle and interior modifications such as grab-bars, head/leg rests devices to secure wheelchairs in a stationary position, roof modifications and safety belts.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X X
Benefit Limits Environmental accessibility modifications: $15,000 per enrollee, per two-year period.

SMES and assistive technology: $10,000 per enrollee, per two-year period.

PERS: Information N/A.

Vehicle accessibility modifications: $20,000 per enrollee, per five-year period.
Training on Use and Repairs Environmental accessibility modifications: Training: yes. Repairs: information N/A.

SMES and assistive technology: Training: yes. Repairs: yes.

PERS: Training: Information N/A. Repairs: yes.

Vehicle accessibility modifications: Training: yes. Repairs: yes.


Elderly and Disabled Waiver (CBS Shelby County) (0062)
Agency Name Tennessee Department of Finance and Administration, Commission on Aging and Disability
Phone 866-836-6678
Web site http://tennessee.gov/tenncare/ltcare/Shelby.htm
Summary of State Plan Coverage To provide case management, homemaker services, personal care services, minor home modifications, personal emergency response systems, home-delivered meals and respite care to elderly and disabled individuals.
Populations Served Disabled individuals over the age of 21 and elderly individuals. In Shelby County, the waiver is limited to the elderly and disabled; in Davidson, Hamilton, and Knox counties, the waiver is limited to individuals 65 and over.
Terminology for HM and AT Minor home modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Minor home modifications: Ramps, rails, non-skid surfacing, and grab-bars.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X   X X X
Benefit Limits None.
Training on Use and Repairs Minor home modifications: Training: no. Repairs: yes.

PERS: Training: yes. Repairs: yes.


Adapt (Disabled and Aged Waiver) (0248)
Agency Name Tennessee Department of Health, administered by Davidson, Hamilton, and Knox Counties
Phone 615-837-0700 (Davidson County)
423-894-4322 (Hamilton County)
865-769-8007 (Knox County)
Web site http://tennessee.gov/tenncare/ltcare/ADAPT.htm
http://www.state.tn.us/tenncare/form/adapt%20fact%20sheet%20.pdf
Summary of State Plan Coverage To provide case management, personal care service, home-delivered meals, minor home modifications, and personal emergency response systems.
Populations Served Medicaid nursing home eligible recipients in Davidson, Hamilton, and Knox counties.
Terminology for HM and AT Minor home modifications, personal emergency response system (PERS).
Examples of Covered HM and AT Services Minor home modifications: Ramps, rails, non-skid surfacing, and grab-bars.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X   X X X
Benefit Limits None.
Training on Use and Repairs Minor home modifications: Training: no. Repairs: yes.

PERS: Training: yes. Repairs: yes.


Disabled Individuals over 21 Waiver (HCBS Statewide) (0381)
Agency Name Tennessee Department of Finance and Administration, Commission on Aging and Disability
Phone 866-836-6678
Web site http://www.state.tn.us/tenncare/ltcare/Statewide.htm
Summary of State Plan Coverage To provide case management, homemaker services, personal care services, minor home modifications, personal emergency response systems, home-delivered meals and respite care to elderly and disabled individuals.
Populations Served Disabled individuals over 21.
Terminology for HM and AT Minor home modifications, personal emergency response system (PERS).
Examples of Covered HM and AT Services Minor home modifications: Ramps, rails, non-skid surfacing, and grab-bars.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X   X X X
Benefit Limits None.
Training on Use and Repairs Minor home modifications: Training: no. Repairs: yes.

PERS: Training: yes. Repairs: yes.


TEXAS

Overview Texas covers assistive technologies and home modifications through the Medicaid State Plan and nine Home and Community-Based Services waivers. Five of the nine waivers also cover personal emergency response systems.
Medicaid State Plan Coverage
Agency Name Texas Health and Human Services Commission
Phone 512-491-1104
Web site http://www.hhsc.state.tx.us/medicaid/med_info.html
Summary of State Plan Coverage The Texas Medicaid State Plan covers wheelchairs and augmentative communication devices under the durable medical equipment benefit, but does not cover home modifications.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), augmentative communication devices (ACD).
Examples of Covered HM and AT Services DME: Augmentative communication devices and wheelchairs.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
  X N/A X X  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Consolidated Waiver Program (MR/DD Waiver) (0374)
Agency Name Texas Department of Aging and Disability Services
Phone 512-438-3444
Web site http://www.dads.state.tx.us/business/pi/mfp_grant/Com_Care_Options_manual.pdf
http://www.dads.state.tx.us/business/communitycare/waiver_comparisons/index.html
Summary of State Plan Coverage For mentally retarded and developmentally disabled individuals. To provide personal care, respite, habilitation (residential, day, supported employment), environmental accessibility adaptations, skilled nursing, transportation, specialized medical equipment and supplies, adaptive aids, vehicle modifications, personal emergency response systems, adult residential care, adult foster care, assistive living, physical therapy, occupational therapy, speech hearing and language, prescribed drugs, family surrogate services, intervenor, dietary service, behavior communication, dental care, and home-delivered meals.
Populations Served Mentally retarded and developmentally disabled individuals in Bexar County.
Terminology for HM and AT Minor home modifications, adaptive aids/specialized medical equipment and supplies (SMES), personal emergency response systems (PERS).
Examples of Covered HM and AT Services Minor home modifications: Purchase or repair of wheelchair ramps, modifications/additions to bathroom or kitchen facilities, and specialized accessibility/safety adaptations/additions that include door widening/grab-bars/door openers.

Adaptive aids/SMES: Lifts, mobility aids, respiratory aids, positioning devices, communication aids, control switches, environmental control units, vehicle modifications, sensory adaptations, adaptive equipment for activities of daily living, and medical supplies.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X  
Benefit Limits Minor home modifications: There are cost caps, but there is no defined price list. Adaptive aids/

SMES: $10,000 per participant, per individual service plan year.

PERS: None.
Training on Use and Repairs Minor home modifications: Training: yes. Repairs: yes. Adaptive aids/

Medical supplies: Training: yes. Repairs: yes.

PERS: Training: yes. Repairs: yes.


Home and Community-Based (HCB) Waiver (ICF/MR Waiver) (0110)
Agency Name Texas Department of Aging and Disability Services
Phone 512-438-4512
Web site http://www.dads.state.tx.us/business/pi/mfp_grant/Com_Care_Options_manual.pdf
http://www.dads.state.tx.us/business/communitycare/waiver_comparisons/index.html
Summary of State Plan Coverage To provide case management, respite care, day habilitation, supported employment, environmental accessibility adaptations, skilled nursing, specialized medical equipment and supplies, supported home living, foster/companion care, supervised living, residential support, counseling and therapies, and dental treatment for individuals with mental retardation and developmental disabilities.
Populations Served Individuals of all ages with mental retardation and developmental disabilities.
Terminology for HM and AT Minor home modifications, adaptive aids/specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Minor home modifications: Widening existing doorways to allow wheelchair accessibility, outside ramps for accessibility, etc.

Adaptive aids/SMES: Medical supplies, devices, controls or appliances not covered under the state plan that enable recipients to retain or to increase their abilities to perform activities of daily living or control their environment. Examples include wheelchairs, grab-bars, walkers, communication devices, positioning devices, etc.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X X
Benefit Limits Minor home modifications: Lifetime limit of $7,500 per individual. After the $7,500 lifetime limit has been reached, an individual is eligible for an additional $300 per IPC year for additional modifications or maintenance of minor home modifications.

Adaptive aids: $10,000 annual limit.
Training on Use and Repairs Minor home modifications: Training: Information N/A. Repairs: yes.

