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

10/27/2006

Terry Moore, BSN, MPH

Abt Associates, Inc.

October 27, 2006

PDF Version (244 pages)


This report was prepared under contract #HHS-100-03-0008 between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and Abt Associates, Inc. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the ASPE Project Officers, Gavin Kennedy and Hakan Aykan, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Their e-mail addresses are: Gavin.Kennedy@hhs.gov and Hakan.Aykan@hhs.gov.

The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization.


 

TABLE OF CONTENTS

ALABAMA

Medicaid State Plan Coverage

Home and Community-Based Wavier for Persons with Mental Retardation

Home and Community-Based Living at Home Wavier for the Mentally Retarded

Home and Community-Based Services for Individuals Under the Technology Assisted Waiver for Adults

Alabama Independent Living Waiver

ALASKA

Medicaid State Plan Coverage

Older Alaskans

People with Mental Retardation and Developmental Disabilities

Adults with Physical Disabilities

ARIZONA

Medicaid State Plan Coverage

ARKANSAS

Medicaid State Plan Coverage

Alternatives for Adults with Physical Disabilities

Alternative Community Service

CALIFORNIA

Medicaid State Plan Coverage

In-Home Medical Care Waiver

Nursing Home Facility A/B Waiver

Nursing Facility Subacute Waiver

Multipurpose Senior Service Program

Home and Community-Based Services Waiver for Persons with Developmental Disabilities

AIDS Waiver

Assisted Living Waiver

COLORADO

Medicaid State Plan Coverage

Home and Community-Based Services for the Elderly, Blind, and Disabled

Home and Community-Based Services for Persons with Major Mental Illness

Home and Community-Based Services for the Developmentally Disabled

Home and Community-Based Services for Persons with Brain Injury

Supported Living Services

CONNECTICUT

Medicaid State Plan Coverage

Connecticut Home Care Program for Elders

Comprehensive Supports Waiver

Acquired Brain Injury

Individual and Family Support Independence Plus

DELAWARE

Medicaid State Plan Coverage

Mental Retardation/Developmentally Disabled Home and Community-Based Waiver

Elderly and Disabled Home and Community-Based Waiver

DISTRICT OF COLUMBIA

Medicaid State Plan Coverage

Mental Retardation and Developmental Disabilities Waiver

Elderly and Physical Disabilities Waiver

HIV/AIDS Waiver

FLORIDA

Medicaid State Plan Coverage

Developmental Services Home and Community-Based Services Waiver

Channeling Services for Frail Elders

Elderly and Disabled Waiver

Project AIDS Care

Nursing Home Diversion

Family and Supported Living Waiver

Home and Community-Based Services Waiver for Traumatic Brain Injury and Spinal Cord Injuries

Adult Cystic Fibrosis Waiver

1915(c) Alzheimer’s Disease Program

GEORGIA

Medicaid State Plan Coverage

Mental Retardation Waiver Program

Community Habilitation and Support Services

Independent Care Waiver Program

HAWAII

Medicaid State Plan Coverage

Developmentally Disabled/Mentally Retarded

Nursing Home Without Walls

HIV Community Care Program

IDAHO

Medicaid State Plan Coverage

Aged and Disabled Waiver

Developmentally Disabled Waiver

Traumatic Brain Injury Waiver

ILLINOIS

Medicaid State Plan Coverage

Waiver for Persons with Brain Injury

Supportive Living Waiver

Elderly Waiver

Home and Community-Based Services Waiver for Persons Diagnosed with HIV/AIDS

Home and Community-Based Services Waiver for Persons with Physical Disabilities

Home and Community-Based Services Waiver for Adults with Developmental Disabilities

INDIANA

Medicaid State Plan Coverage

Aged and Disabled Waiver

Waiver for Persons with Traumatic Brain Injury

Waiver for Persons with Developmental Disabilities

Support Services for Mentally Retarded/Developmentally Disabled

Autism Waiver

IOWA

Medicaid State Plan Coverage

Mental Retardation Waiver

Traumatic Brain Injury Waiver

Physically Disabled Waiver

Ill and Handicapped Waiver

Elderly Waiver

KANSAS

Medicaid State Plan Coverage

Traumatic Brain Injury Waiver

Mental Retardation/Developmentally Disabled Waiver

Frail Elderly Waiver

Physically Disabled Waiver

KENTUCKY

Medicaid State Plan Coverage

Home and Community-Based Wavier for Elderly and Disabled Individuals

Supports for Community Living Waiver

Brain Injuries Waiver

LOUISIANA

Medicaid State Plan Coverage

Elderly and Disabled Adult Waiver

New Opportunities Waiver -- Independence Plus Waiver

MAINE

Medicaid State Plan Coverage

Physically Disabled Waiver

Mental Retardation Waiver

Disabled Adults Under 60

Elderly Waiver

MARYLAND

Medicaid State Plan Coverage

Waiver for Older Adults

Living at Home: Maryland Community Choices

Waiver for Individuals with Mental Retardation/Developmental Disabilities -- Community Pathways

Waiver for Individuals with Mental Retardation/Developmental Disabilities -- New Directions

MASSACHUSETTS

Medicaid State Plan Coverage

Home and Community-Based Services for Elders

Mental Retardation/Developmental Disability Waiver

Traumatic Brain Injury

MICHIGAN

Medicaid State Plan Coverage

Habilitation Supports Waiver

Michigan Choice

MINNESOTA

Medicaid State Plan Coverage

Elderly Waiver

Community Alternatives for Disabled Individuals Waiver

Traumatic Brain Injury Waiver

Mental Retardation/Related Conditions

Community Alternative Care Waiver

MISSISSIPPI

Medicaid State Plan Coverage

Elderly and Disabled Waiver

Independent Living Waiver

Mental Retardation/Developmental Disability Waiver

Assisted Living for the Elderly Waiver

Traumatic Brain Injury Waiver

MISSOURI

Medicaid State Plan Coverage

Physically Disabled Waiver

Mentally Retarded/Developmentally Disabled Waiver

Independent Living Waiver

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

 

Profiles of each state’s Medicaid policies and practices with regard to assistive technology (AT) and home modifications (HM) were developed based upon the review and synthesis of Medicaid coverage policies obtained, to the extent possible, via the internet in the form of Medicaid Provider Manuals, Home and Community-Based Services (HCBS) Waiver Provider Manuals, state web sites, and state statutes and regulations. Profiles are included for all states and for the District of Columbia. The first page of each profile starts with an Overview of the state’s Medicaid coverage for AT and HM, and then describes the state plan coverage in detail. The profiles are arranged alphabetically, by state.

A state profile legend is provided below to describe each field of the state profile.

State Profile Legend

Overview A brief description of AT and HM services offered by the Medicaid State Plan and the state’s relevant HCBS waivers.1 (This section appears only on the first page of the profile.)
Program Name
Agency Name Agency that administers the program.
Phone Phone number for general information.
Web site Web site for general information.
Summary of State Plan Coverage For the state plan, this section describes AT and HM services that are available and the benefit categories under which these services are covered. For the HCBS waivers, this section summarizes the waiver’s services.
Populations Served Individuals who qualify for services. The phrase “Medicaid-eligible individuals” refers to the populations served by the Medicaid State Plan, as this study did not collect data on each state’s criteria for Medicaid eligibility.
Terminology for HM and AT Terminology that is used in the state’s Medicaid regulations and/or provider manuals to refer to covered types of AT and HM.
Examples of Covered HM and AT Services Examples of items that are covered, within the different types of AT and HM.
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
In these fields, the symbol X is used to indicate that the program requires this process in order for the recipient to receive the service; a blank indicates that the process or procedure is not required in order to obtain services; and N/A indicates that the data was not available or not verified by the state. Note that X in a box indicates that at least one type but not necessarily all types of AT/HM meet the criteria for inclusion. The data fields are defined as follows:

Service Coordination/Case Manager. A person, such as a case manager, assesses a client's overall health care needs, may design a service plan, and coordinates services.

MD Order Required. A physician or other licensed medical provider (e.g., physician’s assistant, nurse practitioner) must write a prescription or order for an AT/HM service.

Assessment by other health professional. A specialized therapist (such as a physical, occupational or speech-language) must perform an assessment before an item can be covered.

Medical Necessity Required. The state's Medicaid regulations state that the AT/HM service must be medically necessary in order to be covered.

PA (Prior Authorization) Required. An AT/HM service must receive prior authorization from the program in order to be covered.

Bids Required. A case manager, service coordinator or consumer must obtain one or more bids from an equipment supplier/vendor for an AT/HM service.

Benefit Limits Cost caps or service limits that the program imposes.
Training on Use and Repairs The availability of training on the use of AT/HM*.
Coverage for repair of AT/HM*.
NOTE: * When coding these services, we indicated that these services were covered if they were bundled with the equipment cost (and were not a separate charge.) We also included training and repairs that were billed separately.

SOURCE: Abt Associates review of Medicaid State Plan and HCBS waiver coverage policies, June 2005-February 2006.

NOTES

  1. This investigation of waiver coverage policies was limited to those waivers identified by the WGMD file extracts obtained for the project from Medstat that reportedly offer AT and/or HM services.

 

ALABAMA

Overview Alabama covers augmentative communication devices through the Medicaid State Plan durable medical equipment benefit. Alabama also has one waiver specifically designed to provide assistive technology, and three additional waivers that provide assistive technology and/or home modifications benefits. In addition, the state participates in the Robert Wood Johnson Foundation Cash and Counseling Demonstration.
Medicaid State Plan Coverage
Agency Name Alabama Medicaid Agency
Phone 334-293-5504
Web site http://www.medicaid.alabama.gov/ADMIN_Code/5-A-13-AdmCode.Ch13.Supplies.Appliances.and.Durable.Equipment.pdf
Summary of State Plan Coverage The Alabama Medicaid State Plan covers augmentative communication devices under the durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Augmentative communication devices (ACD).
Examples of Covered HM and AT Services ACD: Portable electronic or non-electronic aids, devices, or systems determined to be necessary to assist a Medicaid-eligible recipient to overcome or ameliorate severe expressive speech-language impairments/limitations that are due to medical conditions in which speech is not expected to be restored. These devices enable the recipient to communicate effectively.
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 There are some individual cost caps.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Home and Community-Based Waiver for Persons with Mental Retardation (0001)
Agency Name Alabama Medicaid Agency, in conjunction with the Alabama Department of Mental Health and Mental Retardation
Phone 334-293-5504
Web site http://www.medicaid.alabama.gov/programs/long_term_care/ltc_waiver_services.aspx?tab=4&sm=b_a
Summary of State Plan Coverage For individuals with mental retardation. To provide personal care, respite care, behavior management, habilitation (residential, day, prevocational, and supported employment), environmental accessibility adaptations, skilled nursing, medical supplies, companion services, assistive technology, crisis intervention, community specialist, speech-language therapy, physical therapy, and occupational therapy.
Populations Served Mentally retarded individuals or persons with related conditions who, without these services, would require services in an Intermediate Care Facility for the Mentally Retardation.
Terminology for HM and AT Environmental accessibility adaptations (EAA), specialized medical equipment and supplies (SMES), assistive technology (AT).
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: 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. Also includes items necessary for life support, and ancillary supplies and equipment necessary to the proper functioning of such items, and durable and non-durable medical equipment and supplies not available under the Medicaid State Plan.

AT: Devices and pieces of equipment or products that are modified or customized and are used to increase, maintain, or improve functional capabilities of individuals with disabilities. It also includes any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device. Such services may include needs evaluation and acquisition, selection, design, fitting, customizing, adaptation, application, 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  
Benefit Limits EAA: Information N/A.  

SMES: $5,000 per year, per individual.  

AT: $20,000 per client.

Training on Use and Repairs Training: yes.

Repairs: no.

 

Home and Community-Based Living at Home Waiver for the Mentally Retarded (0391)
Agency Name Alabama Medicaid Agency, in conjunction with the Alabama Department of Mental Health and Mental Retardation
Phone 334-293-5504
Web site http://www.medicaid.alabama.gov/programs/long_term_care/waiver_living_at_home.aspx?tab=4&sub=1
Summary of State Plan Coverage To provide personal care, respite care, habilitation (residential, day, prevocational services, supported employment), environmental accessibility adaptations, skilled nursing, specialized medical equipment and supplies, physical therapy, occupational therapy, speech and language therapy, behavior therapy, community specialist, and crisis intervention.
Populations Served Mentally retarded individuals aged three and over.
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: 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. This includes durable and non-durable medical equipment and supplies not available under the Medicaid State Plan. Examples include language computers, environmental control devices, augmentative communication device, and page-turners.

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 EAA: $5,000 per year, per individual.

SMES: $5,000 per year, per individual.

Training on Use and Repairs Training: no.

Repairs: no.

 

Home and Community-Based Services for Individuals Under the Technology Assisted Waiver for Adults (0407)
Agency Name Alabama Medicaid Agency
Phone 334-293-5504
Web site http://www.medicaid.alabama.gov/programs/long_term_care/waiver_technology_assisted.aspx?tab=4&sub=1
Summary of State Plan Coverage To provide private duty nursing, personal care/personal attendant, medical supplies and appliances, and assistive technology for individuals who receive private duty nursing benefits under Early and Periodic Screening, Diagnosis, and Treatment and will no longer be eligible upon turning 21.
Populations Served Physically disabled individuals age 21 and above.
Terminology for HM and AT Medical supplies and appliances, assistive technology (AT).
Examples of Covered HM and AT Services Medical supplies and appliances: Devices, controls, or appliances specified in the Plan of Care, not presently covered under the Medicaid State Plan, 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. AT: Includes wheel chairs and 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 X X
Benefit Limits Medical supplies and appliances: $1,800 per client, per waiver year.

AT: $20,000 per client.

Training on Use and Repairs Training: no.

Repairs: no.

 

State of Alabama Independent Living (SAIL) Waiver (0241)
Agency Name Alabama Medicaid Agency, in conjunction with the Alabama Department of Rehabilitation Services
Phone 334-293-5504
Web site http://www.medicaid.alabama.gov/programs/long_term_care/waiver_independent_living.aspx?tab=4&sub=1
Summary of State Plan Coverage To provide case management, personal care, medical supplies, personal emergency response, assistive technology (installation, repair, and evaluation), personal assistance, and environmental adaptations to individuals aged 18 and above with severe and chronic physical disabilities.
Populations Served Individuals aged 18 and above with severe and chronic physical disabilities.
Terminology for HM and AT Environmental accessibility adaptations/environmental adaptations (EAA), personal emergency response systems (PERS), medical supplies, assistive technology (AT).
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.

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

Medical supplies: Supplies and medications that are not covered in the Medicaid State Plan (e.g., egg crate mattress, lift sling, over-the-bed table, shower chair).

AT: Devices, pieces of equipment, or products that are modified or customized and are used to increase, maintain, or improve functional capabilities of individuals with disabilities. Also includes any service that directly assists an individual with disability in the selection, acquisition, or use of an assistive technology device (e.g., needs evaluation, acquisition, selection design, fitting, customizing, adaptation, application).

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 EAA: $5,000 per recipient.

PERS: None.

Medical supplies: $2,300 annually per waiver recipient, including $500.00 for minor assistive technology.

AT: $2,000 per recipient annually and $15,000 per waiver recipient over the lifetime of the waiver.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

ALASKA

Overview Alaska covers a broad range of environmental accessibility adaptations and specialized medical equipment and supplies through three home and community-based waivers. Information was not available on Medicaid State Plan coverage of assistive technology or home modification services.
Medicaid State Plan Coverage
Agency Name Department of Health Services, Division of Health Care Services
Phone 907-465-3347
Web site http://www.hss.state.ak.us/commissioner/medicaidstateplan/default.htm - TOC
Summary of State Plan Coverage Information N/A.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Information N/A.
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 X N/A X X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.

 

Older Alaskans (0261)
Agency Name Division of Senior and Disability Services
Phone 907-465-3372
Web site http://www.hss.state.ak.us/dsds/docs/HCBOA_waiver.pdf
Summary of State Plan Coverage For individuals 65 and older. To provide case management, respite care, adult day health care, environmental accessibility adaptations, transportation, specialized medical equipment and supplies, chore services, meal services, residential supported living arrangements, and specialized private duty nursing.
Populations Served Those over 65 who qualify for nursing home level of care.
Terminology for HM and AT Environmental accessibility adaptations (EAA), environmental modifications, home modifications (HM), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services EAA/HM: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of special electric and plumbing systems needed to accommodate the medical equipment and supplies that are necessary for the welfare of the individual.

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. This service also includes 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.

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 EAA/HM: $10,000 every three years.

SMES: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

People with Mental Retardation and Developmental Disabilities (0260)
Agency Name Division of Senior and Disabilities Services
Phone 907-465-3372
Web site http://www.hss.state.ak.us/dsds/docs/HCBMRDD_waiver.pdf
Summary of State Plan Coverage For persons with mental retardation or developmental disabilities. Provides case management, respite care, residential and day habilitation, supported employment, educational services, and environmental access. Also provides adaptations, transportation, specialized medical equipment and supplies, chore and other services, meal services, intensive active treatment/therapies, and specialized private duty nursing.
Populations Served Persons diagnosed with developmental disability or as mentally retarded.
Terminology for HM and AT Environmental accessibility adaptations (EAA), environmental modifications, 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 needed to accommodate the medical equipment and supplies that are necessary for the welfare of the individual.

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. This service also includes 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.

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 EAA: $10,000 every three years.

SMES: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

Adults with Physical Disabilities (0262)
Agency Name Division of Senior and Disabilities Services
Phone 907-465-3372
Web site http://www.hss.state.ak.us/dsds/docs/HCBAPD_waiver.pdf
Summary of State Plan Coverage For individuals aged 21-64. To provide case management, respite care, adult day health care, environmental accessibility adaptations, transportation, specialized medical equipment and supplies, chore services, meal services, residential supported living arrangements, and specialized private duty nursing.
Populations Served Physically disabled individuals aged 21-64 who meet the nursing facility 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 needed to accommodate the medical equipment and supplies that are necessary for the welfare of the individual.

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. This service also includes 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.

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 EAA: $10,000 every three years.

SMES: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

ARIZONA

Overview Arizona covers a range of services through the Arizona Health Care Cost Containment System and Arizona Long Term Care System, including home modifications, assistive technology, personal emergency response systems, and specialized medical equipment.
Medicaid State Plan Coverage
Agency Name Arizona Department of Health Services
Phone 602-417-4000
Web site http://www.ahcccs.state.az.us/
Summary of State Plan Coverage The Arizona Health Care Cost Containment System managed care program delivers Medicaid State Plan services (e.g., durable medical equipment, home health care) through prepaid, capitated health plans under a 1115 waiver. The Arizona Long Term Care System is a statewide managed care system that delivers both acute and long-term care services (e.g., home and community-based services) through prepaid, capitated program contractors.
Populations Served The Arizona Long Term Care System program is for aged (65 and over), blind, or disabled individuals who need ongoing services at a nursing facility level of care.
Terminology for HM and AT Personal emergency response system (PERS), physical modifications to the home (HM), augmentative communication evaluations and/or devices (ACD), specialized medical equipment.
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.

HM: Installation of one ramp, including handrails, and necessary threshold modification, to facilitate barrier-free access to their homes for members; widening of doorways to allow a member in a wheelchair one access route to his or her home, and one bedroom, and/or one bathroom; and modification of bathroom facilities to allow members access and/or increased independence in bathing and toileting functions. For example, roll-in showers, wall-hung or other wheelchair-accessible sinks, re-positioning of existing fixtures for adequate movement within the bathroom, and specialized toilets to allow for easier transfers.