Adaptive aids: Training: Information N/A. Repairs: yes.


Community Living Assistance and Support Services (CLASS) Program (ICF/MR Waiver) (0221)
Agency Name Texas Department of Aging and Disability Services
Phone 512-438-4481 or 512-438-3078
Web site http://www.dads.state.tx.us/business/pi/mfp_grant/Com_Care_Options_manual.pdf
http://www.dads.state.tx.us/business/communitycare/waiver_comparisons/index.html
Summary of State Plan Coverage To provide case management, respite care, habilitation, environmental modifications, skilled nursing, specialized medical equipment and supplies, extended state plan services (physical, occupational, speech therapies, and drugs) and other services including specialized therapies and psychological services.
Populations Served Persons with a qualifying disability, other than mental retardation, that originated before age 22 and that affects their ability to function in daily life.
Terminology for HM and AT Minor home modifications, adaptive aids/specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Minor home modifications: Bathroom and kitchen modifications to allow wheelchair access, grab-bars, and installation of specialized electric and plumbing systems.

Adaptive aids/SMES: Devices, controls, medically necessary supplies, or appliances not covered under the state plan that enable persons to retain or increase their abilities to perform activities of daily living, control the environment in which they live, and modify or improve the primary transportation vehicle to allow community living and ensure safety, security, and accessibility. Covered services include lifts, mobility aids, positioning devices, communication aids, vehicle modifications and adaptive equipment for activities of daily living.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X X
Benefit Limits Minor home modifications: $10,000 lifetime limit.

Adaptive aids/SMES: $10,000 annual limit.
Training on Use and Repairs Minor home modifications: Training: yes. Repairs: yes.

Adaptive aids/SMES: Training: yes. Repairs: yes.


Community-Based Alternatives (Aged and Disabled Waiver) (0266)
Agency Name Texas Department of Aging and Disability Services
Phone 512-438-4882
Web site http://www.dads.state.tx.us/business/pi/mfp_grant/Com_Care_Options_manual.pdf
http://www.dads.state.tx.us/business/communitycare/waiver_comparisons/index.html
Summary of State Plan Coverage To provide personal assistance, nursing services, physical therapy, speech therapy, occupational therapy, respite (in and out-of-home), adaptive aids, minor home modifications, prescriptions, medical supplies, emergency response services, adult foster care, home-delivered meals, and residential care to aged and disabled individuals.
Populations Served Aged and disabled individuals 21 years of age and above.
Terminology for HM and AT Minor home modifications, adaptive aids/medical supplies, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Minor home modifications: Wheelchair ramps; modifications or additions to bathroom or kitchen facilities; and specialized accessibility, safety adaptations, and additions that include door widening, grab-bars, and door openers.

Adaptive aids/medical supplies: Lifts, mobility aids, respiratory aids, positioning devices, communication aids, control switches, environmental control units, vehicle modifications, sensory adaptations, adaptive equipment for activities of daily living, and medical supplies.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X  
Benefit Limits Minor home modifications: There are cost caps for the waiver, but there is no defined price list.

Adaptive aids/medical supplies: There are cost caps for the waiver, but there is no defined price list.

PERS: None.
Training on Use and Repairs Minor home modifications: Training: yes. Repairs: yes.

Adaptive aids/medical supplies: Training: yes. Repairs: yes.

PERS: Training: yes. Repairs: yes.


CBA-STAR+PLUS (Aged and Disabled Waiver) (0325)
Agency Name Texas Department of Aging and Disability Services
Phone 512-491-1305
Web site http://www.hhsc.state.tx.us/starplus/starplus.htm
Summary of State Plan Coverage For aged and disabled individuals 21 and over. To provide case management, respite care, personal emergency response systems, skilled nursing, prescribed drugs, personal assistance, adult foster care, assisted living/residential care, minor home modifications, adaptive aids and medical supplies, consumer directed services, physical therapy, speech therapy, and occupational therapy.
Populations Served Aged and disabled individuals 21 and over in Harris County.
Terminology for HM and AT Personal emergency response systems (PERS), minor home modifications, adaptive aids/medical supplies.
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.

Minor home modifications: Providing a wheelchair-accessible shower, widening doorways, and creating turnaround space in the kitchen.

Adaptive aids/medical supplies: Devices, controls or medically necessary supplies/appliances that enable persons with functional impairments to increase their abilities to perform activities of daily living, control the environment in which they live and ensure safety, security and accessibility. Examples of adaptive aids include wheelchair lifts, portable ramps, positioning devices, and augmentative communication devices.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X Depends on
HMO
Depends on
HMO
X Depends on
HMO
Depends on
HMO
Benefit Limits PERS: Determined by the contracted HMO.

Minor home modifications: Determined by the contracted HMO.

Adaptive aids/medical supplies: Determined by the contracted HMO.
Training on Use and Repairs PERS: Determined by the contracted HMO.

Minor home modifications: Determined by the contracted HMO.

Adaptive aids/medical supplies: Determined by the contracted HMO.


Waiver for People with Deaf-Blindness and Multiple Disabilities (ICF/MR Waiver) (0281)
Agency Name Texas Department of Aging and Disability Services
Phone 512-438-2622 or 877-438-5658
Web site http://www.dads.state.tx.us/business/pi/mfp_grant/Com_Care_Options_manual.pdf
http://www.dads.state.tx.us/business/communitycare/waiver_comparisons/index.html
Summary of State Plan Coverage To provide case management, respite care, residential habilitation, day habilitation, environmental accessibility adaptations, skilled nursing, specialized medical equipment and supplies, chore services, assisted living, intervenor services, dietary services, behavior communications orientation and mobility training, physical therapy, speech therapy and extended speech, hearing and language services, occupational therapy, prescribed drugs to individuals who are deaf and blind with multiple disabilities and meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Populations Served Individuals who are deaf and blind with multiple disabilities and living in an Intermediate Care Facility for the Mentally Retarded.
Terminology for HM and AT Minor home modifications, adaptive aids/specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Minor home modifications: Widening doorways, providing ramps, making bathrooms accessible.

Adaptive aids/SMES: Lifts, positioning devices, mobility aids, respiratory aids, communication aids, adaptive equipment, durable medical equipment, vehicle modifications, certain copays, sensory adaptations, safety restraints and devices, and rental, lease, purchase or repair of above.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X   X X X X
Benefit Limits Minor home modifications: $5,000 per individual, per lifetime.

Adaptive aids/medical supplies: $10,000 per service plan year, per individual.
Training on Use and Repairs Minor home modifications: Training: yes. Repairs: yes.

Adaptive aids/medical supplies: Training: yes. Repairs: yes.


Consolidated Waiver Program (Aged/Disabled and Medically Dependent Children) (0373)
Agency Name Texas Department of Aging and Disability Services
Phone 512-438-3444
Web site http://www.dads.state.tx.us/business/pi/mfp_grant/Com_Care_Options_manual.pdf
http://www.dads.state.tx.us/business/communitycare/waiver_comparisons/index.html
Summary of State Plan Coverage To provide personal care, respite care, habilitation (residential, day, supported employment), environmental accessibility adaptations, skilled nursing, transportation, specialized medical equipment and supplies, adaptive aids, vehicle modifications, personal emergency response systems, adult residential care, adult foster care, assistive living, physical therapy, occupational therapy, speech hearing and language, prescribed drugs, family surrogate services, intervenor, dietary service, behavior communication, dental care, and home-delivered meals for aged and disabled individuals and medically dependent children.
Populations Served Aged and disabled individuals and medically dependent children in Bexar County.
Terminology for HM and AT Minor home modifications, adaptive aids/special medical equipment and supplies (SMES), personal emergency response systems (PERS).
Examples of Covered HM and AT Services Minor home modifications: Purchase or repair of wheelchair ramps; modifications or additions to bathroom or kitchen facilities; and specialized accessibility, safety adaptations, and additions that include door widening, grab-bars, and door openers.

Adaptive aids/SMES: Lifts, mobility aids, respiratory aids, positioning devices, communication aids, control switches, environmental control units, vehicle modifications, sensory adaptations, adaptive equipment for activities of daily living, and medical supplies.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X  
Benefit Limits Minor home modifications: None.

Adaptive aids/medical supplies: $10,000 per participant, per individual service plan year.

PERS: None.
Training on Use and Repairs Minor home modifications: Training: yes. Repairs: yes.

Adaptive aids/medical supplies: Training: yes. Repairs: yes.

PERS: Training: yes. Repairs: yes.


Texas Home Living Program (0403)
Agency Name Texas Department of Aging and Disability Services
Phone 512-438-4512
Web site http://www.dads.state.tx.us/business/pi/mfp_grant/Com_Care_Options_manual.pdf
http://www.dads.state.tx.us/business/communitycare/waiver_comparisons/index.html
Summary of State Plan Coverage To provide respite care, habilitation (employment assistance, day services, supported employment), home modifications, skilled nursing, adaptive aids, community support, behavioral support, specialized therapies, and dental treatment.
Populations Served Individuals with mental retardation, no age requirement.
Terminology for HM and AT Minor home modifications, adaptive aids.
Examples of Covered HM and AT Services Minor home modifications: Widening existing doorways to allow wheelchair accessibility, outside ramps for accessibility, etc.

Adaptive aids: Medical supplies devices, controls or appliances not covered under the state plan that enable recipients to retain or to increase their abilities to perform activities of daily living or control their environment. Examples include: wheelchairs, grab-bars, walkers, communication devices, positioning devices.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X   X X    
Benefit Limits Minor home modifications: $7,500 lifetime limit.

Adaptive aids: Up to $6,000 per year.
Training on Use and Repairs Minor home modifications: Training: Information N/A. Repairs: yes.

Adaptive aids: Training: Information N/A. Repairs: yes.


UTAH

Overview Utah covers assistive technology and home modifications through four waivers. All four waivers provide personal emergency response systems, one of the waivers provides vehicle medications, and two of the waivers provide specialized medical equipment and supplies/assistive technology. Utah’s Medicaid State Plan covers custom and motorized wheelchairs.
Medicaid State Plan Coverage
Agency Name Utah Department of Health
Phone 1-800-662-9651
Web site http://health.utah.gov/medicaid/
Summary of State Plan Coverage The Utah Medicaid State Plan covers wheelchairs through the durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME).
Examples of Covered HM and AT Services DME: Standard, custom, and motorized wheelchairs.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X X X X
Benefit Limits Information N/A.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.


Developmental Disabilities/Mental Retardation Waiver (0158)
Agency Name Division of Health Care Financing
Phone 801-538-4200
Web site http://hlunix.ex.state.ut.us/medicaid/provhtml/waivers.html
Summary of State Plan Coverage For mentally retarded and developmentally disabled adults and children. To provide support coordination, community living, personal assistance, personal emergency response systems, environmental accessibility adaptations, chore and homemaker services, supported employment, site and non-site based day assistance, senior supports, transportation, latch key services, family assistance and support, respite care, self-directed, educational, specialized medical equipment/supplies/assistive technology, and specialized supports.
Populations Served Mentally retarded and developmentally disabled adults and children.
Terminology for HM and AT Environmental accessibility adaptations (EAA), home and vehicle modifications, personal emergency response systems (PERS), specialized medical equipment/supplies/assistive technology (SMES).
Examples of Covered HM and AT Services Information N/A.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A N/A N/A N/A
Benefit Limits EAA/home and vehicle modifications: Cost cap: $10,000 per service.

PERS: Costs caps for purchase: $225.91; monthly service fee: $38.85; installation and testing: $50.00.

SMES/assistive technology: Cost cap for monthly service fee: $300.00; purchased equipment: $10,000.00 per service.
Training on Use and Repairs Information N/A.


Aged Waiver (0247)
Agency Name Division of Aging and Adult Services
Phone 801-538-3910
Web site http://hlunix.ex.state.ut.us/medicaid/provhtml/waivers.html
Summary of State Plan Coverage To provide case management, homemaker services, in-home respite care, supportive maintenance, adult day care, personal emergency response systems, assistive technology, environmental accessibility adaptations, non-medical transportation, home-delivered meals, and companion services to aged individuals.
Populations Served Individuals aged 65 and older.
Terminology for HM and AT Personal emergency response systems (PERS), specialized medical equipment, supplies (SMES)/assistive technology, environmental accessibility adaptations (EAA).
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.

SMES/assistive technology: Devices, controls, or other appliances that are of direct medical or remedial benefit to the individual and items necessary for life support, ancillary supplies, and equipment necessary to the proper functioning of such items, and durable and non-durable medical equipment not available under the Medicaid State Plan.

EAA: Ramps, grab-bars, widening of doorways or hallways, modification of bathrooms or kitchen facilities, and modification of electric and plumbing systems that are necessary to accommodate medical equipment, care and supplies.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A X N/A  
Benefit Limits PERS: Costs caps for purchase: $225.91; monthly service fee: $38.85; installation, testing, and removal: $50.00.

SMES/assistive technology: $500 limit per item.

EAA: $2000 limit per item.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.


Acquired Brain Injury Waiver (0292)
Agency Name Information N/A
Phone 801-538-4200
Web site http://hlunix.ex.state.ut.us/medicaid/provhtml/waivers.html
Summary of State Plan Coverage To provide case management, homemaker services, respite care, habilitation, supported employment, specialized medical equipment and supplies, personal emergency response systems, companion services, family training, transportation, structured day programming, community support living, and counseling to those with traumatic brain injury aged 18 and over.
Populations Served Individuals with an acquired brain injury aged 18 and over.
Terminology for HM and AT Specialized medical equipment and supplies (SMES), personal emergency response systems (PERS).
Examples of Covered HM and AT Services Information N/A
Process to Access Benefit Information N/A
Benefit Limits SMES: Information N/A.

PERS: Costs caps for purchase: $225.91; monthly service fee: $38.85; installation and testing: $50.00.
Training on Use and Repairs Information N/A


Nursing Facility Level of Care Waiver (331)
Agency Name Information N/A
Phone Information N/A
Web site http://hlunix.ex.state.ut.us/medicaid/provhtml/waivers.html
Summary of State Plan Coverage To provide attendant care, personal emergency response systems, local care support coordination, liaison, consumer preparation, and nursing facility level of care.
Populations Served Information N/A
Terminology for HM and AT Personal emergency response systems (PERS).
Examples of Covered HM and AT Services PERS.
Process to Access Benefit Information N/A
Benefit Limits PERS: Costs caps for purchase: $225.91; monthly service fee: $38.85; installation and testing: $50.00.
Training on Use and Repairs Information N/A


VERMONT

Overview Vermont covers assistive technology and home modifications through the Medicaid State Plan and an 1115 waiver with two sections. Speech-generating devices and wheelchairs are covered under the durable medical equipment benefit through the state plan, while environmental modifications and assistive technology are provided in the waiver.
Medicaid State Plan Coverage
Agency Name Vermont Agency of Human Services, Office of Vermont Health Access
Phone 802-879-5900
Web site http://www.ovha.state.vt.us
Summary of State Plan Coverage The Vermont Medicaid State Plan covers durable medical equipment including wheelchairs and other mobility devices, augmentative communication devices, prosthetics, orthotics and medical supplies.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), augmentative communication devices (ACD).
Examples of Covered HM and AT Services DME: Power, standard, custom, reclining, lightweight, and amputee wheelchairs and accessories, power-operated vehicles, and other mobility devices.