ACD: Upgrades/change of devices and accessories are allowed when documentation supports the medical need for the change. Accessories such as software, wheelchair mounts, and switches are provided when necessary to allow communication across all environments.

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 X   X X
Benefit Limits PERS: Information N/A.

HM: One HM project.

ACD: Information N/A.

Specialized medical equipment: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

ARKANSAS

Overview Arkansas covers a broad range of assistive technologies and home modifications through the Medicaid State Plan and two waivers.
Medicaid State Plan Coverage
Agency Name Arkansas Division of Medical Services, Department of Human Services
Phone 501-682-2441
Web site http://www.medicaid.state.ar.us/
Summary of State Plan Coverage The Arkansas Medicaid State Plan covers durable medical equipment and assistive technologies under the Prosthetics Services benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Specialized rehabilitative equipment, durable medical equipment (DME), mobility-enhancing equipment, augmentative communicative devices (ACD).
Examples of Covered HM and AT Services Specialized rehabilitative equipment: Grab-bars and handrails.

DME/Mobility-enhancing equipment: Includes wheelchairs, wheelchair batteries, tires, cushions and supplies, automobile hand controls.

ACD: Telecommunication and speech 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 ACD: $7,500 lifetime cap.

Other: There are caps on individual items per year.

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

Repairs: yes.

 

Alternatives for Adults with Physical Disabilities (0312)
Agency Name Division of Aging and Adult Services
Phone 501-682-2441
Web site http://www.medicaid.state.ar.us
Summary of State Plan Coverage To provide environmental accessibility adaptations/adaptive equipment and attendant care to physically disabled persons aged 21-64.
Populations Served Adults with chronic or severe physical disabilities aged 21-64.
Terminology for HM and AT Environmental accessibility adaptations/adaptive equipment (EAA).
Examples of Covered HM and AT Services EAA: Installation and/or regular repair of ramps and grab-bars, widening of doorways, modification of bathroom facilities, and installation of specialized electric and plumbing systems or vehicle modifications that are necessary for the welfare 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 X
Benefit Limits $7,500 per person, per the life-of-the-waiver.
Training on Use and Repairs Training: yes.

Repairs: no.

 

Alternative Community Service (0188)
Agency Name Division of Developmental Disabilities
Phone 501-682-8689
Web site http://www.medicaid.state.ar.us/
Summary of State Plan Coverage For individuals with mental retardation and developmental disabilities. To provide case management, respite care, supported living services, supported employment, environmental accessibility adaptations, transportation, specialized medical needs, companion and activities therapy, crisis intervention, supplemental support services, and waiver coordination services. Intermediate Care Facility for the Mentally Retarded residents are given priority to enter this waiver.
Populations Served Persons of any age with a developmental disability.
Terminology for HM and AT Environmental accessibility adaptations (EAA), including adaptive equipment, environmental modifications and specialized medical supplies, and augmentative communication devices (ACD).
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars, widening of doorways, and modification of bathroom facilities or installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.

ACD: Computers, communication boards, and specialized medical equipment, such as devices, controls, or appliances, that will enable the person to perceive, control, or communicate with the environment in which he or she lives.

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: The annual maximum for adaptive equipment is $7,500 per person. If the person is also receiving environmental modification services, the combined annual expenditure cannot exceed $7,500.

ACD: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: yes.

CALIFORNIA

Overview California covers assistive technology and home modifications through the Medicaid State Plan and seven waivers.
Medicaid State Plan Coverage
Agency Name Medical Care Services, Department of Human Services
Phone 916-636-1980
Web site http://www.dhs.ca.gov/mcs/
Summary of State Plan Coverage The California Medicaid State Plan, Medi-Cal, covers assistive technology and specialized equipment through the durable medical equipment benefit.
Populations Served Medi-Cal eligible individuals.
Terminology for HM and AT Specialized equipment, augmentative or alternative communication and speech-generating devices.
Examples of Covered HM and AT Services Specialized equipment: Commode chair, bathtub wall rail, transfer bench, side rails, power-operated vehicles.

Augmentative or alternative communication: Communication board, speech-generating device.

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 N/A
Benefit Limits None.
Training on Use and Repairs Training: N/A.

Repairs: yes.

 

In-Home Medical Care Waiver (Disabled Individuals) (0348)
Agency Name Medi-Cal Operations Division, Medi-Cal In-Home Operations Section
Phone 916-552-9105 in Sacramento
213-897-6774 in Los Angeles
Web site http://www.dhs.ca.gov/mcs/mcod/ihos/default.htm
Summary of State Plan Coverage This waiver allows physically disabled individuals who meet the acute level of care criteria for a minimum of 90 days to remain living at home and in the community as an alternative to hospitalization. Persons in this waiver typically have a catastrophic illness or injury and are dependent on medical technology to replace or supplant major organ systems. Services offered by this waiver include: private duty nursing, certified home health aide services, minor home modifications, and therapies.
Populations Served Individuals enrolled in this waiver typically have a catastrophic illness or injury and are dependent on medical technology to replace or supplant major organ systems.
Terminology for HM and AT Minor home modifications (HM), personal emergency response systems (PERS).
Examples of Covered HM and AT Services HM: Internal ramps, widening doorways for wheelchair access.

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 HM: Lifetime cap of $5,000.

PERS: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: Information N/A.

 

Nursing Home Facility A/B Waiver (Inpatient Nursing Facility) (0139)
Agency Name Medi-Cal Operations Division, Medi-Cal In-Home Operations Section
Phone 916-552-9105 in Sacramento
213-897-6774 in Los Angeles
Web site http://www.dhs.ca.gov/mcs/mcod/ihos/default.htm
Summary of State Plan Coverage This waiver allows persons who meet the criteria for skilled nursing care for a minimum of 365 days to remain living at home and in the community. Services offered under this waiver include personal care and skilled nursing.
Populations Served Physically disabled persons who would otherwise require skilled nursing care at level A or level B for a minimum of 365 days. Individuals enrolled in this waiver typically require assistance with either personal care and/or have some needs for skilled nursing care.
Terminology for HM and AT Minor home modifications (HM), personal emergency response systems (PERS).
Examples of Covered HM and AT Services HM: Internal ramps, widening doorways for wheelchair access.

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 HM: Lifetime cap of $5,000.

PERS: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: Information N/A.

 

Nursing Facility Subacute Waiver (Physically Disabled) (0384)
Agency Name Medi-Cal Operations Division, Medi-Cal In-Home Operations Section
Phone 916-552-9105 in Sacramento
213-897-6774 in Los Angeles
Web site http://www.dhs.ca.gov/mcs/mcod/ihos/default.htm
Summary of State Plan Coverage This waiver allows physically disabled persons who meet the subacute nursing level of care criteria for a minimum of 180 days to remain living at home and in the community. Persons in this waiver typically have a significant illness or injury and are dependent upon some medical technology to supplant or assist major organ function. Services offered by this waiver include: private duty nursing, certified home health aide services, minor home modifications, and personal care services.
Populations Served Physically disabled persons who would otherwise require subacute nursing care for a minimum of 180 days. Individuals enrolled in this waiver typically have a significant illness or injury and are dependent upon some medical technology to supplant or assist major organ function.
Terminology for HM and AT Minor home modifications (HM), personal emergency response systems (PERS).
Examples of Covered HM and AT Services HM: Internal ramps, widening doorways for wheelchair access.

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 HM: Lifetime cap of $5,000.

PERS: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: Information N/A.

 

Multipurpose Senior Service Program (Disabled Frail Elderly Waiver) (0141)
Agency Name California Department of Aging
Phone 800-510-2020
Web site http://www.aging.ca.gov/html/programs/mssp.html
Summary of State Plan Coverage This waiver allows persons aged 65 and over who are medically fragile to remain living at home and in the community. Services offered under this waiver include: adult day care, housing assistance, chore and personal care services, respite care, meal services, and transportation.
Populations Served Clients eligible for the program must be 65 years of age or older, live within a site's service area, be able to be served within the waiver’s cost limitations, be appropriate for care management services, be currently eligible for Medi-Cal, and be certified or certifiable for placement in a nursing facility.
Terminology for HM and AT Physical home adaptations, personal emergency response systems (PERS), assistive devices and communications services.
Examples of Covered HM and AT Services Home adaptations: Ramps, grab-bars, minor home improvements.

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

Assistive devices and communications services: Translation and interpretive services.

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

Repairs: no.

 

Home and Community-Based Services Waiver for Persons with Developmental Disabilities (MR/DD) (0336)
Agency Name Medi-Cal Operations Division, Monitoring and Oversight Section
Phone 916-552-9105
Web site http://www.dhs.ca.gov/mcs/mcod/mos/default.htm
Summary of State Plan Coverage This waiver allows persons with mental retardation/developmental disability who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria to remain living at home and in the community. Services offered under this waiver include: transportation, adult residential care, day habilitation, and respite services.
Populations Served Disabled beneficiaries who would otherwise require institutional care.
Terminology for HM and AT Physical home adaptations, personal emergency response systems (PERS), assistive devices and communications services.
Examples of Covered HM and AT Services Home adaptations: Ramps, grab-bars, minor home improvements.

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

Assistive devices and communications services: Translation and interpretive services.

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

Repairs: no.

 

AIDS Waiver (HIV/AIDS Waiver) (0183)
Agency Name Demonstration Project Unit of the Medi-Cal Policy Division
Phone 916-552-9634
Web site http://www.dhs.ca.gov/mcs/mcpd/RDB/DPU/Links/Office of AIDS Medi.doc
Summary of State Plan Coverage This waiver allows persons who are cognitively and functionally impaired with symptomatic HIV disease or AIDS to remain living at home and in the community as an alternative to institutional care. Services offered under this waiver include: medical case management, attendant care, homemaker services, and transportation.
Populations Served Persons with a diagnosis of Human Immunodeficiency Virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS) with signs, symptoms, or disabilities related to HIV disease or HIV disease treatment, as an alternative to institutionalized care.
Terminology for HM and AT Minor home adaptations, specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Home adaptations: “Minor physical adaptations to the home” are those physical adaptations to the home required by the individual’s service plan that are necessary to enable the individual to function with greater independence in the home, and without which the individual would require institutionalization. For waiver purposes, “home” means a place of residence where the client spends the majority of time.

SMES: Devices, controls, or appliances specified in the plan of care that enable individuals to increase their abilities to perform daily activities or to perceive, control, or communicate with the environment.

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 Home adaptations: $1,000 per calendar year, per client.

SMES: $1,000 per year.

Training on Use and Repairs Training: yes.

Repairs: Information N/A.

 

Assisted Living Waiver (0431)
Agency Name Medi-Cal Operations Division, Home and Community-Based Services Branch
Phone 916-552-9105
Web site http://www.dhs.ca.gov/mcs/mcod/mos/default.htm
Summary of State Plan Coverage This waiver provides services that enable low-income, Medi-Cal eligible persons who reside in Residential Care Facilities for the Elderly, or in publicly funded senior and disabled housing projects, to age in place when they might otherwise require in-patient Nursing Facility care.
Populations Served Aged and/or disabled individuals (age 21 or older) who meet the criteria for Nursing Facility level of care and without the services would be in a nursing facility.
Terminology for HM and AT Environmental accessibility adaptations (EAA), individual response systems (IRS).
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 client.

IRS: 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 X
Benefit Limits General: $1,500 per client for the duration of the waiver.

EAA: Information N/A.

IRS: Information N/A.

Training on Use and Repairs Training: no.

Repairs: no.

 

COLORADO

Overview Of Colorado’s eight home and community-based service waivers, five cover home modifications. Speech augmentation devices and assistive technology are available under the Medicaid State Plan. Colorado’s Single Entry Point process ensures that all beneficiaries have a case manager, and that all services are provided through the Single Entry Point agency.
Medicaid State Plan Coverage
Agency Name Colorado Department of Health Care Policy and Financing (HCPF)
Phone 303-866-3513 or 1-800-221-3943
Web site http://www.chcpf.state.co.us/ACS/Provider_Services/provider_services.asp
Summary of State Plan Coverage The Colorado Medicaid state plan covers assistive technology under the Durable Medical Equipment Prosthetics and Orthotics benefit. There is no coverage of home modifications under the state plan.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Speech augmentation devices, assistive technology.
Examples of Covered HM and AT Services Speech augmentation devices: Covered under the state Durable Medical Equipment Prosthetics and Orthotics benefit.

Assistive technology: Wheelchairs, sip-and-puff controls for wheelchair, electronic door opener, adaptive eating utensils.

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: no.

Repairs: yes.

 

Home and Community-Based Services for the Elderly, Blind, and Disabled (EBD) (0006)
Agency Name Colorado Department of Health Care Policy and Financing (HCPF)
Phone 303-534-0146
Web site http://www.chcpf.state.co.us/ACS/Provider_Services/provider_services.asp
Summary of State Plan Coverage For disabled individuals 18-64 that meet the nursing facility level care criteria. Services include homemaker, personal care, respite care, adult day health care, environmental accessibility adaptations, transportation, personal emergency response systems, alternative care facilities, and in-home support.
Populations Served Any person with a functional impairment, blind persons, or physically disabled persons (aged 18-64).
Terminology for HM and AT Home modifications (HM), personal emergency response systems (PERS), electronic monitoring.
Examples of Covered HM and AT Services HM: Installations of ramps, installation of grab-bars and other durable medical equipment if approved by Medicaid as medically necessary, widening of doorways, modifications of bathroom facilities, installation of specialized electric and plumbing systems.

PERS/electronic monitoring: Electronic devices that enable a person to secure help in an emergency, or a medication monitoring device.

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 HM: There is a lifetime cap of $10,000 per client.

PERS: Information N/A.

Training on Use and Repairs Training: no.

Repairs: yes.

 

Home and Community-Based Services for Persons with Major Mental Illness (0268)
Agency Name Colorado Department of Health Care Policy and Financing (HCPF)
Phone 303-534-0146
Web site http://www.chcpf.state.co.us/ACS/Provider_Services/provider_services.asp
Summary of State Plan Coverage To provide homemaker assistance, personal care, respite care, adult day health care, environmental modifications, transportation, and alternative care facilities to chronically mentally ill individuals 18 and over needing nursing facility level of care.
Populations Served Individuals with a major mental illness 18 and over.
Terminology for HM and AT Home modifications (HM), personal emergency response systems (PERS), electronic monitoring.
Examples of Covered HM and AT Services HM: Installations of ramps, installation of grab-bars and other durable medical equipment if approved by Medicaid as medically necessary, widening of doorways, modifications of bathroom facilities, installation of specialized electric and plumbing systems needed to accommodate the medical equipment and supplies necessary for the welfare of the recipient.

PERS/electronic monitoring: Electronic devices that enable a person to secure help in an emergency, or a medication monitoring device.

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 HM: There is a lifetime cap of $10,000 per client.

PERS: Information N/A.

Training on Use and Repairs Training: no.

Repairs: yes.

 

Home and Community-Based Services for the Developmentally Disabled (0007)
Agency Name Colorado Department of Human Services
Phone 303-866-5700
Web site http://www.cdhs.state.co.us/
Summary of State Plan Coverage To provide habilitation services (day, prevocational, residential, supported employment), transportation, supported living, home modifications, and assisted technology to MR/DD adults and children. The beneficiary would otherwise be living in a group home or a peer companion home. Community center boards administer this waiver.
Populations Served Mentally retarded and developmentally disabled adults 18 and older.
Terminology for HM and AT Personal emergency response systems (PERS), electronic monitoring, environmental engineering, assisted technology (AT).
Examples of Covered HM and AT Services PERS/electronic monitoring: Electronic devices that enable a person to secure help in an emergency, or a medication monitoring device.

Environmental engineering: Adaptations to living quarters including to showers and toilets; control switches for the home; kitchen equipment for the preparation of special diets; and provisions for accessibility such as ramps and railings. Also, mobility devices to help people move around, including wheelchairs (general use and customized) and van adaptations.

AT: Expressive and receptive communication augmentation, including electronic communication boards; and safety-enhancing supports, including security or emergency response systems, if the cost is above and beyond that of normal expenses for personal needs.

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
Benefit Limits Costs caps are dependent upon the amount of annual funding given to the community center boards from the waiver authority.
Training on Use and Repairs Training: Information N/A.

Repairs: Information N/A.

 

Home and Community-Based Services for Persons with Brain Injury
Agency Name Colorado Department of Health Care Policy and Financing (HCPF)
Phone 303-534-0146
Web site http://www.chcpf.state.co.us/ACS/Provider_Services/provider_services.asp
Summary of State Plan Coverage For disabled individuals ages16-64. To provide personal care, respite care, environmental accessibility (home modification), non-medical transportation, specialized medical equipment and supplies, personal emergency response/electronic monitoring, adult day treatment, adult day services, transitional living, substance abuse counseling, mental health counseling, behavior programming, and education.
Populations Served Disabled individuals ages 16-64.
Terminology for HM and AT Environmental accessibility (EA), specialized medical equipment and supplies (SMES), personal emergency response systems (PERS), electronic monitoring.
Examples of Covered HM and AT Services EA: Installations of ramps, installation of grab-bars and other durable medical equipment if approved by Medicaid as medically necessary, widening of doorways, modifications of bathroom facilities, installation of specialized electric and plumbing systems needed to accommodate the medical equipment and supplies necessary for the welfare of the recipient.

SMES: Cognitive orthotics and memory prostheses, lifeline and med monitoring, electronic checkbook, car finder, paging systems, timing devices, sounding devices, security systems, queuing watches, tape recorders, telememo watches, spellcheckers, memory phone, info databases, and text outlining programs.

PERS: Electronic devices that enable a person to secure help in an emergency, or a medication monitoring device.

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 EA: There is a lifetime cap of $10,000 per client.

SMES: Information N/A.

PERS: Information N/A.

Training on Use and Repairs Training: no.

Repairs: yes.

 

Supported Living Services (SLS) (0293)
Agency Name Colorado Department of Human Services, Developmental Disabilities Services and Colorado Department of Health Care Policy and Financing (HPCF)
Phone 303-534-0146
Web site http://www.chcpf.state.co.us/ACS/Provider_Services/provider_services.asp
Summary of State Plan Coverage Supported Living Services are provided as an alternative to institutional placement for individuals with developmental disabilities, and include personal assistant services, habilitation services, environmental engineering, professional services, and dental services.
Populations Served Individuals 18 and older with a developmental disability.
Terminology for HM and AT Environmental engineering (includes home modifications and assistive technology).
Examples of Covered HM and AT Services Environmental engineering: Adaptations to living quarters, including adaptations to showers and toilets; provision of kitchen equipment for the preparation of special diets; modifications for accessibility such as ramps and railings; and mobility devices to help people move around, including wheelchairs (general use and customized) and van adaptations. Also, expressive and receptive communication augmentation, including electronic communication boards; and safety enhancing supports, including security or emergency response systems, if the cost is above and beyond that of normal personal needs expenses. Specialized medical equipment, and non-durable 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 N/A X X X X
Benefit Limits Limited to a maximum of $10,000 per individual within the duration of this waiver.
Training on Use and Repairs Training: no.

Repairs: yes.

 

CONNECTICUT

Overview Connecticut covers wheelchairs and accessories for all clients who live at home, and customized wheelchairs for clients in Intermediate Care Facilities for the Mental Retarded through the Medicaid state plan. In addition, the state offers four waivers that cover a range of assistive technology and home modification services.
Medicaid State Plan Coverage
Agency Name Connecticut Department of Social Services
Phone 1-800-842-1508
Web site http://www.ct.gov/dss
Summary of State Plan Coverage The Connecticut Medicaid State Plan covers wheelchairs and accessories for all clients who live at home, and customized wheelchairs for clients in nursing facilities or Intermediate Care Facilities for the Mental Retarded under the Medical Equipment, Devices, and Supplies benefit. There is no coverage of home modifications under the state plan.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Medical equipment, devices, and supplies (MEDS).
Examples of Covered HM and AT Services MEDS: Wheelchairs and accessories, including motorized wheelchairs and power-operated vehicles; customized wheelchairs when medically necessary for clients in nursing facilities or 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 X X X  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Connecticut Home Care Program for Elders (0140)
Agency Name Connecticut Department of Social Services, Alternate Care Unit
Phone 1-800-445-5394
Web site http://www.ct.gov/dss/cwp/view.asp?a=2353&q=305170
Summary of State Plan Coverage To provide to seniors: case management, homemaker services, visiting nurse care, home health care, respite care, adult day health care, transportation, help with chores, personal emergency response systems, companion services, minor home modifications, and adult residential care.
Populations Served Medicaid recipients who are over 65 and meet nursing home level of care criteria.
Terminology for HM and AT Home modifications (HM), personal emergency response systems (PERS).
Examples of Covered HM and AT Services HM: Ramps, grab-bars in the bathroom, and stair glides.

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
Benefit Limits HM: There is no cost cap for individuals per year, although the program has a monthly cost cap and will give prior authorization only if funds are available.

PERS: None.

Training on Use and Repairs HM: Training: yes. Repairs: no.

PERS: Training: yes. Repairs: yes.

 

Comprehensive Supports Waiver (0153)
Agency Name Connecticut Department of Mental Retardation
Phone 860-418-6000
Web site http://www.dmr.state.ct.us/publications/centralofc/fact_sheets/ifs_hcbswaiver.pdf
Summary of State Plan Coverage For people with mental retardation/developmental disabilities. To provide licensed residential services (community living, training, and assisted living), residential and family support services (supported living, personal support, adult companion services, respite care, personal emergency and response systems, home and vehicle modifications), vocational and day services (supported employment, group and individualized day care), and specialized support services (behavior and nutrition consultation, specialized equipment and supplies, interpreter, transportation, individual directed goods and services, and family and individual support).
Populations Served Medicaid recipients age three and older who meet Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Home (environmental) modifications (HM), vehicle modifications (VM), personal emergency response systems (PERS), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services HM: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems needed to accommodate medical equipment and supplies.

VM: Alterations made to a vehicle that is the individual’s primary means of transportation, including wheelchair lift, wheelchair tie downs, and grab-bars.

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

SMES: Adaptive eating equipment, adaptive technology for speech, sensory integration equipment and supplies, standing tables.

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 HM and VM: Up to $10,000 for home modifications and up to $10,000 for vehicle modifications, over a three-year period.

PERS: None.

SMES: The waiver allows $750 per year with no prior approval (as long as items are specified in the Individual Plan). With prior approval, this benefit can reach $3,000 per three years.

Training on Use and Repairs HM and VM: Training: yes. Repairs: yes.

PERS: Training: yes. Repairs: yes.

SMES: Training: yes. Repairs: yes.

 

Acquired Brain Injury (0302)
Agency Name Connecticut Department of Social Services, Division of Social Work and Prevention
Phone 860-424-5373
Web site http://www.ct.gov/dss/cwp/view.asp?a=2353&q=305236
Summary of State Plan Coverage For disabled individuals with acquired brain injury, aged 18-64. To provide case management, homemaker services, personal care, respite care, habilitation (day, prevocational, supported employment), environmental adaptations, transportation, specialized medical equipment and supplies, chore services, personal emergency response systems, companion services, family training, community living support, home-delivered meals, independent living skill training, intensive behavior programs, substance abuse programs, and transitional living services.
Populations Served People aged 18-64 who are disabled by acquired brain injuries and meet nursing home level of care criteria. Recipients must have monthly income less than 300 percent of Supplemental Security Income, liquid assets of $1,600 or less, and meet all other Medicaid requirements.
Terminology for HM and AT Environmental accessibility adaptations (EAA), personal emergency response systems (PERS), specialized medical equipment and supplies (SMES), vehicle modifications (VM).
Examples of Covered HM and AT Services EAA: Ramp installations, bathroom modifications, and door widening to accommodate wheelchairs.

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, and that are not covered by the Medicaid State Plan. Assistive technology items include communication devices, computers, and personal digital assistants.

VM: Alterations made to a vehicle that is the individual’s primary means of transportation, including ramp installation and modification to accommodate 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
Benefit Limits EAA: Limited to $10,000 per year.

PERS: The waiver has a set rate for reimbursement.

SMES: Limited to $10,000 per year.

VM: Limited to $10,000 per year.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

Individual and Family Support Independence Plus (0426)
Agency Name Connecticut Department of Mental Retardation
Phone 860-418-6000
Web site http://www.dmr.state.ct.us/publications/centralofc/fact_sheets/ifs_hcbswaiver.pdf
Summary of State Plan Coverage For people with mental retardation/developmental disabilities. To provide residential and family support services (supported living, personal support, individual habilitation, companion services, respite care, personal emergency response systems, home and vehicle modifications, family training); vocational and day services (supported employment, group day, individual day); and specialized and support services (behavior and nutrition counseling, specialized equipment and supplies, interpreter, transportation, family and individual support). This waiver provides the same coverage for home modifications and assistive technology as the Comprehensive Supports Waiver.
Populations Served Medicaid recipients age three and older who meet Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Home (environmental) modifications (HM), vehicle modifications (VM), personal emergency response systems (PERS), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services HM: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems needed to accommodate medical equipment and supplies.

VM: Alterations made to a vehicle that is the individual’s primary means of transportation, including wheelchair lift, wheelchair tie downs, and grab-bars.

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

SMES: Adaptive eating equipment, adaptive technology for speech, sensory integration equipment and supplies, standing tables.

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 HM and VM: Up to $10,000 for home modifications and up to $10,000 for vehicle modifications, over a three-year period.

PERS: None.

SMES: The waiver allows $750 per year with no prior approval (as long as items are specified in the Individual Plan). With prior approval, this benefit can reach $3,000 per three years.

Training on Use and Repairs HM and VM: Training: yes. Repairs: yes.

PERS: Training: yes. Repairs: yes.

SMES: Training: yes. Repairs: yes.

 

DELAWARE

Overview Delaware covers selected adaptive and assistive equipment through its Medicaid state plan. In addition, the state offers a mental retardation/developmental disability waiver that covers environmental modifications and an Elderly/Disabled waiver that covers emergency response systems.
Medicaid State Plan Coverage
Agency Name Delaware Health and Social Services (DHHS), Division of Medicaid and Medical Assistance
Phone 1-800-372-2022
Web site http://www.dhss.delaware.gov/dhss/dss/medicaid.html
Summary of State Plan Coverage The Delaware Medicaid State Plan covers customized wheelchairs and augmentative/alternative communication devices 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 Customized wheelchairs, augmentative/alternative communication (AAC) devices, DME.
Examples of Covered HM and AT Services Customized wheelchairs: A wheelchair that has been customized so that only the individual client can use it. The Delaware Medicaid State Plan does not consider a wheelchair to be customized if the wheelchair and all adaptations can be coded with HCPCS procedure codes.

AAC devices and services: Electronic or non-electronic aids, devices, or systems that assist a person to overcome or ameliorate communication limitations that preclude or interfere with meaningful participation in current and projected daily activities. Augmentative/alternative communication devices include communication boards or books; electrolarynxes; speech amplifiers; and electronic devices that produce speech and/or written output. Augmentative/alternative communication services include treatment by a speech-language pathologist to help a person improve his or her communication ability.

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 Customized wheelchairs: None.

AAC devices and services: None.

Training on Use and Repairs Customized wheelchairs: Training: yes. Repairs: yes.

AAC devices and services: Training: yes. Repairs: yes.

 

Mental Retardation and Other Developmental Disabilities Home and Community-Based Waiver (MR/DD Waiver) (0009)
Agency Name Delaware Health and Social Services, Division of Developmental Disabilities Services
Phone 302-744-9600
Web site http://www.dhss.delaware.gov/dhss/dss/homeandc.html
Summary of State Plan Coverage To provide case management, residential habilitation, day habilitation, respite care, clinical support services, pre-vocational training, supported employment, transportation, and environmental modifications, adaptations, and equipment to people with mental retardation/developmental disabilities.
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 modifications, adaptations, and equipment.
Examples of Covered HM and AT Services Environmental modifications, adaptations, and equipment: Installation of external and internal ramps, grab-bars, handrails, level handles and fixtures; widening of doorways/passageways; opening living space areas for maneuverability; modification of bathroom facilities; bedroom modifications to accommodate special equipment/beds/wheelchairs; modification of kitchen facilities; shatterproof windows; lighting modifications; floor covering modifications; vertical platform lifts; environmental control devices and systems; specially designed appliances; alarm systems/alert systems, including auditory, vibratory, and visual; stair mobility devices; barrier-free lift/pulley/tracking/mobility devices; stationary/built-in therapeutic table; weather protective modifications for entrances/exits.
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 The total cost of environmental modifications to a recipient in one year cannot exceed $2,000, with a lifetime cap of $7,000.
Training on Use and Repairs Information N/A.

 

Elderly and Disabled Home and Community-Based Waiver (0136)
Agency Name Delaware Health and Social Services, Division of Services for Aging and Adults with Physical Disabilities
Phone 1-800-223-9074
Web site http://www.dhss.delaware.gov/dhss/dss/homeandc.html
Summary of State Plan Coverage To provide case management, homemaker, adult day care, respite care, personal emergency response systems, medical equipment and supplies, and appliances to people who are elderly or disabled.
Populations Served Medicaid recipients who are elderly or physically disabled and who meet 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 X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

DISTRICT OF COLUMBIA

Overview The District of Columbia covers some assistive technology through the Medicaid State Plan Durable Medical Equipment benefit, and offers a range of assistive technology and home modification services through three waivers.
Medicaid State Plan Coverage
Agency Name District of Columbia (DC) Medical Assistance Administration
Phone 202-671-4200
Web site http://www.dhs.dc.gov/dhs/site/default.asp
Summary of State Plan Coverage The District of Columbia Medicaid State Plan is a fully capitated managed care plan and offers coverage of some assistive technology services through the durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Assistance technology, personal emergency response systems (PERS).
Examples of Covered HM and AT Services AT: Sound amplifiers, TTY devices, Braille devises, learning toys.

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

Adaptive 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
N/A N/A X N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.

 

Mental Retardation and Developmental Disabilities Waiver
Agency Name Mental Retardation and Developmental Disabilities Administration (MRDDA), District of Columbia Department of Human Services
Phone 202-673-4500
Web site http://mrdda.dc.gov/services.asp?id=service
Summary of State Plan Coverage This waiver allows adults with mental retardation/developmental disabilities who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria to remain living at home and in the community. Services include: homemaker, chore aides, personal care aides, physical and occupational therapy, skilled nursing, personal emergency response systems, companion services, family training, dental services, and respite care.
Populations Served Adults, including aged District of Columbia citizens, with mental retardation and other developmental disabilities.
Terminology for HM and AT Adaptive equipment, personal emergency response systems (PERS), assistive technology (AT), augmentative communication devices (ACD).
Examples of Covered HM and AT Services Adaptive equipment: Information N/A.

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

AT/ACD: Sound amplifiers, TTY devices, Braille devices, learning toys, talking calculators, computer software, and other customized or modified barriers-reducing equipment.

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 N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Training: N/A.

Repairs: yes.

 

Elderly and Physical Disabilities Waiver
Agency Name Department of Health
Phone 202-671-5000
Web site http://doh.dc.gov/doh/site/default.asp
Summary of State Plan Coverage This waiver allows physically disabled adults aged 18 and above who meet nursing facility level of care criteria to remain living at home and in the community. Services offered under this program include: personal care aide, respite care, homemaking, and personal emergency response systems.
Populations Served Adults, including the aged, 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.
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 N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.

 

HIV/AIDS Waiver (0317)
Agency Name Department of Health
Phone 202-671-5000
Web site http://doh.dc.gov/doh/site/default.asp
Summary of State Plan Coverage This waiver provides water purification systems and replacement filters to persons with HIV/AIDS who otherwise would need institutionalization in a hospital.
Populations Served Adult residents, including the aged, with HIV.
Terminology for HM and AT Specialized medical equipment.
Examples of Covered HM and AT Services Specialized medical equipment: Water purification systems.
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.

 

FLORIDA

Overview Florida covers a range of assistive technologies and home modifications through the Medicaid State Plan and nine waivers; these include augmentative communication, emergency response systems, specialized medical equipment and supplies, vehicle adaptations, and home modifications.
Medicaid State Plan Coverage
Agency Name Agency for Health Care Administration (AHCA)
Phone 850-488-2520
Web site http://www.fdhc.state.fl.us/Medicaid/flmedicaid.shtml
Summary of State Plan Coverage Under the Florida Medicaid State Plan, durable medical equipment and medical supplies are covered in an effort to promote, maintain, or restore health and minimize the effects of illness, disability, or a disabling condition.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Augmentative and alternative communication systems (AACs). Customization/motorization of wheelchairs.
Examples of Covered HM and AT Services AACs: Are designed to allow individuals the capability to communicate. As defined by the American Speech-Language Hearing Association, an alternative communication systems attempts to compensate for the impairment and disability patterns of individuals with severe, expressive communication disorders (i.e., individuals with severe speech-language and writing impairments). Dedicated systems are designed specifically for a disabled population. Non-dedicated systems are commercially available devices such as laptop computers with special software.

Customization/motorization of wheelchairs: Customized wheelchairs that are specially constructed (K0008, K0013, K0014).

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 AACs: Medicaid will reimburse for one alternative communication systems every five years per recipient, and a software upgrade every two years, if needed.

Customization/motorization of wheelchairs: Information N/A.

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

Repairs: yes.

 

Developmental Services Home and Community-Based Services Waiver (MR/DD Waiver) (0010b.91.R4)
Agency Name Florida Agency for Persons with Disabilities
Phone 888-419-3456
Web site http://apd.myflorida.com/
Summary of State Plan Coverage This waiver allows persons with mental retardation/developmental disability who meet the Intermediate Care Facility for the Developmentally Disabled level of care criteria to remain living at home and in the community. Thirty-four services are offered under this waiver, including: support coordination, adult day training, consumable medical supplies, residential habilitation therapy, transportation, and personal care assistance.
Populations Served Medicaid-eligible individuals with mental retardation and/or developmental disability must meet the level of care criteria for placement in an Intermediate Care Facility for the Developmentally Disabled. Recipients of developmental disability waiver services must need and receive support coordination services.
Terminology for HM and AT Specialized medical equipment (SMES), environmental accessibility adaptations (EAA), vehicle adaptations, augmentative communication devices (ACD).
Examples of Covered HM and AT Services SMES: Wheelchairs, to the extent that they are medically necessary and not covered by the Medicaid State Plan.

EAA: Portable ramps, when the recipient requires access to more than one, otherwise inaccessible, structure.

Vehicle adaptations: Van adaptations, including lifts, tie downs, and raised roof or doors in a family owned or individually owned full-size van.

ACD: Adaptive switches and buttons to operate equipment, communication devices, and environmental controls, such as heat, air conditioning, and lights, for a recipient living alone or who is alone without a caregiver for a major portion of the day.

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 SMES: Information N/A.

EAA: Minor adaptations: under $3,500. Major adaptations: $3,500 and over. Total environmental accessibility adaptations cannot exceed $20,000 during a five-year period.

Vehicle adaptations: Information N/A.

ACD: Information N/A.

Training on Use and Repairs Training: no.

Repairs: yes.

 

Channeling Services for Frail Elders (Frail Elders Waiver) (0116.90.R3)
Agency Name Agency for Health Care Administration
Phone 850-487-2618
Web site http://www.ahca.myflorida.com/
Summary of State Plan Coverage This waiver allows residents from Dade or Broward counties who meet the nursing facility level of care criteria and are aged 65 and above to remain living at home and in the community. Services include: case management, caregiver training, personal care assistance, and consumable medical supplies and equipment.
Populations Served Elderly individuals residing in Broward and Dade counties.
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, and modifications of bathroom facilities or installation of specialized electric and plumbing systems.

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 EAA: $2,000 per calendar year, per recipient.

PERS: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

Elderly and Disabled Waiver (Elderly and Disabled) (0010a)
Agency Name Agency for Health Care Administration
Phone 888-419-3456
Web site http://ahca.myflorida.com/
Summary of State Plan Coverage This waiver allows physically disabled persons aged 18 and above who meet nursing facility level of care criteria to remain living at home and in the community. Services include: adult day health care, attendant care, case management, homemaker assistance, personal care services, and home-delivered meals. Other services include: adult companion services, chore services, consumable medical supplies, counseling, environmental accessibility adaptation, escort, family training, financial risk reduction, health support, nutrition, personal emergency response systems, pest control, physical risk reduction, physical therapy, respite care, skilled nursing, specialized medical equipment and supplies, and speech therapy.
Populations Served Elders and physically disabled persons aged 18 and above who meet nursing facility level of care criteria.
Terminology for HM and AT Personal emergency response systems (PERS), environmental accessibility adaptations (EAA), home modification services.
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.

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.

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  
Benefit Limits PERS: $95 per installation, limited to three installations in a lifetime and $1.30 per day for maintenance of the system.

EAA: Five jobs per year at $1,000, per job or $5,000 per year.

Training on Use and Repairs Training: yes (family).

Repairs: Information N/A.

 

Project AIDS Care (AIDS Waiver) (0194)
Agency Name Agency for Health Care Admin.
Phone 888-419-3456
Web site http://www.fdhc.state.fl.us/index.shtml
Summary of State Plan Coverage This waiver allows persons who have a diagnosis of AIDS and who are at risk of institutionalization in a nursing facility or placement in a hospital to remain living at home and in the community. Services offered under this waiver include: case management, home-delivered meals, homemaker services, massage therapy, and education and support services.
Populations Served Individuals diagnosed with HIV/AIDS.
Terminology for HM and AT Specialized medical equipment and supplies services (SMES), medical and adaptive equipment, environmental accessibility adaptations (EAA).
Examples of Covered HM and AT Services SMES: 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. Adaptive switches and buttons to operate equipment including adaptive door openers and locks or bath or shower chair when medically indicated; and wheelchairs.

Medical and adaptive equipment: Egg crate padding for a bed when medically indicated and prescribed by a physician, or single-room air purifier with documented medical reason such as pulmonary disease.

EAA: Ramps, widening doors and modifying bathroom facilities to accommodate wheelchairs and other assistive devices, installation of specialized electrical or plumbing systems necessary to accommodate required medical equipment.

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 SMES: Information N/A.

Medical and adaptive equipment: Information N/A.