ACD: Digitized and synthesized devices, including software systems, specialized typewriters, customized assist keyboards, hand held computers, and accessories for devices.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A X X X X  
Benefit Limits None.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.


1115 Vermont Global Commitment Waiver
Agency Name Department of Disabilities, Aging and Independent Living, Division of Disability and Aging Services
Phone 802-241-2648
Web site http://www.dail.state.vt.us/
Summary of State Plan Coverage In October 2005, Vermont transitioned from providing care through 1915(c) waivers to providing care through an 1115 Vermont Global Commitment waiver. The new waiver encompasses the former 1915(c) waivers for mental retardation/developmental disability and traumatic brain injury. The 1115 waiver provides case management, respite care, home supports, rehabilitation supports, work supports, community supports, crisis supports, environmental and assistive technology, and psychology and counseling.
Populations Served Vermont residents with developmental disabilities of any age and people aged 16 or older diagnosed with a moderate to severe brain injury who meet other defined eligibility criteria.
Terminology for HM and AT Assistive devices (AD) and home modifications (HM), personal emergency response systems (PERS).
Examples of Covered HM and AT Services AD and HM: Adaptive eating utensils; adaptive kitchen utensils; adaptive sinks/faucets; adaptive telephones with large numbers; air conditioner: for individuals with Chronic Obstructive Pulmonary Disease only; bath/shower chair: with or without transfer bench (for individuals with dual Medicare/Medicaid coverage only); bed rails/U-bar: for the purpose of transferring and/or bed mobility only, NOT to be used as a restraint; doorways widened for accessibility; dressing aides; gait belt; grab-bars/“Super Pole”; hand held shower unit; medication reminder units; raised toilet seat (for individuals with dual Medicare/Medicaid coverage only); ramp for primary entrance/exit; reacher/grabber; repairs/modifications to items purchased by waiver or “pre-approved items” that were purchased privately; roll-in shower unit; seat lift chairs: purchase of the chair only after Medicare/Medicaid pays for lift mechanism (for individuals with dual Medicare/Medicaid coverage only); shampoo tray for bed bath; walker wheels; wander devices: for individuals with dementia only.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X   X X
Benefit Limits $4,000 per participant, per lifetime.
Training on Use and Repairs Training: no.

Repairs: yes.


1115 Choices for Care Medicaid Waiver
Agency Name Department of Disability, Aging and Independent Living, Division of Disability and Aging Services
Phone 802-241-2648
Web site http://www.dail.state.vt.us/
Summary of State Plan Coverage In October 2005, Vermont transitioned from providing long-term care through two 1915c waivers (home-based and enhanced residential care) to providing care through an 1115 waiver. The new waiver, Choices for Care, will offer additional choices including a PACE program and a Cash and Counseling program. This waiver provides: case management, personal care, respite care, companion care, adult day services, assistive devices, assistive devices and home modifications, and personal emergency response services to aged and disabled individuals.
Populations Served Vermont residents age 65 or older, or those age 18 and older who have a physical disability and meet the nursing home level of care criteria.
Terminology for HM and AT Assistive device (AD) and home modifications (HM), personal emergency response system (PERS).
Examples of Covered HM and AT Services AD and HM: Adaptive eating utensils; adaptive kitchen utensils; adaptive sinks/faucets; adaptive telephones with large numbers; air conditioner: for individuals with Chronic Obstructive Pulmonary Disease only; bath/shower chair: with or without transfer bench (for individuals with dual Medicare/Medicaid coverage only); bed rails/U-bar: for the purpose of transferring and/or bed mobility only, NOT to be used as a restraint; doorways widened for accessibility; dressing aides; gait belt; grab-bars/“Super Pole”; hand held shower unit; medication reminder units; raised toilet seat (for individuals with dual Medicare/Medicaid coverage only); ramp for primary entrance/exit; reacher/grabber; repairs/modifications to items purchased by waiver or “pre-approved items” that were purchased privately; roll-in shower unit; seat lift chairs: purchase of the chair only after Medicare/Medicaid pays for lift mechanism (for individuals with dual Medicare/Medicaid coverage only); shampoo tray for bed bath; walker wheels; wander devices: for individuals with dementia only.

PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X   X N/A
Benefit Limits Expenditures for assistive devices and home modifications are limited to a maximum of $750 per participant, per calendar year.
Training on Use and Repairs Training: no.

Repairs: yes.


VIRGINIA

Overview Virginia covers assistive technology and home modifications through the Medicaid State Plan and three waivers.
Medicaid State Plan Coverage
Agency Name Virginia Department of Medical Assistance Services
Phone 804-786-7933
Web site http://www.dmas.virginia.gov/
Summary of State Plan Coverage The Virginia Medicaid State Plan provides coverage of wheelchairs and accessories, electronic or manual augmentative communication devices, and assistive technology/adaptive equipment through the durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), assistive technology/adaptive equipment, augmentative communication devices (ACD).
Examples of Covered HM and AT Services DME: Fully reclining, hemi wheelchair, high strength light, amputee, heavy duty, motorized, lightweight, as well as accessories. Strollers, scooters, or wheelchairs for community use.

Assistive technology/adaptive equipment: Recipient lifts, bath chairs, wall-mounted insulin delivery devices, and automatic feeder systems. All assistive technology equipment must be essential for the treatment of illness or injury.

ACD: Communication boards, digitized and synthesized speech-generating devices and accessories, speech-generating software program.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A N/A X X X  
Benefit Limits Information N/A.
Training on Use and Repairs Training: yes.

Repairs: yes.


Mental Retardation Waiver
Agency Name Virginia Department of Medical Assistance Services (DMAS)
Phone 804-786-7933
Web site http://www.dmas.virginia.gov/
Summary of State Plan Coverage For mentally retarded individuals aged six and older, and those individuals under age six who are at risk of developmental delay. To provide personal assistance, respite care, habilitation (residential, day support, prevocational and supported employ), environmental accessibility adaptations, skilled nursing, specialized medical equipment and supplies, personal emergency response systems, assistive technology, companion services, crisis stabilization and therapeutic consultation.
Populations Served Mentally retarded individuals aged six and older, and those individuals under age six who are at risk of developmental delay.
Terminology for HM and AT Environmental modifications, personal emergency response systems (PERS), assistive technology/specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Environmental modifications: Installation of ramps and grab-bars, widening of doorways, modifications of bathroom facilities, specialized electric and plumbing systems to accommodate medical equipment and supplies, and modifications to the primary vehicle.

PERS: An electronic device that enables a person to secure help in an emergency.

Assistive technology/SMES: Organizational devices, computer/software or communication device, orthotics, such as braces, writing orthotics, support chairs, handicapped toilets, other specialized devices/equipment, specially designed utensils for eating, and weighted blankets/vests.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X  
Benefit Limits Environmental modifications: $5,000 per year.

PERS: There is a one-time reimbursement for installation of the unit(s) per provider. A unit of service for personal emergency response system monitoring is the one-month rental price set by the Department of Medical Assistance Services.

Assistive technology/SMES: $5,000 per year.
Training on Use and Repairs Environmental modifications: Training: no. Repairs: yes.