EAA: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

Nursing Home Diversion (0315.90.04)
Agency Name Department of Elder Affairs
Phone 850-414-2308; 888-419-3456
Web site http://elderaffairs.state.fl.us/doea/english/longtermcared.html
Summary of State Plan Coverage This waiver allows persons aged 65 and above who are residents of specific counties, who meet the nursing facility level of care and are dually eligible for Medicaid and Medicare Parts A & B, to remain living at home and in the community. Long-term care waiver services offered include adult companion services; adult day health; assisted living; case management; chore services; homemaker services; escort; family training; financial assessment and risk reduction; home-delivered meals; nutritional assessment and risk reduction; personal care; personal emergency response systems; respite care; occupational, physical, and speech therapies; home health care; nursing facility services; and consumable medical supplies. Acute care waiver services offered include mental health services; dental, hearing, and visual services; physicians; independent laboratory and x-ray; inpatient hospital and outpatient hospital/emergency; and prescribed drugs (not covered by Medicare Part D).
Populations Served Persons aged 65 and above who are residents of specific counties who meet the nursing facility level of care criteria and who are dually eligible for Medicaid and Medicare.
Terminology for HM and AT Environmental accessibility adaptations (EAA), personal emergency response systems (PERS), assistive devices.
Examples of Covered HM and AT Services EAA: Grab-bars for bathrooms and stairways and doorway modifications 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
X N/A N/A   X  
Benefit Limits Information N/A.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Family and Supported Living Waiver (Disabilities Waiver) (0294.90.R1.01)
Agency Name Agency for Persons with Disabilities
Phone 850-414-2308; 888-419-3456
Web site http://apd.myflorida.com/
Summary of State Plan Coverage This waiver allows persons with mental retardation/developmental disability aged 18 and above who meet the Intermediate Care Facility for the Developmentally Disabled level of care criteria to remain living at home and in the community. Services offered under this waiver include: adult day training, in-home support services, supported living coaching, supported employment and transportation.
Populations Served Persons with mental retardation/developmental disability aged 18 and above who meet the Intermediate Care Facility for the Developmentally Disabled level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations/home modifications (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 or installation of specialized electric and plumbing systems.

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 General: The overall spending limit for the waiver is $14,282.

EAA: Maximum annual dollar amount: $2,000.

PERS: Maximum annual dollar amount: $300.

Training on Use and Repairs Training: no.

Repairs: no.

 

Home and Community-Based Services Waiver for Traumatic Brain Injury and Spinal Cord Injuries (TBI/Spinal Injury) (0342.90.02)
Agency Name Florida Department of Health, Brain and Spinal Cord Injury Program (BSCIP)
Phone 850-245-4045; 1-866-875-5660
Web site http://www.doh.state.fl.us/Workforce/BrainSC/Medicaid/medicaidhome.html
Summary of State Plan Coverage This waiver allows persons with traumatic brain injury and spinal cord injury aged 18 and above who meet the nursing facility level of care criteria and have been referred to the state's Brain and Spinal Cord Injury Program Central Registry to remain living at home and in the community. Services provided include: adaptive health and wellness, assistive technologies, attendant care, behavior programming, community support coordination, companion care, consumable medical supplies, environmental accessibility adaptations, life skills training, personal adjustment counseling, personal care, and rehabilitation engineering evaluation.
Populations Served Florida residents, 18 or older, who meet the state definition of traumatic brain injury, spinal cord injury, or both; are medically stable; meet at least the Level II nursing home level of care criteria; and are financially eligible for Florida Medicaid.
Terminology for HM and AT Environmental accessibility adaptations (EAA), assistive technology (AT).
Examples of Covered HM and AT Services EAA: Installation of ramps and grab-bars; widening of doorways; modification of bathroom facilities.

AT: Adaptive switches to operate equipment, environmental controls, and 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 N/A X X X  
Benefit Limits Specific reimbursement rates and maximum limits per recipient for each waiver service are being established.
Training on Use and Repairs Training: yes.

Repairs: Information N/A.

 

Adult Cystic Fibrosis Waiver (0392)
Agency Name Agency for Health Care Administration, operated by the Department of Health-BSCIP/ Adult CF
Phone 850-487-2618 (Agency for Health Care Administration)
850-345-4045 (Department of Health BSCIP)
Web site http://www.ahca.myflorida.com/
Summary of State Plan Coverage This waiver allows individuals 18 years of age and older and diagnosed with cystic fibrosis who are at risk of hospitalization to remain living at home and in the community. Services provided include acupuncture, case management, chore services, counseling, dental services, durable medical equipment, exercise therapy, homemaker services, massage therapy, nutritional consultation, personal care, personal emergency response, physical therapy, prescribed drugs, respiratory therapy, respite care (home), skilled nursing, specialized medical equipment and supplies, transportation, and vitamins and nutritional supplements for adults disabled with cystic fibrosis.
Populations Served Individuals 18 years of age and older with a diagnosis of cystic fibrosis and a need for services provided by the waiver, who, but for the provision of home and community-based services, would require hospital level of care, and are eligible for Florida Medicaid.
Terminology for HM and AT Specialized medical equipment and supplies (SMES), personal emergency response systems (PERS).
Examples of Covered HM and AT Services SMES: Vest and like products designed for airway clearance, devices, controls, or appliances to increase recipients’ abilities to perform activities of daily living.

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 Specific reimbursement rates and maximum limits per recipient for each waiver service are under development.
Training on Use and Repairs SMES: Training: yes. Repairs: not in the first year of service.

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

 

1915(c) Alzheimer’s Disease Program (0418)
Agency Name Agency for Health Care Administration
Phone 888-419-3456
Web site http://ahca.myflorida.com/
Summary of State Plan Coverage To provide case management, personal care, respite care, adult day health care, environmental modification, family training, incontinence supplies, wanderer alarm system, wanderer identification and location program, behavioral assessment and intervention, and pharmacy review to individuals aged 60 and above with Alzheimer's disease.
Populations Served Individuals aged 60 and above with Alzheimer's disease, living at home with a caregiver.
Terminology for HM and AT Wanderer alarm system, wanderer identification system, environmental accessibility adaptations (EAA).
Examples of Covered HM and AT Services Wanderer alarm system: Alert panels, voice alarms, electromagnetic door locks, perimeter alarms and transmitter alarms.

Wanderer identification system: Individuals are registered with a national database and wear a bracelet or necklace with an identity number and a toll-free “hotline” to contact if the person is missing and when found.

EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities or installation of specialized electric and plumbing systems to accommodate the 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 N/A N/A N/A N/A N/A
Benefit Limits Wanderer alarm system: $1,200 per year.

Wanderer identification system: $100 per year.

EAA: Five jobs of $1,000 per job or $5,000 per year.

Training on Use and Repairs Training: yes (family).

Repairs: Information N/A.

 

GEORGIA

Overview Georgia covers selected types of assistive technologies through the Medicaid state plan DME benefit. In addition, Georgia offers four waivers that cover a range of assistive technology, home modification, vehicle adaptations, and personal emergency response systems.
Medicaid State Plan Coverage
Agency Name Division of Medical Assistance and Georgia Health Partnership
Phone 866-211-0950
Web site http://dch.georgia.gov/00/channel_title/0,2094,31446711_31944826,00.html
Summary of State Plan Coverage The Georgia Medicaid state plan covers wheelchairs and augmentative communication devices through the durable medical equipment (DME) benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Custom wheeled mobility, augmentative and alternative communication.
Examples of Covered HM and AT Services Custom wheeled mobility: Power wheelchairs, customized wheelchairs.

Augmentative and alternative communication: Dedicated voice output communication devices as well as computer-based devices that have been adapted for use as the member’s communication devices (e.g., speech aids).

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 X N/A
Benefit Limits Custom wheeled mobility: Information N/A.

Augmentative and alternative communication: Information N/A.

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

Repairs: yes.

 

Mental Retardation Waiver Program (MR/DD Waiver) (0175)
Agency Name Department of Human Resources, Division of Mental Health Developmental Diseases and Addictive Diseases
Phone 404-657-5737
Web site http://www.communityhealth.state.ga.us/departments/dch/v4/top/shared/medicaid/publications/home_comm_services.pdf
Summary of State Plan Coverage This waiver allows mentally retarded/developmentally disabled persons who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria to remain living at home and in the community. Services include: service coordination, respite care, day habilitation and supported employment, residential training and supervision, and specialized medical equipment and supplies.
Populations Served People who have mental retardation or a developmental disability. A diagnosis of developmental disability includes mental retardation or other closely related conditions such as cerebral palsy, epilepsy, autism, or neurological problems that require the level of care provided in an Intermediate Care Facility for the Mentally Retarded.
Terminology for HM and AT Assistive technology (AT), emergency response systems (PERS), specialized medical equipment and supplies (SMES), vehicle adaptations, environmental modifications (EM).
Examples of Covered HM and AT Services AT: Scanning communicator, speech amplifier, control switch, personal emergency response system electronic control unit, a wheelchair, locks, and door openers.

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

SMES: Information N/A.

Vehicle adaptations: Hydraulic lifts ramps, special seats.

EM: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing systems.

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 N/A X  
Benefit Limits AT: Information N/A.

PERS: Information N/A.

SMES: $13,474.76 per member, per lifetime.

Vehicle adaptations: $3,120 per member lifetime. Limit: one unit per year (up to but not to exceed lifetime maximum).

EM: $10,000 per member, per lifetime. Limit: one unit per year (up to but not to exceed lifetime maximum).

Training on Use and Repairs Training: yes.

Repairs: yes.

 

Community Habilitation and Support Services
Agency Name Department of Human Resources, Division of Mental Health Developmental Diseases and Addictive Diseases
Phone 800-766-4456
Web site https://www.ghp.georgia.gov/wps/portal
Summary of State Plan Coverage This waiver allows mentally retarded/developmentally disabled persons who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria to remain living at home and in the community. Participants choose a single Medicaid provider for a package of services.
Populations Served People who have mental retardation or a developmental disability. A diagnosis of developmental disability includes mental retardation or other closely related conditions such as cerebral palsy, epilepsy, autism, or neurological problems that require the level of care provided in an Intermediate Care Facility for the Mentally Retarded.
Terminology for HM and AT Emergency response systems (PERS), specialized medical equipment and supplies (SMES), vehicle adaptations, environmental accessibility adaptations (EAA), home modifications (HM).
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.

SMES: Environmental control such as a computer, scanning communicator, speech amplifier, control switch or electronic control unit; devices, assessment, or training needed to assist members with mobility, seating, bathing, transferring, security, or other skills such as operating a wheelchair, locks, or door openers.

Vehicle adaptations: Hydraulic lifts ramps, special seats, and other interior vehicle modifications.

EAA: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, or installation of specialized electric and plumbing 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 N/A N/A X X N/A
Benefit Limits PERS: Information N/A.

SMES: $5,200 per member, per year.

Vehicle adaptations: Information N/A.

EAA: $6,273.28 per member per year.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

Independent Care Waiver Program (ICWP)
Agency Name Division of Medical Assistance and Georgia Health Partnership
Phone 866-483-1044; 866-483-1045
Web site https://www.ghp.georgia.gov/wps/portal
Summary of State Plan Coverage This waiver allows persons with physical disabilities, including traumatic brain injury, aged 21-64 who meet the nursing facility or hospital level of care criteria to remain living at home and in the community. Services include: service coordination, respite care, specialized medical equipment and supplies, counseling, and home modification.
Populations Served Independent Care is for eligible Medicaid recipients who have severe physical disabilities, are between the ages of 21 and 64 when they apply, and meet the criteria below:
  • Capable of directing their own services (individuals with a traumatic brain injury do not have to meet this criterion);
  • Have a severe physical impairment and/or traumatic brain injury that substantially limits one or more activities of daily living and requires the assistance of another individual;
  • Medically stable but currently in a hospital or nursing facility or at risk of placement because community-based support services are not available; and
  • Certified for a level of care appropriate for placement in a hospital or nursing facility.
Terminology for HM and AT Specialized medical equipment and supplies (SMES)/vehicle adaptations, assistive technology (AT), durable medical equipment (DME), adaptive equipment, home modifications (HM), personal emergency response systems (PERS).
Examples of Covered HM and AT Services SMES/Vehicle adaptations: Hydraulic lifts ramps, special seats, and other interior vehicle modifications or devices to allow access into and out of the vehicle, for driving the vehicle if appropriate, and for security while the vehicle is moving.

AT: Special needs computers, direct selection communicators, scanning communicators, speech amplifiers, control switches, electronic control units, and electronic communication devices.

Adaptive equipment: Locks, door openers, mechanical feeders.

HM: Ramps and modification to bathrooms.

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 N/A X N/A
Benefit Limits SMES/Vehicle adaptations: $225 per year.

AT: $1,026 per month.

Adaptive equipment: $1,026 per month.

HM: $8,000 per member, per lifetime.

PERS: Installation and testing $75 per residence; monitoring, $25 per month.

Training on Use and Repairs Training: no.

Repairs: no.

 

HAWAII

Overview Hawaii covers augmentative communication devices, customized wheelchairs, and wheelchair ramps through its Medicaid State Plan. In addition, the state offers a range of home modification and assistive technology services through three waivers.
Medicaid State Plan Coverage
Agency Name Hawaii Department of Human Services, Med-QUEST Division
Phone 808-586-5390
Web site http://www.med-quest.us/
http://www.state.hi.us/dhs
Summary of State Plan Coverage The Hawaii Medicaid State Plan covers wheelchairs and augmentative communication devices under the Durable Medical Equipment, Prosthetic and Orthotic Devices, and Medical Supplies benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Augmentative communication devices (ACD); Durable Medical Equipment, Prosthetic and Orthotic Devices, and Medical Supplies (DMEPOS).
Examples of Covered HM and AT Services ACD: Information N/A.

Customized wheelchairs/wheelchair ramps: Specialized seating systems, motorized wheelchairs and scooters.

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 N/A
Benefit Limits ACD: None.

Customized wheelchairs/wheelchair ramps: None.

Training on Use and Repairs ACD: Training: yes. Repairs: yes.

Customized wheelchairs/wheelchair ramps: Training: yes. Repairs: yes.

 

Developmentally Disabled/Mentally Retarded (0013)
Agency Name Hawaii State Department of Health, Developmental Disabilities Division
Phone 808-586-5840
Web site http://www.hawaii.gov/health/disability-services/developmental/index.html
Summary of State Plan Coverage For people with mental retardation/developmental disabilities who meet Intermediate Care Facility for the Mentally Retarded level of care criteria. To provide habilitation, supported employment, adult day health care, respite care, personal assistance, skilled nursing, transportation, specialized services team, specialized environmental accessibility adaptations, and consumer directed personal assistance.
Populations Served Medicaid recipients of all ages who meet Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Specialized environmental accessibility adaptations (SEAA), personal emergency response systems (PERS), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services SEAA: Installation of sidewalks and ramps, widening of doorways and corridors, removal of other architectural barriers, enlargement of the bath facility.

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

SMES: Adaptive equipment or supplies that the state plan does not cover.

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 SEAA: None.

PERS: None.

SMES: None.

Training on Use and Repairs SEAA: Training: yes. Repairs: yes.

PERS: Training: yes. Repairs: yes.

SMES: Training: yes. Repairs: yes.

 

Nursing Home Without Walls (0057)
Agency Name Hawaii Department of Human Services, Adult and Community Care Services Branch (ACCSB)
Phone 808-586-5584 (Oahu)
586-5584 (other islands)
Web site http://www.hawaii.gov/dhs/protection/social_services/adult_services/healthpgms - top
Summary of State Plan Coverage To provide case management, personal assistance, respite care, adult day health care, environmental accessibility adaptations, non-medical transportation, specialized medical equipment and supplies, personal emergency response systems, private duty nursing, counseling and training, moving assistance, home-delivered meals, and home maintenance to individuals who are aged or disabled.
Populations Served Medicaid recipients of all ages who meet nursing home level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (also called environmental modifications) (EAA), personal emergency response systems (PERS), specialized medical equipment and supplies (SMES), home maintenance.
Examples of Covered HM and AT Services EAA: Installation of ramps and handrails, widening of doorways, removal of other architectural barriers, and modifications to the telephone system.

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

SMES: May include adaptive equipment or supplies that the state plan does not cover.

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.

PERS: None.

SMES: None.

Training on Use and Repairs EAA: Training: yes. Repairs: yes.

PERS: Training: yes. Repairs: yes.

SMES: Training: yes. Repairs: yes.

 

HIV Community Care Program (0182)
Agency Name Hawaii Department of Human Services, Adult and Community Care Services Branch (ACCSB)
Phone 808-586-5541 or contact the local ACCSB
Web site http://www.hawaii.gov/dhs/protection/social_services/adult_services/healthpgms - HCCP
Summary of State Plan Coverage To provide case management, personal care, respite care, adult day health care, environmental accessibility adaptations, non-medical transportation, specialized medical equipment and supplies, personal emergency response systems, private duty nursing, counseling and training, moving assistance, home-delivered meals, and home maintenance to individuals with a diagnosis of AIDS or conditions associated with HIV infection.
Populations Served Medicaid recipients of all ages with a diagnosis of HIV/AIDS who meet nursing home or hospital level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (EAA), personal emergency response systems (PERS), specialized medical equipment and supplies (SMES), home maintenance.
Examples of Covered HM and AT Services EAA: Installation of ramps and handrails, widening of doorways, removal of other architectural barriers, and modifications to the telephone system.

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

SMES: May include adaptive equipment or supplies that the state plan does not cover.

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 EAA: None.

PERS: None.

SMES: None.

Training on Use and Repairs EAA: Training: yes. Repairs: yes.

PERS: Training: yes. Repairs: yes.

SMES: Training: yes. Repairs: yes.

 

IDAHO

Overview The Idaho Medicaid State Plan covers select durable medical equipment such as lifts and communication devices. The state also offers a broad range of assistive technology and home modifications through three waivers.
Medicaid State Plan Coverage
Agency Name Idaho Department of Health and Welfare, Division of Medicaid
Phone 208-334-5500
Web site http://www.healthandwelfare.idaho.gov/portal/alias__Rainbow/lang__en-US/tabID__3438/DesktopDefault.aspx
Summary of State Plan Coverage The Idaho Medicaid State Plan offers durable medical equipment coverage, but does not cover non-medical equipment and supplies and related services.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), communication devices.
Examples of Covered HM and AT Services DME: Electric or hydraulic lift devices designed to transfer a person to and from bed to wheelchair or bathtub; or a lift mechanism for a chair; but excludes devices attached to motor vehicles and wall-mounted chairs that lift persons up and down stairs. Hand held showers, sip-and-puff controls for wheelchairs, and communication devices are considered durable medical equipment.
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  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Aged and Disabled Waiver
Agency Name Idaho Department of Health and Welfare, Division of Medicaid
Phone 208-334-5500
Web site http://www.healthandwelfare.idaho.gov/portal/alias__Rainbow/lang__en-US/tabID__3438/DesktopDefault.aspx
Summary of State Plan Coverage To provide case management, homemaker services, respite care, adult day health care, environmental access adaptations, skilled nursing care, transportation, special medical equipment and supplies, chore services, personal emergency response systems, companion services, attendant care, adult residential care, home-delivered meals, consultation, and psychiatric consultation to aged adults or disabled adults aged 18 and older.
Populations Served Aged, disabled over 18.
Terminology for HM and AT Environmental access adaptations (EAA), home modifications, specialized medical equipment and supplies (SMES), personal emergency response systems (PERS), assistive technology (AT).
Examples of Covered HM and AT Services EAA (including home modifications): Installation of ramps and lifts, widening of doorways, modification of bathroom facilities, installation of electrical or plumbing systems necessary to accommodate the medical equipment needed for the welfare of the participant.

SMES: Any item, piece of equipment, or product system beyond the scope of the Medicaid state plan, whether acquired off the shelf or customized, that is used to increase, maintain, or improve the functional capability of the participant.

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

AT: Assistive technology can range from something as simple as a reacher, a cane, or a bathroom grab-bar to something as complex as life-support, supplies and equipment to support such systems, adaptive computer key board, augmentative communication device, or durable and non-durable medical equipment.

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

Repairs: yes.

 

Developmentally Disabled Waiver
Agency Name Idaho Department of Health and Welfare, Division of Medicaid
Phone 208-334-5500
Web site http://www.healthandwelfare.idaho.gov/portal/alias__Rainbow/lang__en-US/tabID__3438/DesktopDefault.aspx
Summary of State Plan Coverage For mentally retarded persons and those with related conditions, aged 18 and older. To provide respite care, habilitation (residential, supported employment), environmental accessibility adaptations, skilled nursing care, transportation, special medical equipment and supplies (includes assistive technology), chore services, personal emergency response systems, home-elivered meals, behavior consultation/crisis management, and adult day care.
Populations Served Mentally retarded and developmentally disabled, aged 18 and older.
Terminology for HM and AT Specialized medical equipment and supplies (SMES), assistive technology (AT), environmental accessibility adaptations (EAA), home modifications.
Examples of Covered HM and AT Services SMES/AT: Devices, controls, or appliances, specified in the individual service plan. The equipment and supplies must enhance the participants’ daily living, and enable them to control and communicate within their environment. This also includes 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 state plan.

EAA (including home modifications): Installation of ramps and lifts, widening of doorways, modification of bathroom facilities, installation of electrical or plumbing 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 N/A N/A X X X
Benefit Limits Information N/A.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Traumatic Brain Injury Waiver
Agency Name Idaho Department of Health and Welfare, Division of Medicaid
Phone 208-334-5500
Web site http://www.healthandwelfare.idaho.gov/portal/alias__Rainbow/lang__en-US/tabID__3438/DesktopDefault.aspx
Summary of State Plan Coverage The Traumatic Brain Injury Waiver provides residential habilitation, chore services, respite care, supported employment, skilled nursing, non-medical transportation, home modifications, personal emergency response systems, personal care services, home-delivered meals, specialized medical equipment and supplies (includes assistive technology), extended state plan services (physical, occupational, and speech therapies), and day rehab services, to adults who have suffered a brain injury after the age of 22 and would need to be institutionalized without this waiver.
Populations Served Adults who have suffered a brain injury after the age of 22.
Terminology for HM and AT Specialized medical equipment and supplies (SMES), home modifications (HM), personal emergency response systems (PERS).
Examples of Covered HM and AT Services SMES: Devices, controls, or appliances, specified in the individual service plan, that enhance the participants’ daily living, and enable them to control and communicate within their environment. This also includes 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 state plan.

HM: Interior or exterior physical adaptations to the home owned or rented by the participant, identified on the participant’s individual service plan, and necessary to ensure the health, welfare, and safety of the individual. Such adaptations may include: installation of ramps and lifts, widening of doorways, modification of bathroom facilities, and installation of electrical or plumbing systems necessary to accommodate the medical equipment needed for the welfare of the participant.

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

Repairs: yes.

 

ILLINOIS

Overview Illinois covers a range of assistive technologies and home modifications through the Medicaid State Plan and six waivers. Covered services include augmentative communication devices, wheelchairs, emergency home response systems, specialized medical equipment and supplies, and environmental accessibility adaptations.
Medicaid State Plan Coverage
Agency Name Illinois Department of Healthcare and Family Services
Phone 800-843-6154
Web site http://www.hfs.illinois.gov/medical/
Summary of State Plan Coverage The Illinois Medicaid State Plan covers augmentative communication devices and 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 Augmentative communication devices, wheelchairs (including power and customized).
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: Information N/A.

Repairs: yes.

 

Waiver for Persons with Brian Injury (BI) (0329)
Agency Name Department of Human Services, Division of Rehabilitation Services
Phone 217-557-1868
Web site http://www.hfs.illinois.gov/hcbswaivers/bi.html
Summary of State Plan Coverage To provide homemaker services, personal assistance services, adult day care, habilitation, supported employment services, assistive equipment, environmental accessibility adaptations, specialized medical equipment and supplies, and personal emergency home response systems to persons of any age with brain injury who meet nursing facility level of care criteria.
Populations Served Persons with brain injury of any age who meet nursing facility level of care criteria.
Terminology for HM and AT Assistive equipment, environmental accessibility adaptations (EAA), specialized medical equipment and supplies (SMES), personal emergency response systems (PERS).
Examples of Covered HM and AT Services Assistive equipment: Devices or equipment either purchased or rented to increase an individual's independence and capability to perform household and personal care tasks at home.

EAA: Home and vehicle modifications including ramps, grab-bars, porch lifts, and construction (widening doorways, installation of specialized electrical or plumbing systems to accommodate medical equipment).

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 their environment. Also includes items necessary for life support, and ancillary supplies and equipment not covered under the state plan.

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 X
Benefit Limits $18,000 per year maximum for all services.
Training on Use and Repairs Assistive equipment: Training: Information N/A. Repairs: yes.

EAA: Information N/A.

SMES: Information N/A.

PERS: Training: yes. Repairs: yes.

 

Supportive Living Waiver (Aged and Disabled) (0326)
Agency Name Department of Healthcare and Family Services (HFS), Bureau of Long Term Care
Phone 217-524-7245
Web site http://www.hfs.illinois.gov/hcbswaivers/slf.html
Summary of State Plan Coverage To provide personal care, intermittent nursing, housekeeping, transportation, health promotion and exercise programming, and personal emergency response systems to persons with physically disabilities aged 22 and over who meet the nursing facility level of care criteria.
Populations Served Individuals with disabilities 22 years and over or individuals 65 years and over who 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
N/A N/A N/A N/A N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Training: no.

Repairs: no.

 

Elderly Waiver (0143)
Agency Name Illinois Department on Aging
Phone 217-557-1868
Web site http://www.hfs.illinois.gov/hcbswaivers/elderly.html
Summary of State Plan Coverage To provide homemaker, emergency response, and adult day care services to persons aged 60 and older who meet the nursing facility level of care criteria.
Populations Served Individuals 60 years of age or older who meet the nursing facility level of care criteria.
Terminology for HM and AT Emergency home response system (EHRS).
Examples of Covered HM and AT Services EHRS: 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 Provider service rates are established by the state.
Training on Use and Repairs Training: yes.

Repairs: Information N/A.

 

Home and Community-Based Services Waiver for Persons Diagnosed with HIV/AIDS (HIV/AIDS Waiver) (0202)
Agency Name Department of Human Services (DHS), Division of Rehabilitation Services
Phone 217-557-1868
Web site http://www.hfs.illinois.gov/hcbswaivers/hiv.html
Summary of State Plan Coverage To provide personal assistance services, skilled nursing, therapies, respite care, transportation for employment, home-delivered meals, environmental accessibility adaptations, specialized medical equipment and supplies, and personal emergency response systems to persons of any age diagnosed with HIV/AIDS who meet the hospital level of care criteria.
Populations Served Persons diagnosed with Human Immune Deficiency Virus (HIV), or Acquired Immune Deficiency Syndrome (AIDS), of any age, who meet the hospital level of care criteria.
Terminology for HM and AT Environmental accessibility adaptations (EAA), specialized medical equipment and supplies (SMES), personal emergency response system (PERS).
Examples of Covered HM and AT Services EAA: Home and vehicle modifications including ramps, grab-bars, porch lifts, construction (widening doorways, installation of specialized electrical or plumbing systems to accommodate medical equipment).

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 their environment. Also includes items necessary for life support, ancillary supplies, and equipment not covered under the state plan.

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 X
Benefit Limits $18,000 per year maximum for all services.
Training on Use and Repairs EAA: Information N/A.

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

PERS: Training: yes. Repairs: yes.

 

Home and Community-Based Services Waiver for Persons with Physical Disabilities (NF Waiver) (0142)
Agency Name Department of Human Services (DHS), Division of Rehabilitation Services
Phone 217-557-1868
Web site http://www.hfs.illinois.gov/hcbswaivers/disabilities.html
Summary of State Plan Coverage To provide personal assistance services, homemaker services, adult day care, environmental accessibility adaptations, specialized medical equipment and supplies, personal emergency response systems, and home-delivered meals to persons with physical disabilities (including ventilator dependent adults), aged 59 and younger who meet the nursing facility level of care criteria.
Populations Served Individuals with physical disabilities, from the ages of 0-59 (including ventilator dependent adults), who meet the nursing facility level of care criteria. Also, those 60 or older, who began services before age 60, may choose to remain in this waiver.
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: Home and vehicle modifications including ramps, grab-bars, porch lifts, construction (widening doorways, installation of specialized electrical or plumbing systems necessary to accommodate medical equipment).

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. Also includes items necessary for life support, ancillary supplies, and equipment not covered under the state plan.

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 X
Benefit Limits $18,000 per year maximum for all services.
Training on Use and Repairs EAA: Information N/A.

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

PERS: Training: yes. Repairs: yes.

 

Home and Community-Based Services Waiver for Adults with Developmental Disabilities (MR/DD Waiver) (0350)
Agency Name Department of Human Services (DHS), Division of Developmental Disabilities Services
Phone 217-557-1868
Web site http://www.hfs.illinois.gov/hcbswaivers/dd.html
Summary of State Plan Coverage To provide residential habilitation, day habilitation, home-based support services, therapies, adaptive equipment, minor home and vehicle modifications, and personal emergency response systems to mentally retarded/developmentally disabled persons aged 18 and older, who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Populations Served Individuals with developmental disabilities or mental retardation, 18 years or older, who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Adaptive equipment, minor home modifications (HM), minor vehicle modifications (VM), personal emergency response systems (PERS).
Examples of Covered HM and AT Services Adaptive equipment: Devices, controls, and appliances that enable individuals to increase their ability to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live.

Minor HM: Physical adaptations to the home that are necessary to ensure the health, welfare, and safety of the individual as it relates to the person’s developmental disability, or that enable the individual to function with greater independence in the home.

Minor VM: Vehicle adaptations such as lifts, door or seating modifications, and safety/security 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 N/A N/A X X
Benefit Limits Adaptive equipment, home, and vehicle modifications are limited to no more than $15,000 per individual over five years.
Training on Use and Repairs Training: yes.

Repairs: Information N/A.

 

INDIANA

Overview Indiana covers a range of assistive technologies and home modifications through the Medicaid State Plan and five waivers. Covered services include emergency response systems, environmental and home modifications, vehicle modifications, adaptive aids and devices, and specialized medical equipment.
Medicaid State Plan Coverage
Agency Name Indiana Family and Social Services Administration
Phone 800-457-4584
Web site http://www.in.gov/fssa/healthcare/
Summary of State Plan Coverage The Indiana Medicaid State Plan covers selected items under the durable medical equipment benefit, including customized wheelchairs and augmentative communication devices.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment, augmentative communication devices (ACD).
Examples of Covered HM and AT Services Customized wheelchairs: Wheelchairs that are customized to meet a client’s special needs.

ACD: Speech augmentation devices for individuals who require them to communicate.

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

Repairs: no.

 

Aged and Disabled Waiver
Agency Name Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning
Phone 800-986-3505
Web site http://www.in.gov/fssa/elderly/medicaid/
Summary of State Plan Coverage To provide adaptive aids and devices/specialized medical equipment, adult day services, attendant services, case management, homemaker services, respite care, environmental modifications, and personal emergency response systems to physically disabled persons who meet the nursing facility level of care criteria.
Populations Served Physically disabled persons and/or those aged 65 and older who meet the nursing facility level of care criteria.
Terminology for HM and AT Environmental modifications, personal emergency response systems (PERS), adaptive aids and devices/specialized medical equipment (SME).
Examples of Covered HM and AT Services Environmental modifications: Home and vehicle modifications, including 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.

Adaptive aids and devices/SME: Items 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. Includes devices, controls, appliances, 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 N/A N/A X N/A
Benefit Limits The total cost of services cannot exceed the cost of institutional care.

Environmental modifications: $15,000 lifetime cap, plus $500 annually for repair, replacement, or an adjustment to an existing modification.

PERS: Information N/A.

Adaptive aids and devices/SME: None.

Training on Use and Repairs Information N/A.

 

Waiver for Persons with Traumatic Brain Injury (TBI Waiver) (40197)
Agency Name Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning
Phone 800-986-3505
Web site http://www.in.gov/fssa/elderly/medicaid/
Summary of State Plan Coverage To provide personal care, adult companion services, case management, environmental modifications, personal emergency response systems, specialized medical equipment/supplies, homemaker assistance, and independent living skills training to persons with brain injury who meet the nursing facility level of care criteria.
Populations Served Persons with brain injury who meet the nursing facility level of care criteria.
Terminology for HM and AT Environmental modifications, personal emergency response systems (PERS), specialized medical equipment/supplies (SMES).
Examples of Covered HM and AT Services Environmental modifications: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, and 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.

SMES: Devices, controls, appliances, 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.

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 The total cost of services cannot exceed the cost of institutional care.

Environmental modifications: $15,000 lifetime cap, plus $500 annually for repair, replacement, or an adjustment to an existing modification.

PERS: Information N/A.

SMES: None.

Training on Use and Repairs Information N/A.

 

Waiver for Persons with Developmental Disabilities (MR/DD Waiver) (0378)
Agency Name Indiana Family and Social Services Administration
Phone 317-233-9525
Web site http://www.in.gov/fssa/elderly/medicaid/
Summary of State Plan Coverage To provide homemaker assistance, chore aides, personal care aides, therapy, skilled nursing, respite care, specialized medical equipment, personal emergency response systems, and environmental modifications to adults with mental retardation/developmental disabilities who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Populations Served Adults with mental retardation/developmental disabilities who meet the Intermediate Care Facility for the Mental Retarded level of care criteria.
Terminology for HM and AT Specialized medical equipment (SME), personal emergency response systems (PERS), environmental modifications.
Examples of Covered HM and AT Services SME: Devices, controls, appliances, 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.

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

Environmental modifications: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, and 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 N/A N/A N/A X N/A
Benefit Limits The total cost of services cannot exceed the cost of institutional care.

SMES: None.

PERS: Information N/A.

Environmental modifications: $15,000 lifetime cap, plus $500 annually for repair, replacement, or an adjustment to an existing modification.

Training on Use and Repairs Information N/A.

 

Support Services for Mental Retardation/Developmental Disability
Agency Name Indiana Family and Social Services Administration
Phone 800-986-3505
Web site http://www.in.gov/fssa/elderly/medicaid/
Summary of State Plan Coverage To provide community habilitation, respite care, adult day services, specialized medical equipment, therapies, transportation, and personal emergency response systems to mentally retarded/developmentally disabled persons who require an Intermediate Care Facility for the Mentally Retarded level of care.
Populations Served Mentally retarded/developmentally disabled persons who require an Intermediate Care Facility for the Mentally Retarded level of care.
Terminology for HM and AT Personal emergency response system (PERS), specialized medical equipment (SME).
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.

SME: Devices, controls, appliances, 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.

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 The total cost of services cannot exceed the cost of institutional care.

PERS: Information N/A.

SMES: None.

Training on Use and Repairs Information N/A.

 

Autism Waiver
Agency Name Indiana Family and Social Services Administration
Phone 317-232-1726
Web site http://www.in.gov/fssa/elderly/medicaid/
Summary of State Plan Coverage To provide adult day services, environmental modifications, family and caregiver training, supported employment, personal assistance, assistive technology, personal emergency response systems, and respite care to persons with a diagnosis of autism.
Populations Served Persons with a diagnosis of autism who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Assistive technology (AT), environmental modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services AT: Information N/A.

Environmental modifications: Installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, and 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 N/A X N/A
Benefit Limits The total cost of services cannot exceed the cost of institutional care.

AT: None.

Environmental modifications: $15,000 lifetime cap, plus $500 annually for repair, replacement, or an adjustment to an existing modification.

PERS: Information N/A.

Training on Use and Repairs Information N/A.

 

IOWA

Overview Iowa covers a range of assistive technologies and home modifications through the Medicaid State Plan and six waivers. Covered services include augmentative communication systems, emergency response systems, specialized medical equipment and supplies, vehicle adaptations, and home modifications.
Medicaid State Plan Coverage
Agency Name Iowa Department of Human Services, Iowa Medicaid Enterprise
Phone 515-725-1003 or 800-338-8366
Web site http://www.ime.state.ia.us/
Summary of State Plan Coverage The Iowa Medicaid State Plan covers durable medical equipment, prosthetic devices, and sickroom supplies, subject to state requirements.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME), prosthetic devices, augmentative communication systems (ACD).
Examples of Covered HM and AT Services Specialized equipment: Shower commode chairs and bedside rails.

ACD: Tracheotomy speaking valves and communication device wheelchair attachments. Augmentative communication systems are considered prosthetic devices and are covered for persons unable to communicate their basic needs through oral speech or manual sign language. Coverage is allowed for recipients in nursing facilities, intermediate care facilities for the mentally retarded, and private homes.

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

Repairs: yes.

 

Mental Retardation Waiver (0242)
Agency Name Iowa Department of Human Services, Iowa Bureau of Long-term Care
Phone 515-281-5233
Web site http://www.ime.state.ia.us/HCBS/help_ownhome.html
Summary of State Plan Coverage To provide supported community living, consumer directed attendant care, respite care, home and vehicle modifications, and personal emergency response systems to mentally retarded/developmentally disabled persons who are moving from Intermediate Care Facilities for the Mentally Retard or nursing homes into the community.
Populations Served Individuals with mental retardation/developmental disabilities who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Home and vehicle modifications, personal emergency response system (PERS).
Examples of Covered HM and AT Services Home and vehicle modifications: Physical modifications to the home and/or vehicle including: kitchen counters, sink space, cabinets, and special adaptations to refrigerators, stoves, and ovens; bathtubs and toilets to accommodate transfer, special handles and hoses for showerheads, water faucet controls, and accessible shower and sink areas; grab-bars and handrails; turnaround space adaptations; ramps, lifts, and door, hall and window widening; fire safety alarm equipment specific for disability; voice activated, sound activated, light activated, motion activated, and electronic devices directly related to consumer’s disability; vehicle lifts, driver specific adaptations, remote start systems, including such modifications already installed in a vehicle; keyless entry systems; automatic opening device for home or vehicle door; special door and window locks; specialized doorknobs and handles; plexiglass replacement for glass windows; modification of existing stairs to widen, lower, raise, or enclose open stairs; motion detectors; low pile carpeting or slip resistant flooring; telecommunications device for people who are deaf; exterior hard surface pathway; new door opening; pocket doors; installation or relocation of controls, outlets, and switches; air conditioning and air filtering if medically necessary; heightening of existing garage door opening to accommodate modified van; bath chairs.

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 Home and vehicle modifications: $5,000 maximum lifetime benefit.

PERS: 12 months of service per state fiscal year.

Training on Use and Repairs Training: no.

Repairs: no.