PERS: Training: yes. Repairs: yes.

Assistive technology/SMES: Training: Information N/A. Repairs: yes.


Elderly or Disabled with Consumer Direction Waiver Services
Agency Name Virginia Department of Medical Assistance Services (DMAS)
Phone 804-786-7933
Web site http://www.dmas.virginia.gov/
Summary of State Plan Coverage To provide personal care, respite care, adult day health care and personal emergency response systems to individuals who are aged and disabled.
Populations Served Individuals who are elderly or 14 and older, with physical disabilities.
Terminology for HM and AT Personal emergency response systems (PERS).
Examples of Covered HM and AT Services PERS: an electronic device that enables a person to secure help in an emergency. When appropriate, personal emergency response systems may also include medication monitoring devices.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X  
Benefit Limits PERS: There is a one-time reimbursement for installation of the unit(s) per provider. A unit of service for personal emergency response system monitoring is the one-month rental price set by the Department of Medical Assistance Services.
Training on Use and Repairs Training: yes.

Repairs: yes.


Individual and Family Developmental Disabilities Support Waiver
Agency Name Virginia Department of Medical Assistance Services (DMAS)
Phone 804-786-7933
Web site http://www.dmas.virginia.gov/
Summary of State Plan Coverage To provide personal care, attendant care, respite care, crisis stabilization, therapeutic consultation, assistive technology, personal emergency response systems, family/caregiver training, habilitation (day support, in-home residential support, and supported employment), companion care, consumer-directed adult companion services, skilled nursing and environmental modifications for individuals aged six and older with developmental disabilities.
Populations Served Individuals aged six and older with developmental disabilities.
Terminology for HM and AT Environmental modifications, personal emergency response systems (PERS), assistive technology/specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Environmental/vehicular modifications: Installation of ramps and grab-bars, widening of doorways, modifications of bathroom facilities, specialized electric and plumbing systems to accommodate medical equipment and supplies, and modifications to the primary vehicle.

PERS: An electronic device that enables a person to secure help in an emergency. When appropriate, personal emergency response systems may also include medication-monitoring devices.

Assistive technology/SMES: Organizational devices, computer/software or communication devices, orthotics, such as braces, writing orthotics, support chairs, handicapped toilets, other specialized devices/equipment, specially designed utensils for eating, and weighted blankets/vests.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X  
Benefit Limits Environmental modifications: $5,000 per year.

PERS: There is a one-time reimbursement for installation of the unit(s) per provider. A unit of service for personal emergency response system monitoring is the one-month rental price set by the Department of Medical Assistance Services.

Assistive technology/SMES: $5,000 per year.
Training on Use and Repairs Environmental modifications: Training: no. Repairs: yes.

PERS: Training: yes. Repairs: yes.

Assistive technology/SMES: Training: yes. Repairs: yes.


WASHINGTON

Overview The Washington Medicaid State Plan provides coverage for wheelchairs, augmentative communication devices, grab-bars, and bath aids through the durable medical equipment benefit. In addition, the state provides coverage of assistive technologies and home modifications through seven waivers. Coverage is provided for individuals living at home and selectively for those living in residential facilities.
Medicaid State Plan Coverage
Agency Name Washington Department of Social and Health Services
Phone 1-800-422-3263
Web site http://www1.dshs.wa.gov/geninfo/medicaid.html
Summary of State Plan Coverage The Washington Medicaid State Plan provides coverage for wheelchairs, augmentative communication devices, grab-bars, and bath aids through the durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), augmentative communication devices (ACD).
Examples of Covered HM and AT Services DME: Wheelchairs, including standard, lightweight, high-strength lightweight, custom heavy duty, rigid, custom, power drive, three or four wheel power drive scooter cart, and accessories.

ACD: Including communication boards, speech-generating devices (digitized, synthesized), speech-generating software programs, and accessories; bath aids including grab-bars, tub stools or benches, and hand-held showers.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
  X X X X  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Medically Needy Residential Waiver
Agency Name Washington Department of Social and Health Services, Home and Community Services Division
Phone 1-800-422-3263
Web site http://www1.dshs.wa.gov/geninfo/medicaid.html
Summary of State Plan Coverage To provide skilled nursing, specialized medical equipment and supplies, adult residential care, adult family home, assisted living and recipient training services, community transition services, and transportation to aged, blind and disabled individuals in community-based residential settings.
Populations Served Aged, blind and disabled individuals living in adult family homes and at boarding homes with an Enhanced Adult Residential Care or assisted living facilities contract.
Terminology for HM and AT Specialized medical equipment and supplies (SMES) (includes assistive technology).
Examples of Covered HM and AT Services SMES: Services to help individuals with their activities of daily living or to better participate in their environment. Examples include power and manual wheelchairs.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X X
Benefit Limits There are cost caps on specialized medical equipment and supplies.
Training on Use and Repairs Training: yes.

Repairs: yes.


Medically Needy In-Home Waiver
Agency Name Washington Department of Social and Health Services, Home and Community Services Division
Phone 1-800-422-3263
Web site http://www1.dshs.wa.gov/geninfo/medicaid.html
Summary of State Plan Coverage To provide skilled nursing, specialized medical equipment and supplies, adult residential care, adult family home services, assisted living and recipient training services, community transition services, and transportation to aged, blind and disabled individuals living at home.
Populations Served Aged, blind and disabled individuals living at home.
Terminology for HM and AT Specialized medical equipment and supplies (SMES) (includes assistive technology and home modifications).
Examples of Covered HM and AT Services SMES: Services to help individuals with their activities of daily living or to better participate in their environment. Examples include power and manual wheelchairs, grab-bars, ramps and railings, van lifts, widening of doorways, and modification of bathroom facilities.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X X
Benefit Limits There are cost caps on specialized medical equipment and supplies.
Training on Use and Repairs Training: yes.

Repairs: yes.


Community Options Program Entry System (COPES) Waiver
Agency Name Washington Department of Social and Health Services, Home and Community Services Division
Phone 1-800-422-3263
Web site http://www1.dshs.wa.gov/geninfo/medicaid.html
Summary of State Plan Coverage To provide skilled nursing, specialized medical equipment and supplies, adult residential care, adult family home, assisted living and recipient training services, community transition services, and transportation to aged, blind and disabled individuals living at home and in residential settings.
Populations Served Aged, blind and disabled individuals living at home and in adult family homes, and at boarding homes with an Enhanced Adult Residential Care or assisted living facilities contract.
Terminology for HM and AT Specialized medical equipment and supplies (SMES) (includes assistive technology and home modifications).
Examples of Covered HM and AT Services SMES: Services to help individuals with their activities of daily living or to better participate in their environment. Examples include power and manual wheelchairs, grab-bars, ramps and railings, van lifts, widening of doorways, and modification of bathroom facilities.

Individuals living in residential facilities are not eligible to receive home modifications (including ramps, railings, widening of doorways, and modification of bathroom facilities) under this waiver.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X X
Benefit Limits There are cost caps on specialized medical equipment and supplies.
Training on Use and Repairs Training: yes.

Repairs: yes.


Basic Waiver
Agency Name Washington Department of Social and Health Services, Division of Developmental Disabilities
Phone 360-725-3445
Web site http://www1.dshs.wa.gov/ddd/waivers.shtml
Summary of State Plan Coverage To provide behavior management and consultation, community guide, environmental accessibility adaptations, specialized medical equipment and supplies, occupational therapy, specialized psychiatric services, physical therapy, speech, hearing and language services, staff/family consultation and training, transportation, person to person services, supported employment, community accessibility, pre-vocational services, mental health diversion services, personal care, respite care, and emergency assistance to individuals who are developmentally disabled and live with their families or in their own home.
Populations Served Individuals who are developmentally disabled and live with their families or in their own home.
Terminology for HM and AT Environmental accessibility adaptations (EAA) (including home modifications), specialized medical equipment and supplies (SMES) (including assistive technology).
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electrical and/or plumbing systems necessary to accommodate medical equipment and supplies.