 

Traumatic Brain Injury (TBI) Waiver (0299)
Agency Name Iowa Department of Human Services, Iowa Bureau of Long-term Care
Phone 515-725-1150
Web site http://www.ime.state.ia.us/HCBS/help_ownhome.html
Summary of State Plan Coverage To provide case management, consumer directed attendant care, supported community living, respite care, home and vehicle modifications, personal emergency response systems, and specialized medical equipment to persons with brain injury who meet the Intermediate Care Facility for the Mentally Retarded, intermediate care facility, skilled nursing facility, or nursing facility level of care criteria.
Populations Served Individuals with brain injury between one month and 64 years old who meet the criteria for one of the following levels of care: Intermediate Care Facility for the Mentally Retarded, intermediate care facility, nursing facility, or skilled nursing facility.
Terminology for HM and AT Home and vehicle modifications, personal emergency response systems (PERS), specialized medical equipment (SME).
Examples of Covered HM and AT Services Home and vehicle modifications: Physical modifications to the home and/or vehicle including: kitchen counters, sink space, cabinets, and special adaptations to refrigerators, stoves, and ovens; bathtubs and toilets to accommodate transfer, special handles and hoses for showerheads, water faucet controls, and accessible shower and sink areas; grab-bars and handrails; turnaround space adaptations; ramps, lifts, and door, hall and window widening; fire safety alarm equipment specific for disability; voice activated, sound activated, light activated, motion activated, and electronic devices directly related to consumer’s disability; vehicle lifts, driver specific adaptations, remote start systems, including such modifications already installed in a vehicle; keyless entry systems; automatic opening device for home or vehicle door; special door and window locks; specialized doorknobs and handles; plexiglass replacement for glass windows; modification of existing stairs to widen, lower, raise, or enclose open stairs; motion detectors; low pile carpeting or slip resistant flooring; telecommunications device for people who are deaf; exterior hard surface pathway; new door opening; pocket doors; installation or relocation of controls, outlets, and switches; air conditioning and air filtering if medically necessary; heightening of existing garage door opening to accommodate modified van; bath chairs.

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

SME: Electronic aids and organizers, medicine-dispensing devices, communication devices, bath aids, and non-covered 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  
Benefit Limits Home and vehicle modifications: $500 per month not to exceed $6,000 per year. If the amount of the modification is allocated monthly, the monthly amount must be included in the $2,650 monthly dollar cap.

PERS: 12 months of service per state fiscal year.

SME: $500 per month not to exceed $6,000 per year.

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

Repairs: yes.

 

Physically Disabled Waiver (0345)
Agency Name Iowa Department of Human Services, Iowa Bureau of Long-term Care
Phone 515-725-1150
Web site http://www.ime.state.ia.us/HCBS/help_ownhome.html
Summary of State Plan Coverage To provide consumer-directed attendant care, emergency response, home and vehicle modifications, and specialized medical equipment to persons with physical disabilities who meet the nursing facility level of care criteria.
Populations Served Individuals aged 18-64 who meet the intermediate care facility or skilled nursing facility level of care criteria and have the ability to manage personal care attendants.
Terminology for HM and AT Home and vehicle modifications, personal emergency response systems (PERS), specialized medical equipment (SME).
Examples of Covered HM and AT Services Home and vehicle modifications: Physical modifications to the home and/or vehicle to assist with the health, safety, and welfare needs of the consumer and to increase or maintain independence.

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

SME: Electronic aids and organizers, medicine-dispensing devices, communication devices, bath aids, and non-covered 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  
Benefit Limits Home and vehicle modifications: $500 per month not to exceed $6,000 per year.

PERS: 12 months of service per state fiscal year.

SME: $500 per month not to exceed $6,000 per year. Total cost of all waiver services cannot exceed $621/month.

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

Repairs: yes.

 

Ill and Handicapped Waiver (Non-Elderly Disability) (4111)
Agency Name Iowa Department of Human Services, Iowa Bureau of Long-term Care
Phone 515-725-1146
Web site http://www.ime.state.ia.us/HCBS/help_ownhome.html
Summary of State Plan Coverage To provide consumer-directed attendant care, counseling, home-delivered meals, homemaker services, emergency response, home and vehicle modifications, and respite care to persons with mental retardation/developmental disabilities who meet the nursing facility, skilled nursing facility, or Intermediate Care Facility for the Mentally Retarded level of care criteria.
Populations Served Individuals of all ages with mental retardation/developmental disabilities who meet the nursing facility, skilled nursing facility, or Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Home and vehicle modifications, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Home and vehicle modifications: Physical modifications to the home and/or vehicle including: kitchen counters, sink space, cabinets, and special adaptations to refrigerators, stoves, and ovens; bathtubs and toilets to accommodate transfer, special handles and hoses for showerheads, water faucet controls, and accessible shower and sink areas; grab-bars and handrails; turnaround space adaptations; ramps, lifts, and door, hall, and window widening; fire safety alarm equipment specific for disability; voice activated, sound activated, light activated, motion activated, and electronic devices directly related to consumer’s disability; vehicle lifts, driver specific adaptations, and remote start systems, including such modifications already installed in a vehicle; keyless entry systems; automatic opening device for home or vehicle door; special door and window locks; specialized doorknobs and handles; plexiglass replacement for glass windows; modification of existing stairs to widen, lower, raise, or enclose open stairs; motion detectors; low pile carpeting or slip resistant flooring; telecommunications device for people who are deaf; exterior hard surface pathway; new door opening; pocket doors; installation or relocation of controls, outlets, and switches; air conditioning and air filtering if medically necessary; heightening of existing garage door opening to accommodate modified van; bath chairs.

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 Home and vehicle modifications: $500 per month not to exceed $6,000 per year. If the amount of the modification is allocated monthly, the monthly amount must be included in the monthly dollar cap according to the dollar amount established for the level of care.

PERS: 12 months of service per state fiscal year.

Training on Use and Repairs Training: no.

Repairs: no.

 

Elderly Waiver (4155)
Agency Name Iowa Department of Human Services, Iowa Bureau of Long-term Care
Phone 515-725-1147
Web site http://www.ime.state.ia.us/HCBS/help_ownhome.html
Summary of State Plan Coverage To provide emergency response, homemaker services, home-delivered meals, assistive services, and physical modifications to the home and/or vehicle for persons aged 65 and older who meet nursing home or skilled nursing facility level of care criteria.
Populations Served Individuals who are 65 and older who meet the nursing home or skilled nursing facility level of care criteria.
Terminology for HM and AT Physical modifications to the home and/or vehicle, personal emergency response system (PERS).
Examples of Covered HM and AT Services Home and vehicle modifications: Physical modifications to the home and/or vehicle including: kitchen counters, sink space, cabinets, and special adaptations to refrigerators, stoves, and ovens; bathtubs and toilets to accommodate transfer, special handles and hoses for showerheads, water faucet controls, and accessible shower and sink areas; grab-bars and handrails; turnaround space adaptations; ramps, lifts, and door, hall and window widening; fire safety alarm equipment specific for disability; voice activated, sound activated, light activated, motion activated and electronic devices directly related to consumer’s disability; vehicle lifts, driver specific adaptations, remote start systems, including such modifications already installed in a vehicle; keyless entry systems; automatic opening device for home or vehicle door; special door and window locks; specialized doorknobs and handles; plexiglass replacement for glass windows; modification of existing stairs to widen, lower, raise, or enclose open stairs; motion detectors; low pile carpeting or slip resistant flooring; telecommunications device for people who are deaf; exterior hard surface pathway; new door opening; pocket doors; installation or relocation of controls, outlets, and switches; air conditioning and air filtering if medically necessary; heightening of existing garage door opening to accommodate modified van; bath chairs.

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 N/A X X  
Benefit Limits Home and vehicle modifications: $1,000 maximum lifetime benefit.

PERS: Information N/A.

Training on Use and Repairs Training: no.

Repairs: no.

 

KANSAS

Overview Kansas offers some assistive technology devices through its Medicaid State Plan. In addition, the state offers assistive technology, home modifications, and vehicle modifications through four waivers.
Medicaid State Plan Coverage
Agency Name Kansas Department of Social and Rehabilitation Services
Phone 785-296-3959
Web site http://www.srskansas.org/
Summary of State Plan Coverage The Kansas Medicaid State Plan covers patient lifts and augmentative communication devices through the durable medical equipment benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Augmentative communication devices (ACD), durable medical equipment (DME), personal emergency response systems (PERS).
Examples of Covered HM and AT Services ACD: Includes non-electronic augmentative or alternative communication device, speech-generating device, speech software program.

DME: Patient lifts (movable from room to room with disassembly and reassembly), includes all components/accessories.

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  
Benefit Limits None.
Training on Use and Repairs Training: Information N/A.

Repairs: no.

 

Traumatic Brain Injury Waiver (4164)
Agency Name Department of Social and Rehabilitation Services
Phone 785-296-3959
Web site http://www.srskansas.org/
Summary of State Plan Coverage To provide personal emergency response systems and installation, assistive services, personal services, transitional living skills, sleep cycle support, and six rehabilitation therapies (physical, occupational, speech, behavioral, cognitive, and drug and alcohol therapies) to individuals age 16-64 with traumatically acquired brain injury.
Populations Served Individuals age 16-64 with traumatically acquired brain injury.
Terminology for HM and AT Personal emergency response systems (PERS), assistive services, home modifications (HM), environmental control systems, adaptive equipment, vehicle modifications (VM).
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.

Assistive services: Augmentative communication devices, wheelchair controls, palm pilots, electronic door openers, environmental control systems (control temperature, lights, security system).

HM: Ramps, lifts, modifications/additions of bathroom facilities (roll-in showers, sink modifications, bathtub modifications, toilet modifications, water faucet controls, floor urinal and bidet adaptations, plumbing modifications, turnaround space adaptations), specialized accessibility/safety adaptations/additions (door-widening, electrical wiring, grab-bars and bidet adaptations, plumbing modifications, turnaround space adaptations).

VM: Van lifts, vehicle changes (e.g., hand controls, roll-in access, 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 X   X X
Benefit Limits PERS: $25 per month (if rental), and a twice a year installation cost of $53.

Assistive services/HM: There is a lifetime individual cost cap of $7,500 for HM and assistive services combined. Assistive services/assistive technology funded by other waiver programs is calculated into the lifetime maximum.

VM: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: Information N/A.

 

Mental Retardation/Developmentally Disabled (MR/DD) Waiver (0224)
Agency Name Department of Social and Rehabilitation Services, Health Care Policy Division
Phone 785-296-3959
Web site http://www.srskansas.org/
Summary of State Plan Coverage To provide communication devices, day services, family/individual supports, home modifications, medical alert-rental, night support, residential services, respite care-overnight, screening, supportive home care, van lifts, wellness monitoring, and wheelchair modifications to individuals aged five and over except those with severe emotional disabilities.
Populations Served Individuals with mental retardation or a developmental disability, aged five and over.
Terminology for HM and AT Personal emergency response systems (PERS), home modifications (HM), housing modification services, communication devices, van lifts, vehicle modifications (VM).
Examples of Covered HM and AT Services PERS: An electronic device that enables a person to secure help in an emergency.

HM: Ramps, lifts (porch or stair, hydraulic, manual, or other electronic lifts), modifications/additions of bathroom facilities (roll-in showers, sink modifications, bathtub modifications, toilet modifications, water faucet controls, floor urinal and bidet adaptations, plumbing modifications, turnaround space adaptations), specialized accessibility/safety adaptations/additions (door-widening, electrical wiring, grab-bars and handrails, automatic door openers/doorbells, voice activated, light activated, motion activated, and electronic devices, fire safety adaptations, necessary air filtering devices, medically necessary heating/cooling adaptations, medically necessary modifications as identified by recipient's physician).

Communication devices: Available to Medicaid beneficiaries who are 18 years of age or older and do not meet Medicaid State Plan durable medical equipment criteria; these include non-electronic augmentative or alternative communication device speech-generating device, speech software programs.

VM: Van lifts provided for safe transfer and transportation to enhance community integration.

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.

 

Frail Elderly Waiver
Agency Name Kansas Department on Aging
Phone 785-296-4986
Web site http://www.agingkansas.org/index.htm
Summary of State Plan Coverage To provide nursing evaluation visit, assistive technology, adult day care, sleep cycle support, personal emergency response systems, wellness monitoring, medication reminder, and attendant care to aged individuals.
Populations Served Individuals aged 65 and older.
Terminology for HM and AT Assistive technology (AT), home modifications (HM), housing modifications, accessibility adaptations, personal emergency response systems (PERS).
Examples of Covered HM and AT Services AT: Ramps, door widening, some remodeling.

HM: Ramps, lifts (stair), modifications of bathroom facilities (roll-in showers, sink modifications, bathtub modifications, toilet modifications, water faucet controls, turnaround space adaptations), specialized accessibility adaptations (door-widening, grab-bars and handrails).

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 AT: Lifetime maximum of $7,500 per individual, with assistive technology funded by other waiver programs included in this maximum.

HM: Information N/A.

PERS: Limited to rental, $25 per month, and a one-time installation cost of $53.

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

Repairs: no.

 

Physically Disabled Waiver (304)
Agency Name Department of Social and Rehabilitation Services, Health Care Policy Division
Phone 785-296-3959
Web site http://www.srskansas.org/
Summary of State Plan Coverage To provide personal care services, independent living counseling, and assistive services to physically disabled adults.
Populations Served Medicaid-eligible consumers aged 16-64 who are physically disabled.
Terminology for HM and AT Assistive services, adaptive equipment, assistive technology (AT), environmental modifications.
Examples of Covered HM and AT Services Assistive services/AT: Ramps, lifts, modifications to bathrooms and kitchens specifically related to accessibility, specialized safety adaptations, assistive technology that improves mobility or communication.

[Note: Environmental modifications may be purchased only in rented apartments or homes when the landlord agrees in writing to maintain the modifications for a period of not less than three years and will give first rent priority to tenants with physical disabilities.]

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 Lifetime maximum of $7,500 per individual, with assistive technology funded by other waiver programs included in this maximum.
Training on Use and Repairs Training: yes.

Repairs: Information N/A.

 

KENTUCKY

Overview The Kentucky Medicaid State Plan covers assistive devices through the durable medical equipment benefit and a range of assistive technology and home modification services through three waivers.
Medicaid State Plan Coverage
Agency Name Kentucky Department of Medicaid Services
Phone 502-564-7704
Web site http://www.chfs.ky.gov/dms/
Summary of State Plan Coverage The Kentucky Medicaid State Plan offers limited assistive technology services through 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-operated vehicles, speech-generating devices and accessories.
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  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Home and Community-Based Waiver for Elderly and Disabled Individuals (Aged/Disabled) (0144)
Agency Name Kentucky Department of Medicaid Services
Phone 502-564-7540, 502-564-5198
Web site http://chfs.ky.gov/dms/hcb.htm
Summary of State Plan Coverage This waiver provides necessary medical services to Medicaid-eligible individuals who are aged or disabled and who would otherwise require nursing facility level of care to remain living at home and in the community. Services include: case management, homemaker services, personal care services, and adult day health services.
Populations Served Individuals who are aged or disabled, and who might otherwise, without these services, be admitted to a nursing facility.
Terminology for HM and AT Minor home adaptations.
Examples of Covered HM and AT Services Minor home adaptations: Bathtub rails, commode railings, grab-bars, commode extenders, step railings, bathtub seat, ramps, etc., including labor and necessary 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 X
Benefit Limits $500 per recipient per calendar year.
Training on Use and Repairs Training: no.

Repairs: no.

 

Supports for Community Living Waiver (0314)
Agency Name Kentucky Department of Mental Health/Mental Retardation, Division of Mental Retardation
Phone 502-564-7702, 502-564-5198, 502-564-5560, 502-564-7540
Web site http://www.mhmr.ky.gov/mr/sclhmpg.asp?sub1|sub14
Summary of State Plan Coverage This waiver allows mentally retarded/developmentally disabled persons who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria to remain living at home and in the community. Services offered include: supported coordination, community habilitation, behavioral services, and respite care.
Populations Served Individuals with mental retardation or developmental disabilities who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria, and who meet other Medicaid requirements.
Terminology for HM and AT Specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services SMES: May be covered when unavailable through the Kentucky state plan durable medical equipment, vision, or dental programs. Examples are not available.
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 Information N/A.

 

Brain Injuries Waiver (0333)
Agency Name Kentucky Department of Mental Health/Mental Retardation, Division of Substance Abuse
Phone 502-564-3615
Web site http://chfs.ky.gov/dms/mhmr.htm
Summary of State Plan Coverage The Acquired Brain Injury Waiver program provides rehabilitative home and community based services to individuals with a brain injury as an alternative to nursing facility services, so that the individual can return to the community with existing resources.
Populations Served Individuals with an acquired brain injury between the ages of 21 and 65 years old that meet the nursing facility level of care criteria, that are expected to benefit from waiver services, and are financially eligible for Medicaid services.
Terminology for HM and AT Environmental modifications, specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Environmental modifications: Those physical adaptations to the home that are necessary to ensure the health, welfare, and safety of the individual, or that enable the individual to function with greater independence in the home. Modifications must have direct medical or remedial benefit.

SMES: Including durable and nondurable medical equipment, devices, controls--and appliances or ancillary supplies, devices, controls, or appliances--that are specified in the plan of care and 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. This excludes items that are not of direct medical or remedial benefit to the recipient, and are not essential to the rehabilitation and retraining 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 X   X X X
Benefit Limits Environmental modifications: $1,000 per recipient per six months.

SMES: Information N/A.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

LOUISIANA

Overview Louisiana covers special wheelchairs and adaptive hygiene equipment through its Medicaid State Plan. In addition, the state offers two waivers that cover a range of assistive technology and environmental accessibility modification services.
Medicaid State Plan Coverage
Agency Name Louisiana Department of Health and Hospitals, Bureau of Health Services Financing
Phone 225-342-5774
Web site http://www.dhh.louisiana.gov/offices/?ID=92
Summary of State Plan Coverage Coverage for selected types of assistive technology is available under the medical equipment, appliances and supplies benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Medical equipment, appliances and supplies.
Examples of Covered HM and AT Services Special wheelchairs: Customized wheelchairs with special attachments or construction.

Adaptive hygiene equipment: Elevated toilet seats, bath or shower stools, and safety guard 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 N/A N/A X N/A N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.

 

Elderly and Disabled Adult Waiver (0257)
Agency Name Louisiana Department of Health and Hospitals, Bureau of Community Supports and Services
Phone 877-456-1146
Web site http://www.dhh.louisiana.gov/offices/page.asp?ID=92&Detail=4123
Summary of State Plan Coverage To provide case management, household supports (homemaker), personal care, environmental accessibility adaptations, personal emergency response systems, day and night supervision, and adult companion services to disabled adults and aged persons.
Populations Served Medicaid recipients who are 65 and older, or disabled adults 21 or older, who meet the nursing home 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: Modifications to the home to enable a person to function with greater independence and safety. Modifications include changes/additions to bathroom facilities such as roll-showers, sink modifications, bathtub modifications, toilet modifications, water faucet controls, floor urinal and bidet adaptations, plumbing modifications, and turnaround space adaptations. Specialized accessibility/safety adaptations include door widening, electrical wiring, grab-bars, handrails, automatic door openers/doorbells, voice/light/motion activated electronic devices, fire safety adaptations, air filtering devices, and heating/cooling adaptations.

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  
Benefit Limits Environmental modifications: $3,000 lifetime cap per recipient.