SMES: Services to help individuals with their activities of daily living or to better participate in their environment including switches, communication devices, specialized alarm systems, and wheelchairs.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X X
Benefit Limits $1,425 per year for any combination of services.
Training on Use and Repairs Training: yes.

Repairs: yes.


Basic Plus Waiver
Agency Name Washington Department of Social and Health Services, Division of Developmental Disabilities
Phone 360-725-3445
Web site http://www1.dshs.wa.gov/ddd/waivers.shtml
Summary of State Plan Coverage To provide skilled nursing, behavior management and consultation, community guide, environmental accessibility adaptations, specialized medical equipment and supplies, occupational therapy, specialized psychiatric services, physical therapy, speech, hearing and language services, staff/family consultation and training, transportation, adult foster care, adult residential care, person to person services, supported employment, community access, pre-vocational services, mental health diversion services, personal care, respite care and emergency assistance to individuals who are developmentally disabled and live with their families or in their own home.
Populations Served Individuals who are developmentally disabled and live with their families or in their own home.
Terminology for HM and AT Environmental accessibility adaptations (EAA) (includes home modifications), specialized medical equipment and supplies (SMES) (includes assistive technology).
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installing specialized electrical and/or plumbing systems necessary to accommodate medical equipment and supplies.

SMES: Services to help individuals with their activities of daily living or to better participate in their environment. Assistive technology examples include switches, communication devices, specialized alarm systems, and wheelchairs.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X X
Benefit Limits $6,070 per year for any combination of services.
Training on Use and Repairs Training: yes.

Repairs: yes.


Community Protection Waiver
Agency Name Washington Department of Social and Health Services, Division of Developmental Disabilities
Phone 360-725-3445
Web site http://www1.dshs.wa.gov/ddd/waivers.shtml
Summary of State Plan Coverage To provide residential habilitation, skilled nursing, behavior management and consultation, environmental accessibility adaptations, specialized medical equipment and supplies, occupational therapy, specialized psychiatric services, physical therapy, speech, hearing and language services, staff/family consultation and training, transportation, person to person, supported employment, pre-vocational services, mental health diversion services to individuals who are developmentally disabled and need on-site, awake, 24-hour supervision.
Populations Served Individuals who are developmentally disabled and need on-site, awake, 24-hour supervision and who agree to receive services from a certified Community Protection Supported Living provider.
Terminology for HM and AT Environmental accessibility adaptations (EAA) (includes home modifications), specialized medical equipment and supplies (SMES) (includes assistive technology).
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installing specialized electrical and/or plumbing systems necessary to accommodate medical equipment and supplies.

SMES: Services to help individuals with their activities of daily living or to better participate in their environment. Assistive technology examples include switches, communication devices, specialized alarm systems, and wheelchairs.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X X
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Core Waiver
Agency Name Washington Department of Social and Health Services, Division of Developmental Disabilities
Phone 360-725-3445
Web site http://www1.dshs.wa.gov/ddd/waivers.shtml
Summary of State Plan Coverage To provide residential habilitation, skilled nursing, behavior management and consultation, community guide services, environmental accessibility adaptations, specialized medical equipment and supplies, occupational therapy, specialized psychiatric services, physical therapy, speech, hearing and language services, staff/family consultation and training, transportation, person to person services, supported employment, community access, pre-vocational services, mental health diversion services, personal care, and respite care to individuals who are developmentally disabled and live with their families or in their own home.
Populations Served Individuals with a developmental disability (a condition defined as mental retardation, cerebral palsy, epilepsy, autism, or another neurological or other condition); the disability originates before the individual reaches 18 years of age, is expected to continue indefinitely, and results in a substantial handicap.
Terminology for HM and AT Environmental accessibility adaptations (EAA) (includes home modifications), specialized medical equipment and supplies (SMES) (includes assistive technology).
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electrical and/or plumbing systems necessary to accommodate medical equipment and supplies.

SMES: Services to help individuals with their activities of daily living or to better participate in their environment. Assistive technology examples include switches, communication devices, specialized alarm systems, and wheelchairs.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X X X X
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


WEST VIRGINIA

Overview West Virginia covers patient lifts, power-operated vehicles and augmentative communication devices under the durable medical equipment benefit, and covers environmental accessibility adaptations through one waiver.
Medicaid State Plan Coverage
Agency Name West Virginia Bureau for Medical Services (BMS)
Phone 1-304-558-1740
Web site http://www.wvdhhr.org/bms/
Summary of State Plan Coverage The West Virginia Medicaid State Plan covers durable medical equipment such as patient lifts, power-operated vehicles, augmentative communication devices, and wheelchairs.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), augmentation communication devices (ACD).
Examples of Covered HM and AT Services DME: Equipment that is uniquely constructed for a specific member according to the description and order of the beneficiary’s physician. Examples include patient lifts (hydraulic, with seat or sling), power-operated vehicles (three or four wheel), wheelchairs (motorized/power) and accessories, and augmentation communication devices (synthesized speech devices, communication boards).
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A N/A N/A X N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Training: yes.

Repairs: yes.


Mentally Retarded/Developmentally Disabled Waiver
Agency Name Bureau for Medical Services, Office of Behavioral Health Services
Phone 304-558-5978
Web site http://www.wvdhhr.org/bms/
Summary of State Plan Coverage To provide case management, habilitation (residential, day, prevocational supported employment, in-home support), personal care, specialized medical equipment and supplies, environmental modifications, specialized consultation services, occupational therapy, speech therapy, dietary services, psychological services, respite care, nursing, physical therapy and respiratory therapy to mentally retarded and developmental disabled individuals.
Populations Served Mentally retarded and developmentally disabled individuals.
Terminology for HM and AT Environmental accessibility adaptations (EAA).
Examples of Covered HM and AT Services EAA: Installation of grab-bars, installation of ramp(s), widening of doorways, modification of bathroom facilities, installation of specialized electric and plumbing systems where necessary to accommodate medical equipment and supplies, vehicle modifications, and lifts.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A X N/A   N/A
Benefit Limits Maximum of $1,000 per calendar year.
Training on Use and Repairs Training: yes.

Repairs: Information N/A.


WISCONSIN

Overview Wisconsin covers home modifications and assistive technologies through five home and community based waivers. The Wisconsin Medicaid State Plan covers a broad range of assistive and adaptive equipment such as adaptive eating utensils.
Medicaid State Plan Coverage
Agency Name Department of Health and Family Services
Phone 608-266-1865
Web site http://dhfs.wisconsin.gov/Medicaid/index.htm?ref=hp
Summary of State Plan Coverage The Wisconsin Medicaid State Plan covers assistive and adaptive equipment, patient lifts, and wheelchairs under the durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), adaptive equipment.
Examples of Covered HM and AT Services DME: Occupational therapy assistive or adaptive equipment including adaptive hygiene equipment, adaptive positioning equipment and adaptive eating utensils; home health care durable medical equipment including patient lifts, hospital beds and traction equipment; physical therapy splinting or adaptive equipment; wheelchairs including standard weight wheelchairs, lightweight wheelchairs, and electrically powered wheelchairs.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A N/A N/A X N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Community Options Waiver
Agency Name Department of Health and Family Services
Phone 608-266-1865
Web site http://dhfs.wisconsin.gov/Medicaid/index.htm?ref=hp
Summary of State Plan Coverage For persons moving from an institutional setting into the community. To provide case management, respite care, adult day health care, personal care, daily living skills, counseling and therapeutic resources, environmental and home modifications, nursing services, transportation, specialized medical equipment and supplies, personal emergency response systems and home-delivered meals, transitional case management, housing start-up, and utility payments.
Populations Served Individuals aged 65 and over who have a long-term or irreversible illness or disability that impairs daily functioning; adults age 18 and over with physical disabilities who have received a disability determination.
Terminology for HM and AT Specialized medical equipment and therapeutic supplies, environmental and home modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Specialized medical equipment and therapeutic supplies: Items that maintain the participant’s health, manage a medical or physical condition, improve functioning, or enhance independence. Examples include room air conditioners, air purifiers, humidifiers and water treatment systems.

Environmental and home modifications: Physical adaptations to the home including ramps (fixed or portable); porch/stair lifts; doors/doorways, door handles, door opening devices, and adaptive door bells; locks and security devices; plumbing and electrical modifications; medically necessary heating, cooling or ventilation systems; shower, sink, tub, and toilet modifications; faucets/water controls; accessible cabinetry, counter tops, or work surfaces; grab-bars and handrails.

PERS: An electronic device that enables a person to secure help in an emergency. May include a cellular telephone and cellular service when a conventional personal emergency response system is not feasible.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A X N/A N/A X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Specialized medical equipment and therapeutic supplies: Training: Information N/A. Repairs: yes.

Environmental and home modifications: Training: Information N/A. Repairs: yes.

PERS: Information N/A.


Mentally Retarded/Developmentally Disabled Waiver (0368)
Agency Name Wisconsin DHFS Division of Disability and Elder Services, Bureau of Long Term Support
Phone 608-266-1865
Web site http://dhfs.wisconsin.gov/Medicaid/index.htm?ref=hp
Summary of State Plan Coverage To provide case management, personal care, respite care, adult day health/adult day care, habilitation (day, prevocational, supported employment, daily living skills training, counseling and therapeutic), environmental accessibility, home modifications, specialized transportation, specialized medical equipment and supplies, personal emergency response systems, adult residential care, adaptive aids, communication aids, home-delivered meals, consumer education and training, housing counseling, and consumer directed supports for persons who are mentally retarded or developmentally disabled.
Populations Served Individuals who are mentally retarded or developmentally disabled aged 17 years, nine months and older.
Terminology for HM and AT Adaptive aids, communication aids, specialized medical and therapeutic supplies, home modifications (HM), personal emergency response systems (PERS).
Examples of Covered HM and AT Services Adaptive aids: Van and vehicle lifts; lift and transfer units (manual, hydraulic or electronic); standing boards and frames; wheelchairs, walkers and other assistive mobility devices; control switches; pneumatic devices including sip-and-puff controls; portable ramps; over-the-bed tables; hygiene/meal preparation aids; environmental control units; electronic control panels; adaptive security systems, door handles, and locks.

Communication aids: Assistive listening devices; telecommunication equipment; low vision magnification equipment; Braille writing equipment; augmentative communication devices; visual fire alarm systems; direct selection communicators; alphanumeric, scanning or encoding communicators; speech amplifiers.

Specialized medical and therapeutic supplies: Room air conditioners, air purifiers, humidifiers and water treatment systems.

HM: Physical adaptations to the home including ramps (fixed or portable); porch/stair lifts; doors/doorways; door handles or door opening devices; adaptive door bells, locks, security items or devices; plumbing, electrical modifications, medically necessary heating, cooling or ventilation systems; shower, sink, tub and toilet modifications; faucets/water controls; accessible cabinetry, counter tops or work surfaces; grab-bars and handrails.

PERS: An electronic device that enables a person to secure help in an emergency. May include a cellular telephone and cellular service when a conventional personal emergency response system is not feasible.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X N/A X X X
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Aged and Disabled Waiver (367)
Agency Name Wisconsin DHFS Division of Disability and Elder Services, Bureau of Long Term Support
Phone 608-266-1865
Web site http://dhfs.wisconsin.gov/Medicaid/index.htm?ref=hp
Summary of State Plan Coverage To provide case management, personal care, respite care, adult day health care, habilitation, (including day habilitation, prevocational, supported employment, daily living skills, counseling and therapeutic resources), environmental accessibility adaptations, transportation, specialized medical equipment and supplies, personal emergency response systems, adult residential care (including adult family home, community-based residential facility and residential care apartment complex), adaptive aids (including cognitive aids), communication aids, home-delivered meals, and consumer directed supports for individuals who are aged and disabled.
Populations Served Frail older adults (65 years or older; age 60 or older in Milwaukee County) and people with physical disabilities (17 years, nine months or older).
Terminology for HM and AT Adaptive aids, communication aids, specialized medical and therapeutic supplies, environmental accessibility adaptations (EAA)/home modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Adaptive aids: Van and vehicle lifts; lift and transfer units (manual, hydraulic or electronic); standing boards and frames; wheelchairs, walkers, and other assistive mobility devices; control switches; pneumatic devices, including sip-and-puff controls, portable ramps; over-the-bed tables; hygiene/meal preparation aids; environmental control units; electronic control panels; adaptive security systems, door handles, and locks.

Communication aids: Assistive listening devices, telecommunication equipment, low vision magnification equipment, Braille writing equipment, augmentative communication devices, visual fire alarm systems, direct selection communicators, communicators (alphanumeric, scanning or encoding), and speech amplifiers.

Specialized medical and therapeutic supplies: Room air conditioners, air purifiers, humidifiers and water treatment systems.

EAA/home modifications: Ramps (fixed or portable), porch/stair lifts, doors/doorways, door handles or door opening devices, adaptive door bells, locks or security items or devices, plumbing and electrical modifications, medically necessary environmental control systems (heating, cooling or ventilation), bathroom modifications (shower, sink, tub and toilet), faucets/water controls, accessible cabinetry (counter tops or work surfaces), grab-bars, and handrails.

PERS: An electronic device that enables a person to secure help in an emergency. May include a cellular telephone and cellular service when a conventional personal emergency response system is not feasible.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X   X X X X
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.


Traumatic Brain Injury Waiver (275)
Agency Name Department of Health and Family Services
Phone 608-266-1865
Web site http://dhfs.wisconsin.gov/Medicaid/index.htm?ref=hp
Summary of State Plan Coverage To provide adaptive aids, adult day care, alternative living, communication aids, consumer-directed training and education, counseling/therapeutic resources, daily living skills training, day services, guardianship services, home modifications, housing counseling, personal emergency response systems, prevocational services, protective payee, respite care, support/service coordination, supported employment, supportive home care (attendant care, personal care, and personal care provider room and board) and transportation to individuals with traumatic brain injury.
Populations Served Individuals of all ages with a diagnosis of traumatic brain injury.
Terminology for HM and AT Adaptive aids, communication aids, environmental accessibility adaptations (EAA)/home modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Adaptive aids: Van and vehicle lifts, lift and transfer units (manual, hydraulic or electronic), standing boards and frames, assistive mobility devices (including wheelchairs and walkers), control switches, pneumatic devices (including sip and puff controls), portable ramps, over-the-bed tables, hygiene/meal preparation aids, environmental control units, electronic control panels, adaptive security systems (including door handles and locks).