PERS: None.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

New Opportunities Waiver -- Independence Plus Waiver (0401-IP)
Agency Name Louisiana Department of Health and Hospitals, Bureau of Community Supports and Services (in conjunction with Office for Citizens with Developmental Disabilities)
Phone 800-660-0488
Web site http://www.dhh.louisiana.gov/offices/page.asp?ID=92&Detail=4124
Summary of State Plan Coverage To provide respite care, habilitation (residential, day, supported employment and employment-related training), environmental accessibility adaptations, skilled nursing, specialized medical equipment and supplies, personal emergency response systems, adult residential care (adult foster care), individualized and family support, community integration development, professional services, professional consultation, one-time transitional expenses, and transitional professional support services for people with mental retardation/developmental disabilities.
Populations Served Medicaid recipients who are three years or older with mental retardation or developmental disabilities, and who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Environmental accessibility modifications, personal emergency support systems (PERS), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Environmental accessibility modifications: Information N/A.

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

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
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.

 

MAINE

Overview Maine’s Medicaid State Plan and waivers fall under the MaineCare Services. Assistive technology is covered under the state plan, and four waivers cover assistive technologies and home and vehicle modifications.
Medicaid State Plan Coverage
Agency Name Maine Department of Health and Human Services, Office of MaineCare Services
Phone 207-624-7539
Web site http://www.maine.gov/sos/cec/rules/10/ch101.htm
Summary of State Plan Coverage The Maine Medicaid State Plan covers assistive technology under the durable medical equipment benefit.
Populations Served Medicaid-eligible beneficiaries.
Terminology for HM and AT Durable medical equipment (DME) (assistive technology).
Examples of Covered HM and AT Services DME (assistive technology): Wheelchairs, low and medium technical devices, augmentative communication devices, orthotics, prosthetics, hearing aids, vision devices, sip-and-puff controls for wheelchairs if they can be proven to be medically necessary.
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.

 

Physically Disabled Waiver (0127)
Agency Name Maine Department of Health and Human Services, Office of MaineCare Services
Phone 207-624-7539
Web site http://www.maine.gov/sos/cec/rules/10/ch101.htm
Summary of State Plan Coverage To provide personal care attendant services, personal emergency response systems, and case management/consumer direction for individuals aged 18 and older with physical disabilities.
Populations Served Individuals aged 18 and older with physical disabilities.
Terminology for HM and AT Personal emergency response system (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 N/A X  
Benefit Limits There is a $35 per month leasing cap per consumer for PERS.
Training on Use and Repairs Training: yes.

Repairs: no.

 

Mental Retardation Waiver (0159)
Agency Name Maine Department of Health and Human Services, Office of MaineCare Services
Phone 207-624-7539
Web site http://www.maine.gov/sos/cec/rules/10/ch101.htm
Summary of State Plan Coverage To provide day habilitation, residential training, personal supports, crisis intervention, supported employment, environmental modifications, adaptive aids, communication aids, respite care, consultation services, transportation, non-traditional communication assessment, and non-traditional communication consultation.
Populations Served Developmentally disabled individuals. Information about whether there is an age restriction on waiver eligibility could not be obtained.
Terminology for HM and AT Environmental modification services, adaptive aids/specialized medical equipment and supplies (SMES), communication aids.
Examples of Covered HM and AT Services Environmental modification services: Installation of ramps and grab-bars, hydraulic lifts, widening of doorways, modification of bathroom facilities, or the installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.

Adaptive aids/SMES: Lifts such as van lifts/adaptations for vehicles; lift devices; standing boards; frames; standard wheelchairs; pediatric wheelchairs; "hemi" chairs; tilt-in-space and reclining wheelchairs; control switches/pneumatic switches and devices such as sip and puff controls, and adaptive switches or devices that increase the member’s ability to perform activities of daily living; environmental control units; other devices necessary for life support; and durable and non-durable medical equipment that is not otherwise covered for reimbursement under the MaineCare state plan.

Communication aids: Direct selection, alphanumeric, scanning and encoding communicators; and speech amplifiers, aids and assistive devices not otherwise covered under other sections of the MaineCare Benefits Manual.

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 The total amount allowable for these services is limited to a maximum expenditure of $10,000 every five-year period per member. Once that cap is reached, an additional maximum of $300 per year, per member, is allowable for repair and replacement of previously installed modifications, or for additional modifications.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.

 

Disabled Adults Under 60 (0276)
Agency Name Maine Department of Health and Human Services, Office of MaineCare Services
Phone 207-624-7539
Web site http://www.maine.gov/sos/cec/rules/10/ch101.htm
Summary of State Plan Coverage To provide case management, homemaker, home health aide, personal care, respite care, adult day health care, environmental accessibility, skilled nursing, transportation, personal emergency response systems, independent living assessment, home health care, and therapies (physical, occupational, speech, hearing and language) to adults with disabilities.
Populations Served Adults with disabilities aged 18-60.
Terminology for HM and AT Environmental accessibility (includes home modifications), personal emergency response systems (PERS).
Examples of Covered HM and AT Services Environmental accessibility (including home modifications): Physical modifications to the member’s place of residence. May include ramps, and lifts for porch and stairs. Bathroom modifications include: roll-in showers, sink, faucets, floor urinals, and turnaround space adaptations. Kitchen modifications include: sinks, faucets, turnaround space, cabinetry adjustments, door widening, grab-bars, handrails, voice activation, light/motion devices, fire safety, air safety devices, and smooth flooring.

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 Environmental accessibility (including home modifications): $3,000 per consumer, per year.

PERS: $48 per month, per consumer.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

Elderly Waiver (0088)
Agency Name Maine Department of Health and Human Services, Office of MaineCare Services
Phone 207-624-7539
Web site http://www.maine.gov/sos/cec/rules/10/ch101.htm
Summary of State Plan Coverage For individuals aged 60 and older. To provide case management, adult day health care, personal care, transportation, homemaker/chore services, emergency response, home care/home health, respite care, environmental accessibility adaptations, and independent living assessment for hearing-impaired individuals.
Populations Served Adults age 60 and older.
Terminology for HM and AT Environmental accessibility adaptations (EAA) (includes home modifications), personal emergency response systems (PERS).
Examples of Covered HM and AT Services EAA: Physical modifications to the member’s place of residence. May include ramps and lifts for porch and stairs. Bathroom modifications include: roll-in showers, sinks, faucets, floor urinals, and turnaround space adaptations. Kitchen modifications include: sinks, faucets, turnaround space, cabinetry adjustments, door widening, grab-bars, handrails, voice activation, light/motion devices, fire safety, air safety devices, and smooth flooring.

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 EAA: $3,000 per consumer, per year.

PERS: $48 per month, per consumer.

Training on Use and Repairs Training: yes.

Repairs: yes.

 

MARYLAND

Overview Maryland covers selected types of assistive technology through the Medicaid State Plan’s disposable medical supplies/durable medical equipment benefit. In addition, Maryland offers four waivers that cover a range of assistive technology, environmental modifications, and personal emergency response systems.
Medicaid State Plan Coverage
Agency Name Maryland Department of Health and Mental Hygiene (DHMH)
Phone 410-767-1739
Web site http://www.dhmh.state.md.us/mma
Summary of State Plan Coverage Certain categories of assistive technology are covered under the disposable medical supplies/durable medical equipment benefit. Home modifications are not covered.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Disposable medical supplies/durable medical equipment (DMS/DME).
Examples of Covered HM and AT Services Non-electronic communication devices, wheelchairs (including customized adaptations), prosthetic devices, patient lifts, gait trainers, and other equipment that is medically necessary for use in the recipient’s 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 X X  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Waiver for Older Adults (265)
Agency Name Maryland Department of Health and Mental Hygiene (DHMH) and Maryland Department of Aging
Phone 1-800-AGE-DIAL, or any local Area Agency on Aging (AAA)
Web site http://www.dhmh.state.md.us/mma/waiverprograms/pdf/olderadultfaq.pdf
Summary of State Plan Coverage For aged/disabled persons 50 years and older. To provide personal care, respite care, adult day health care, senior center plus, environmental assessments, environmental accessibility adaptations, assistive devices, personal emergency response systems, family or consumer training, assisted living, behavior consultation, home-delivered meals, and dietitian/nutritionist services.
Populations Served Low-income individuals who are at least 50 years old and meet the nursing facility level of care criteria.
Terminology for HM and AT Assistive devices, environmental assessments, environmental accessibility adaptations (EAA), personal emergency response systems (PERS).
Examples of Covered HM and AT Services Assistive devices: Door alarm, portable ”help” button, shower seat, bed rail, extenders to assist with reaching or dressing and geriatric chair.

Environmental assessments: On-site environmental assessments of the participant’s home or residence, including a licensed assisted living facility.

EAA: Physical adaptations to the home, including a licensed assisted living facility. May include installation of ramps and grab-bars, widening of doorways, modification of bathroom facilities, and 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 N/A X X
Benefit Limits Assistive devices: $1,000 per participant, per year.

Environmental assessments: $350 per assessment.

EAA: For modifications, there is a $10,000 per participant lifetime limit.

PERS: $1,000 for purchase and installation; $45/month for maintenance.

Training on Use and Repairs Assistive devices: Training: no. Repairs: no.

Environmental assessments: Information N/A.

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

PERS: Training: yes. Repairs: yes.

 

Living at Home: Maryland Community Choices (0353)
Agency Name Maryland Department of Health and Mental Hygiene (DHMH)
Phone 410-767-7479
Web site http://www.dhmh.state.md.us/mma/commchoic/index.html
Summary of State Plan Coverage To provide funding for attendant care, nursing supervision of attendants, assistive technology, personal emergency response systems, family training, environmental accessibility adaptations, consumer training and transition services to individuals with physical disabilities.
Populations Served Individuals with physical disabilities, aged 18 years and older, who meet the nursing home level of care criteria.
Terminology for HM and AT Assistive technology (AT), environmental accessibility adaptations (EAA), personal emergency response systems (PERS).
Examples of Covered HM and AT Services AT: Aids for daily living and self-help aids used in activities such as eating, bathing, cooking, dressing, toileting, and home maintenance; augmentative communication and communication-enhancement devices; environmental control units for participants’ homes to allow spontaneous or programmed control of household appliances and other home devices; equipment needed to adapt the participant’s or family’s automotive vehicle for personal transportation; personal computers, software, and computer accessories that enable participants to function more independently.

EAA: Visual fire alarms; lifts; ramps; grab-bars or handrails; stair glides; widening of doorways; modification of bathroom or kitchen facilities to make them physically accessible; lock, buzzer, or other device on a doorway to prevent or stop wandering; home modifications to help a participant identify the physical environment; and specialized electrical 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 N/A X X
Benefit Limits AT and EAA: $6,024 every 12 months. Only two residences may be modified for a participant every three consecutive years.

PERS: $1,095 per unit of service. However, up to $1,314 is allowed for a system with a motion detector.

Training on Use and Repairs AT: Training: yes. Repairs: yes.

EAA: Training: no. Repairs: no.

PERS: Training: yes. Repairs: yes.

 

Waiver for Individuals with Mental Retardation/Developmental Disabilities -- Community Pathways (0023)
Agency Name Maryland Department of Health and Mental Hygiene, Developmental Disabilities Administration (DDA)
Phone 410-767-5600 or contact one of the DDA Regional Offices
Web site http://ddamaryland.org/waiver.htm
Summary of State Plan Coverage For individuals with developmental disabilities. To provide case management (resource coordination), respite, habilitation (residential, day, prevocational, supported employment), accessibility adaptations, transportation, personal support, family and individual support services, assistive technology and adaptive equipment, behavioral support and transition services.
Populations Served Individuals with developmental disabilities of any age who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Assistive technology and adaptive equipment, accessibility adaptations.
Examples of Covered HM and AT Services Assistive technology and Adaptive equipment: Communication devices, equipment needed to adapt the participant’s or family’s vehicle, any piece of technology or equipment that enables an individual to live more independently.

Accessibility adaptations: Widening of doorways, installation of grab-bars, construction of access ramps and railings, installation of chair glides along stairways, installation of detectable warning on walking surfaces, installation of visible fire alarms for individuals who have a hearing impairment.

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 None.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Waiver for Individuals with Mental Retardation/Developmental Disabilities -- New Directions (0424-IP)
Agency Name Maryland Department of Health and Mental Hygiene, Developmental Disabilities Administration (DDA)
Phone 410-767-5569 or contact one of the DDA Regional Offices
Web site http://ddamaryland.org/waiver.htm
Summary of State Plan Coverage To provide support brokerage, respite care, day habilitation-supported employment, personal support, transportation, accessibility adaptations, family and individual support services, assistive technology and adaptive equipment.
Populations Served Individuals with developmental disabilities who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria, who already receive funding from the Developmental Disabilities Administration, and who wish to self-direct their services. This is an Independence-Plus Demonstration program; enrollment is capped at 100 for the first year with an additional 100 in each of the next two years for a total of 300.
Terminology for HM and AT Assistive technology and adaptive equipment, accessibility adaptations (also called environmental modifications).
Examples of Covered HM and AT Services Assistive technology and adaptive equipment: Communication devices, equipment needed to adapt the participant’s or family’s vehicle, any piece of technology or equipment that enables an individual greater ability to live independently. These services shall be reimbursed only if approved in the plan of care and not otherwise available under the Medicaid State Plan or through other resources.

Accessibility adaptations: Widening of doorways, installation of grab-bars, construction of access ramps and railings, installation of chair glides along stairways, installation of detectable warning on walking surfaces, installation of visible fire alarms for individuals who have a hearing impairment.

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 None.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

MASSACHUSETTS

Overview Massachusetts covers augmentative communication devices, specialized medical equipment and supplies, special adaptive mobility systems, and personal emergency response systems through MassHealth, the Medicaid State Plan. In addition, Massachusetts operates three waivers that cover environmental modifications, assistive devices, and specialized equipment.
Medicaid State Plan Coverage
Agency Name MassHealth
Phone 800-531-2229
Web site http://www.mass.gov/?pageID=eohhs2agencylanding&L=4&L0=Home&L1=Government&L2=Departments+and+Divisions&L3=MassHealth&sid=Eeohhs2
Summary of State Plan Coverage MassHealth provides an array of home and community-based services to match the needs of individual consumers and their families. These services include certain assistive technology devices, durable medical equipment, home health aides, personal care attendant services, hospice care, and early intervention and therapy services.
Populations Served Individuals who are eligible for MassHealth and for whom the services are medically necessary.
Terminology for HM and AT Mobility systems, special adaptive mobility systems, augmentative communication devices (ACD), personal emergency response systems (PERS), specialized equipment, assistive technology (AT).
Examples of Covered HM and AT Services Mobility systems: Manual or motorized wheelchair or wheeled device and its modifications. Includes made-to-order equipment to meet specific needs of patients.

Special adaptive mobility systems: Customized mobility and seating equipment that is designed to meet the needs of a specific individual. This benefit is also available to nursing home residents, although the nursing home must pay the first $500.

ACD: Communication boards or books, speech amplifiers, and electronic devices that produce speech or written output.

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

Specialized equipment: Pressure-reducing support systems and equipment to meet bath and shower needs, such as shower chairs and transfer benches.

AT: Devices and services that help to maximize an individual’s control over his or her environment.

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

Repairs: yes.

 

Home and Community Based Services for Elders (Aged and Disabled 60 and Older Waiver) (0059)
Agency Name Executive Office of Elder Affairs
Phone 800-243-4636, 617-727-7750
Web site http://www.mass.gov/?pageID=eldershomepage&L=1&L0=Home&sid=Eelders
Summary of State Plan Coverage To provide homemaker services, home-delivered meals, respite care, personal care, assistive devices, environmental modifications, specialized equipment, and augmentative communication devices to frail persons who are 60 and older.
Populations Served Individuals aged 60 years of age and older who meet nursing or residential facility level of care criteria.
Terminology for HM and AT Specialized equipment/assistive devices, environmental modifications, augmentative communication devices (ACD).
Examples of Covered HM and AT Services Environmental modifications: Widening of doorways, leveling of thresholds, bathroom modifications, other minor internal structural modifications, and specialized electrical equipment.

Specialized equipment/assistive devices: Wheelchair ramp/porch lift, grab-bars, raised toilet/seat, custom electrical equipment.

ACD: Specialized augmentative communication devices other than those provided for in the 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   X X
Benefit Limits Capped at the average per-person expenditure in the previous year.
Training on Use and Repairs Information N/A.

 

Mental Retardation/Developmental Disability Waiver (0064)
Agency Name Division of Mental Retardation
Phone 617-427-5608
Web site http://mass.gov/?pageID=eohhs2agencylanding&L=4&L0=Home&L1=Government&L2=Departments+and+Divisions&L3= Department+of+Mental+Retardation&sid=Eeohhs2
Summary of State Plan Coverage To provide residential services, employment supports, transportation, adult day services, environmental modifications, assistive devices/specialized equipment to mentally retarded/ developmentally disabled persons who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Populations Served Mentally retarded/developmentally disabled persons who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Environmental modifications, specialized equipment/assistive devices.
Examples of Covered HM and AT Services Environmental modifications: Widening of doorways, leveling of thresholds, bathroom modifications, other minor internal structural modifications, and specialized electrical equipment.

Specialized equipment/assistive devices: Wheelchair ramp/porch lift, grab-bars, raised toilet/seat, custom electrical equipment.

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 Capped at the average per-person expenditure in the previous year.
Training on Use and Repairs Information N/A.

 

Traumatic Brain Injury
Agency Name Massachusetts Rehabilitation Commission
Phone 617-204-3852
Web site http://www.mass.gov/?pageID=eohhs2agencylanding&L=4&L0=Home&L1=Government&L2=Departments+and+Divisions&L3= Massachusetts+Rehabilitation+Commission&sid=Eeohhs2
Summary of State Plan Coverage To provide residential habilitation, respite care, supportive employment, environmental adaptations, specialized equipment, assistive devices, and augmentative communication devices to individuals with brain injury who meet the specialized nursing facility level of care criteria.
Populations Served Individuals aged 22 and older with externally caused traumatic brain injuries.
Terminology for HM and AT Environmental modifications, specialized equipment/assistive devices, augmentative communication devices (ACD).
Examples of Covered HM and AT Services Environmental modifications: Widening of doorways, leveling of thresholds, bathroom modifications, other minor internal structural modifications, and specialized electrical equipment.

Specialized equipment/assistive devices: Wheelchair ramp/porch lift, grab-bars, raised toilet/seat, custom electrical equipment.

ACD: Specialized augmentative communication devices other than those provided for in the 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   X X
Benefit Limits Capped at the average per-person expenditure in the previous year.
Training on Use and Repairs Information N/A.