Communication aids: Assistive listening devices, telecommunication equipment, low vision magnification equipment, Braille writing equipment, augmentative communication devices, visual fire alarm systems, direct selection communicators, alphanumeric, scanning or encoding communicators, and speech amplifiers.

EAA/home modifications: Ramps (fixed or portable), porch/stair lifts, doors/doorways, door handles or door opening devices, adaptive door bells, locks or security items or devices, plumbing and electrical modifications, medically necessary environmental control systems (including heating, cooling or ventilation systems), bathroom modifications (including shower, sink, tub and toilet modifications), faucets/water controls, accessible cabinetry (including counter tops or work surfaces), grab-bars, and handrails.

PERS: An electronic device that enables a person to secure help in an emergency. May include a cellular telephone and cellular service when a conventional personal emergency response system is not feasible.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.


Wisconsin Community Integration Program (0229)
Agency Name Department of Health and Family Services
Phone 608-266-1865
Web site http://dhfs.wisconsin.gov/Medicaid/index.htm?ref=hp
Summary of State Plan Coverage To provide care management, respite care, personal care, adult day care, habilitation (prevococational, supported employment, daily living skills and day services), personal emergency response systems, home modifications, communication aids, adaptive aids, transportation, counseling, nursing services, specialized medical and therapeutic supplies, financial management, home-delivered meals, and housing start up to developmentally disabled individuals.
Populations Served Individuals of all ages who are diagnosed as developmentally disabled.
Terminology for HM and AT Adaptive aids, communication aids, specialized medical and therapeutic supplies, home modifications (HM), personal emergency response systems (PERS).
Examples of Covered HM and AT Services Adaptive aids: Van and vehicle lifts, lift and transfer units (manual, hydraulic or electronic), standing boards and frames wheelchairs, walkers and other assistive mobility devices, control switches, pneumatic devices, including sip-and-puff controls, portable ramps, over-the-bed tables, hygiene/meal preparation aids, environmental control units, electronic control panels, adaptive security systems, door handles and locks.

Communication aids: Assistive listening devices, telecommunication equipment, low vision magnification equipment, Braille writing equipment, augmentative communication devices, visual fire alarm systems, direct selection communicators, communicators (alphanumeric, scanning or encoding), and speech amplifiers.

Specialized medical and therapeutic supplies: Room air conditioners, air purifiers, humidifiers and water treatment systems.

HM: Ramps (fixed or portable), porch/stair lifts, doors/doorways, door handles or door opening devices, adaptive door bells, locks or security items or devices, plumbing and electrical modifications, medically necessary environmental control systems (heating, cooling or ventilation systems), bathroom modifications (shower, sink, tub and toilet), faucets/water controls, accessible cabinetry (including counter tops or work surfaces), grab-bars, and handrails.

PERS: An electronic device that enables a person to secure help in an emergency. May include a cellular telephone and cellular service when a conventional personal emergency response system is not feasible.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A X N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.


WYOMING

Overview Wyoming covers assistive technology and home modifications through three waivers, and power-operated vehicles through the Medicaid State Plan.
Medicaid State Plan Coverage
Agency Name Wyoming Medicaid Services
Phone 800-251-1268
Web site http://wdh.state.wy.us/medicaid/index.asp
http://wyequalitycare.acs-inc.com/index.html
Summary of State Plan Coverage The Wyoming Medicaid State Plan covers medical supplies and equipment and durable medical equipment, such as hydraulic and electric lifts, power-operated vehicles, bathtub patient lifts, and toilet rails through the medical supplies and equipment/durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Medical supplies and equipment/durable medical equipment (DME).
Examples of Covered HM and AT Services Medical supplies and equipment/DME: Hydraulic and electric lifts, wheelchairs, power-operated vehicles, bathtub patient lifts, slings, and toilet rails.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
N/A X N/A X X N/A
Benefit Limits Defined price lists are established for many services.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.


Adult Developmental Disability Waiver (0226)
Agency Name Developmental Disabilities Division
Phone 307-777-7115
Web site http://ddd.state.wy.us/Documents/waiver.htm
Summary of State Plan Coverage To provide case management, personal care, respite care, habilitation (residential, day, prevocational and supported employment), environmental accessibility adaptations, skilled nursing, specialized medical equipment and supplies, physical therapy, occupational therapy, psychological therapy, respiratory therapy, dietician, skilled nursing, complex skilled nursing and speech hearing and language therapy to developmentally disabled individuals age 21 and older.
Populations Served Individuals with a diagnosis of a developmental disability aged 21 and older who qualify for Intermediate Care Facility for the Mentally Retarded services, or persons with related conditions.
Terminology for HM and AT Environmental accessibility adaptations (EAA), specialized medical equipment and supplies (SMES)/personal adaptive equipment.
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems needed to accommodate the medical equipment and supplies that are necessary for the welfare of the individual. Lifts, such as porch or stair lifts or hydraulic, manual or other electronic lifts; modifications/additions of bathroom facilities, such as roll-in showers, sink modifications.

SMES/personal adaptive equipment: Power wheelchairs, amigo-style carts, walkers, and gait belts; seating and positioning supports; transfer assists or lifts; augmentative or adaptive communications devices; adaptive eating, cooking, bathing and grooming utensils, programmable telephones, emergency signalers and adapted clocks.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X N/A X X
Benefit Limits None.
Training on Use and Repairs Training: no.

Repairs: yes.


Acquired Brain Injury Waiver (0370)
Agency Name Developmental Disabilities Division
Phone 307-777-7115
Web site http://wdh.state.wy.us/ddd/brain.asp
Summary of State Plan Coverage To provide case management, personal care, respite care, habilitation (residential, in-home support, day habilitation, prevocational and supported employment), environmental accessibility adaptations, skilled nursing, specialized medical equipment and supplies, physical therapy, occupational therapy, psychological therapy, cognitive retraining, vision therapy, speech, hearing and language therapy, and dietician services to disabled individuals age 21-64 with an acquired brain injury.
Populations Served Individuals who are 21-64 with a diagnosis of acquired brain injury.
Terminology for HM and AT Environmental accessibility adaptations (EAA), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems.

SMES: Modified cooking equipment and eating utensils, compensatory memory devices, alarm, watches, electronic day planners, mini tape recorders, and electronic key finders.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X X X N/A X X
Benefit Limits None.
Training on Use and Repairs Training: no.

Repairs: yes.


Aged and Disabled Waiver (0236)
Agency Name Department of Health, Aging Division
Phone 307-777-7986
Web site http://wdhfs.state.wy.us/aging/services/ltchcbs.htm
Summary of State Plan Coverage To provide case management, personal care, respite care, adult day health care, skilled nursing, non-medical transportation, personal emergency response systems, home-delivered meals to aged/disabled individuals 19 and above.
Populations Served Individuals 19 and above who are aged or disabled.
Terminology for HM and AT Personal emergency response systems (PERS).
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.
Process to Access Benefit Service
Coordination/
Case Manager
MD Order
Required
Assessment by
Other Health
Professional
Medical
Necessity
Required
PA
Required
Bids
Required
X N/A N/A X X  
Benefit Limits None.
Training on Use and Repairs Training: no.

Repairs: no.


Compendium of Home Modification and Assistive Technology Policy and Practice Across the States
Volume I: Final Report -- http://aspe.hhs.gov/daltcp/reports/2006/HM-ATI.htm
Volume II: State Profiles (Alabama through Missouri) -- http://aspe.hhs.gov/daltcp/reports/2006/HM-ATII.htm
Volume II: State Profiles (Montana through Wyoming) -- http://aspe.hhs.gov/daltcp/reports/2006/HM-ATII2.htm