 

MICHIGAN

Overview Michigan covers a wide range of home modifications and assistive technologies through two waivers, and selected assistive technology and power wheelchairs through the Medicaid State Plan.
Medicaid State Plan Coverage
Agency Name Michigan Department of Community Health (MDCH)
Phone 517-373-3740
Web site http://www.michigan.gov/mdch
Summary of State Plan Coverage The Michigan Medicaid State Plan covers a wide range of durable medical equipment, but does not cover adaptive equipment, environmental control units, home modifications, vehicle ramps, certain wheelchair accessories, or stair or wheelchair lifts.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Durable medical equipment (DME) and medical supplies.
Examples of Covered HM and AT Services DME and medical supplies: Standard hydraulic lifts, electric lifts, sip-and-puff controls for wheelchairs, custom and power wheelchairs, 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 X X N/A  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Habilitation Supports Waiver (0167)
Agency Name Department of Community Health, Bureau of Community Mental Health Services
Phone 517-241-3044 (# specific to Waiver Coordinator)
Web site http://www.michigan.gov/mdch
Summary of State Plan Coverage For persons with developmental disabilities who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria. To provide chore services, community living supports, enhanced pharmacy, enhanced medical equipment and supplies, environmental modifications, out-of-home non-vocational services, personal emergency response systems, prevocational services, private duty nursing, respite care, supported employment, and supports coordination.
Populations Served Persons with a developmental disability who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Enhanced medical equipment and supplies (assistive technologies), physical adaptations to the home and/or workplace, personal emergency response systems (PERS).
Examples of Covered HM and AT Services Enhanced medical equipment and supplies: Devices, supplies, controls, or appliances that are not available under regular Medicaid coverage or through other insurances. Items must be of direct medical or remedial benefit to the beneficiary, necessary to prevent institutionalization, and specified in the plan of service. Includes adaptations to vehicles.

Physical adaptations to the home and/or workplace: Installation of wheelchair ramp or grab-bars, modification of bathroom facilities or installation of specialized electric and plumbing systems required to accommodate medical equipment, widening doorways.

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 X
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Michigan Choice (0233)
Agency Name Department of Community Health, Medical Services Administration
Phone 517-335-5068 (# specific to Waiver Contract Manager)
Web site http://www.michigan.gov/mdch/0,1607,7-132-2943_4857_5045---,00.html
Summary of State Plan Coverage To provide personal care, homemaker services, respite services, adult day care, environmental modifications, personal emergency response systems, private duty nursing, counseling, home-delivered meals, adult day health, training, nursing facility transition services, chore services, and specialized medical supplies and equipment to the elderly and/or disabled.
Populations Served Individuals who are elderly (aged 65 or older), or younger persons with disabilities aged 18 or older.
Terminology for HM and AT Specialized medical equipment and supplies (assistive technologies), experimental items, physical adaptations to the home, personal emergency response system (PERS).
Examples of Covered HM and AT Services Specialized medical equipment and supplies: Specialized wheelchairs and modifications to wheelchairs; amplifiers for the telephone, television, or other device; assistive communication devices ordered by an occupational therapist; white boards; and vehicle modifications.

Experimental items: Items whose use has not been supported in one or more studies in a refereed professional journal. This coverage includes: adaptations to vehicles and ancillary supplies and equipment necessary for proper functioning of such items.

Physical adaptations to the home and/or workplace: Air conditioning (window installments only), adjustments of sink heights, shower modifications, light switches, wheelchair ramps, raised toilet or raised toilet seats, porch lifts, widening of doorways, threshold leveling, other minor structural changes, electronic door openers, environmental control systems (to control temperature, lights, telephone, security systems).

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 $38 per day, per participant.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

MINNESOTA

Overview Minnesota’s Medicaid program covers assistive technology, home modifications, and vehicle modifications through the state plan and five waivers.
Medicaid State Plan Coverage
Agency Name Department of Human Services
Phone 651-296-7675
Web site http://www.dhs.state.mn.us
Summary of State Plan Coverage The Minnesota Medicaid State Plan covers augmentative communication devices, customized wheelchairs, and lifts under the medical equipment and supplies benefit.
Populations Served Medicaid-eligible individuals.
Terminology for HM and AT Medical equipment and supplies, augmentative communication devices.
Examples of Covered HM and AT Services Augmentative communication devices, including communication picture books, communication charts and boards, and mechanical/electronic devices; customized and power wheelchairs and wheelchair accessories; lifts.
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  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Elderly Waiver (EW)
Agency Name Department of Human Services
Phone 651-431-2600
Web site http://www.dhs.state.mn.us/main/groups/aging/documents/pub/dhs_id_005942.hcsp
Summary of State Plan Coverage For disabled persons who are over age 65. To provide case management, homemaker services, respite care, adult day care, environmental modifications, transportation, chore services, adult companion services, family and caregiver training, adult residential care, adult foster care, assisted living, residential care, home-delivered meals, extended personal care, extended supplies and equipment, bath, consumer directed community supports, and transitional supports.
Populations Served Individuals over the age of 65 who are disabled.
Terminology for HM and AT Home and vehicle modifications, environmental modifications, extended supplies and equipment.
Examples of Covered HM and AT Services Home and vehicle modifications: Physical adaptations to the home and/or vehicle. Home adaptations may include installation of ramps and grab-bars, widening of doorways, modifications of bathroom facilities, or installation of specialized electric and plumbing systems to accommodate medical equipment and supplies. Vehicle modifications may include, but are not limited to, wheelchair lifts, adapted seating, door widening, door handle replacements, steering wheel, acceleration and braking controls, and wheelchair securing devices.

Environmental modifications: Modifications to items that are not permanently attached to the living setting or building itself, and can be transitioned with the client to a new setting. Items may include, but are not limited to, adaptive furniture, adaptive cooking utensils, portable ramps, and adaptive cleaning devices.

Extended supplies and equipment: Durable and non-durable medical supplies and equipment that are provided as a necessary adjunct to direct treatment of the recipient’s condition.

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 Home and vehicle modifications/adaptations: Combined total of $4,739.

Extended supplies and equipment: None.

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

Repairs: yes.

 

Community Alternatives for Disabled Individuals (CADI) Waiver
Agency Name Department of Human Services
Phone 651-431-2400
Web site http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/DHS_id_003905.hcsp
Summary of State Plan Coverage For disabled individuals under age 65. To provide case management, homemaker services, respite care, adult day health care, habilitation, prevocational services, supported employment, environmental modifications and adaptations, family support, consumer directed community supports, extended state plan services, home health care, physical therapy, occupational therapy, speech, hearing, and language, personal care, supplies and equipment, child foster care, independent living skills, residential care, home-delivered meals, foster care, assisted living, adult day health care.
Populations Served Disabled individuals under age 65.
Terminology for HM and AT Modifications to the home, vehicle modifications.
Examples of Covered HM and AT Services Modifications to the home: Installation and maintenance of ramps and grab-bars, widening of doorways, modification of bathrooms and kitchens, installation of specialized electric and plumbing systems to accommodate medical equipment, shatterproof windows, floor coverings (i.e., allergy flooring/accessibility flooring), modifications to meet egress, alarm systems, and other requirements of the applicable life safety and fire codes, if any.

Vehicle modifications: Door handle replacements, door widening, roof extensions, lifting devices, wheelchair securing devices, adapted seat devices, and handrails and 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 N/A N/A X X X
Benefit Limits None.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.

 

Traumatic Brain Injury (TBI) Waiver
Agency Name Department of Human Services
Phone 651-431-2400
Web site http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/DHS_id_003908.hcsp
Summary of State Plan Coverage For those 65 and under with a traumatic brain injury. To provide case management, personal care, homemaker assistance, respite care, adult day health care, environmental modifications and adaptations, transportation, specialized medical equipment and supplies, chore services, companion services, home health care, physical therapy, occupational therapy, speech hearing and language, mental health services, independent living skills, structured day program, cognitive rehabilitation therapy, behavioral programming, family support, foster care, prevocational services, supported employment, consumer directed community supports.
Populations Served Individuals 65 and under with a traumatic brain injury.
Terminology for HM and AT Modifications to home or vehicle, specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Home and Vehicle modifications: Home modifications may include, but are not limited to: installation and maintenance of ramps and grab-bars, widening of doorways, modification of bathrooms and kitchens, installation of specialized electric and plumbing systems to accommodate medical equipment, shatterproof windows, floor coverings (i.e., allergy flooring/accessibility flooring), modifications to meet egress needs, alarm systems, and other requirements of the applicable life safety and fire codes, if any. Vehicle modifications may include, but are not limited to: door handle replacements, door widening, roof extensions, lifting devices, wheelchair securing devices, adapted seat devices, and handrails and grab-bars.

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 X
Benefit Limits None.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.

 

Mental Retardation/Related Conditions (MR/RC)
Agency Name Department of Human Services
Phone 651-431-2443
Web site http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/DHS_id_003900.hcsp
Summary of State Plan Coverage For people with mental retardation and other related conditions for people of all ages. To provide case management, homemaker services, respite, habilitation (residential, day, prevocation, supported employment), environmental accessibility adaptations, transportation, chore, personal care attendant, crisis respite, 24-hour emergency assistance, caregiver training, adult day care, housing access coordination, assistive technology, personal support, consumer training and education, consumer-directed community supports, and caregiver living expenses.
Populations Served Individuals of all ages with mental retardation and other related conditions.
Terminology for HM and AT Assistive technology (AT), modifications and adaptations (including home and vehicle adaptations), environmental modifications.
Examples of Covered HM and AT Services AT: Devices or equipment that improve a person’s ability to perform activities of daily living or to control/access and communicate in the community. Examples include communication devices and necessary software.

Modifications and adaptations: Home modifications may include, but are not limited to: installation and maintenance of ramps and grab-bars, widening of doorways, modification of bathrooms and kitchens, installation of specialized electric and plumbing systems to accommodate medical equipment, shatterproof windows, floor coverings (i.e., allergy flooring/accessibility flooring), modifications to meet egress needs, alarm systems, and other requirements of the applicable life safety and fire codes, if any. Vehicle modifications may include, but are not limited to: door handle replacements, door widening, roof extensions, lifting devices, wheelchair securing devices, adapted seat devices, and handrails and grab-bars.

Environmental modifications: Modifications to items that are not permanently attached to the living setting or building itself, and can be transitioned with the client to a new setting. Equipment such as adaptive couches, chairs, tables and beds, adaptive bikes and strollers, and portable ramps are included.

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 None.
Training on Use and Repairs AT: Training: yes. Repairs: yes.

Modifications and adaptations: Training: Information N/A. Repairs: yes.

Environmental modifications: Information N/A.

 

Community Alternative Care (CAC) Waiver
Agency Name Department of Human Services
Phone 651-431-2400
Web site http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/DHS_id_003902.hcsp
Summary of State Plan Coverage To provide case management, homemaker assistance, respite care, environmental accessibility adaptations, transportation, specialized medical equipment and supplies, family training, home health care, therapies (including physical, occupational, speech, hearing, and language), prescribed drugs, respiratory therapy, personal care, nutrition therapy, private duty nursing, foster care, and consumer directed community supports to chronically ill individuals 65 and under.
Populations Served Children and adults under age 65 who are chronically ill and choose to receive care in the community rather than in a facility.
Terminology for HM and AT Home and vehicle modifications, specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services Home and vehicle modifications: Home modifications may include, but are not limited to: installation and maintenance of ramps and grab-bars, widening of doorways, modification of bathrooms and kitchens, installation of specialized electrical equipment and plumbing to accommodate medical equipment, shatterproof windows, floor coverings (i.e., allergy flooring/accessibility flooring), modifications to meet egress needs, alarm systems, and other requirements of the applicable life safety and fire codes, if any. Vehicle modifications may include, but are not limited to: door handle replacements, door widening, roof extensions, lifting devices, wheelchair securing devices, adapted seat devices, handrails, and grab-bars.

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 X
Benefit Limits None.
Training on Use and Repairs Training: Information N/A.

Repairs: yes.

 

MISSISSIPPI

Overview Mississippi covers selected types of assistive technologies through the Medicaid State Plan, and offers assistive technologies and home modifications through five waivers.
Medicaid State Plan Coverage
Agency Name Mississippi Division of Medicaid
Phone 601-359-6050
Web site http://www.dom.state.ms.us/
Summary of State Plan Coverage The Mississippi Medicaid State Plan covers selected types of assistive technology 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 Custom wheelchairs and/or seating systems.
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 X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.

 

Elderly and Disabled Waiver
Agency Name Division of Medicaid, Community Long-term Care Division
Phone 601-359-6050
Web site http://www.dom.state.ms.us/Long_Term_Care/HCBS_Waiver_Programs/hcbs_waiver_programs.html - Elderly
Summary of State Plan Coverage To provide adult day health care, home-delivered meals, homemaker services, escorted transportation, respite care, and home health visits to persons aged 21 and above who meet the nursing facility level of care criteria.
Populations Served Individuals over the age of 21 who meet the nursing facility level of care criteria.
Terminology for HM and AT Information N/A.
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 X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.

 

Independent Living Waiver
Agency Name Department of Rehabilitation Services
Phone 601-359-6050
Web site http://www.dom.state.ms.us/Long_Term_Care/HCBS_Waiver_Programs/hcbs_waiver_programs.html - Elderly
Summary of State Plan Coverage To provide case management, rehabilitation, specialized medical equipment and supplies, and home modifications to persons with severe orthopedic and/or neurological impairments who meet the nursing facility level of care criteria.
Populations Served Individuals with severe orthopedic and/or neurological impairments who meet the nursing facility level of care criteria.
Terminology for HM and AT Specialized medical equipment and supplies (SMES), home modifications (HM).
Examples of Covered HM and AT Services SMES: Devices, controls, and 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.

HM: Physical adaptations to the home to ensure the safety of residents or to meet the requirements of the life safety code.

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 (0282)
Agency Name Department of Health, Bureau of Mental Retardation
Phone 601-359-6050
Web site http://www.dom.state.ms.us/Long_Term_Care/HCBS_Waiver_Programs/hcbs_waiver_programs.html - Elderly
Summary of State Plan Coverage To provide respite care, habilitation, therapies, specialized medical supplies, and attendant care services to mentally retarded/developmentally disabled persons who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Populations Served Mentally retarded/developmentally disabled persons who meet the Intermediate Care Facility for the Mentally Retarded level of care criteria.
Terminology for HM and AT Specialized medical supplies.
Examples of Covered HM and AT Services Specialized medical supplies: Supplies such as adult diapers that enable individuals to increase their abilities 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
N/A X N/A N/A X N/A
Benefit Limits Information N/A.
Training on Use and Repairs Information N/A.

 

Assisted Living for the Elderly Waiver
Agency Name Division of Medicaid, Community Long-term Care
Phone 601-359-6050
Web site http://www.dom.state.ms.us/Long_Term_Care/HCBS_Waiver_Programs/hcbs_waiver_programs.html - Elderly
Summary of State Plan Coverage To provide case management, personal care, homemaker services, chore services, attendant care, skilled nursing services, and attendant call systems to residents of Bolivar, Forrest, Harrison, Hinds, Lee, Newton, or Sunflower counties who are 21 years of age or older and who meet the nursing facility level of care criteria.
Populations Served Residents of Bolivar, Forrest, Harrison, Hinds, Lee, Newton, or Sunflower counties who are 21 years of age or older and who meet the nursing facility level of care criteria. Individuals must require assistance with at least three activities of daily living, or have a diagnosis of Alzheimer's disease or another type of dementia and require assistance with two or more activities of daily living.
Terminology for HM and AT Attendant call systems.
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.

 

Traumatic Brain Injury Waiver
Agency Name Division of Medicaid Long-Term Care
Phone 601-359-6050
Web site http://www.dom.state.ms.us/Long_Term_Care/HCBS_Waiver_Programs/hcbs_waiver_programs.html - Elderly
Summary of State Plan Coverage To provide case management, respite care, attendant care services, environmental accessibility accommodations, and specialized medical equipment and supplies to persons with traumatic brain or spinal cord injury who meet the nursing facility level of care criteria.
Populations Served Individuals who have a traumatic brain or spinal cord injury who meet the nursing facility level of care criteria. In addition, individuals must be medically stable. Medical stability is defined as the absence of any of the following: an active, life- threatening condition; an IV drip to control or support blood pressure; intercranial pressure; or arterial monitoring.
Terminology for HM and AT Environmental accessibility adaptations (EAA), specialized medical equipment and supplies (SMES).
Examples of Covered HM and AT Services EAA: Adaptations to the home that are necessary to ensure the health, welfare, and safety of the individual, or that enable the individual to function with greater independence in the home.

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 their living environment.

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.

 

MISSOURI

Overview Missouri covers augmentative communication devices and wheelchairs in the Medicaid State Plan, as well as environmental accessibility adaptations and assistive technology through three waivers.
Medicaid State Plan Coverage
Agency Name Missouri Division of Medical Services
Phone 573-751-3425
Web site www.dss.mo.gov/dms
Summary of State Plan Coverage The Missouri Medicaid State Plan covers augmentative communication devices and wheelchairs under the durable medical equipment benefit. The state plan does not cover environmental control items and 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 ACD: Power and custom wheelchairs and accessories.
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.

 

Physically Disabled Waiver (4019)
Agency Name Missouri Department of Social Services, Division of Medical Services with the Missouri Department of Health and Senior Services, Bureau of Special Health Care Needs
Phone 573-751-3425
Web site http://manuals.momed.com/lpBin22/lpext.dll?f=templates&fn=searchform-frames.htm&id=MOPMSearch&
Summary of State Plan Coverage To provide home and community-based services to individuals with serious and complex medical needs, who have reached the age of 21, and who are no longer eligible for home care services available under Early, Periodic, Screening, Diagnosis, and Treatment. The physical disabilities waiver provides a cost-effective alternative to placement in an intermediate care facility for the mentally retarded.
Populations Served Individuals with serious and complex medical needs, who have reached the age of 21.
Terminology for HM and AT Specialized medical equipment (SME)/assistive technology.
Examples of Covered HM and AT Services SME/assistive technology: Devices, controls, or appliances that improve quality of life; items necessary for life support; ancillary supplies and equipment necessary to the proper functioning of such items; durable and non-durable medical equipment and supplies not available under the 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 X X  
Benefit Limits None.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Mentally Retarded/Developmentally Disabled Waiver (0178)
Agency Name Department of Mental Health (DMH), Division of Mental Retardation and Developmental Disabilities (DMRDD)
Phone 573-751-4122
Web site http://manuals.momed.com/lpBin22/lpext.dll?f=templates&fn=searchform-frames.htm&id=MOPMSearch&
Summary of State Plan Coverage To provide personal assistant services, community-specific services, counseling services, crisis intervention, communication skills instruction, supported living residential habilitation, day habilitation, supported employment, respite care, behavior therapy, physical therapy, occupational therapy, speech therapy, transportation adaptations, specialized medical equipment, and home modifications to the mentally retarded and developmentally disabled.
Populations Served Mentally retarded and developmentally disabled individuals.
Terminology for HM and AT Environmental accessibility adaptations (EAA), specialized medical equipment (SME).
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.

SME: Devices, controls, or appliances that increase a person’s ability to perform activities of daily living; 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.

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 $5,000 per year a piece for environmental accessibility adaptations and specialized medical equipment.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

Independent Living (IL) Waiver
Agency Name Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS)
Phone 573-526-3626
Web site http://manuals.momed.com/lpBin22/lpext.dll?f=templates&fn=searchform-frames.htm&id=MOPMSearch&
Summary of State Plan Coverage To provide home and community-based services to individuals with disabilities who require services beyond the scope of the Medicaid State Plan.
Populations Served Medicaid-eligible individuals aged 18-64, with a physical and/or cognitive disability (cognitive disability acquired after age 22).
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, and modification of bathroom facilities.

SMES: Devices, controls, or appliances that enable individuals to increase their ability to perform activities of daily living, or communicate with their environment. Also includes items necessary for life support, ancillary supplies and equipment necessary to functioning of durable medical equipment items, and durable medical equipment not covered 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 X N/A
Benefit Limits $5,000 per person, per year, for all waiver services. Limit may be exceeded if the consumer requires adult diapers.
Training on Use and Repairs Training: yes.

Repairs: yes.

 

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

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