PDFWAC 388-845-0910

What limits apply to environmental adaptations?

The following service limits apply to environmental adaptations:
(1) Clinical and support needs for an environmental adaptation must be identified in the waiver participant's DDA assessment and documented in the person-centered service plan.
(2) Environmental adaptations require prior approval by the DDA regional administrator or designee,
(3) Environmental adaptations must be supported by itemized and written bids from licensed contractors. For an adaptation that costs:
(a) $1,500 or less, one bid is required;
(b) More than $1,500 and equal to or less than $5,000, two bids are required; or
(c) More than $5,000, three bids are required.
(4) All bids must include:
(a) The cost of all required permits and sales tax; and
(b) An itemized and clearly outlined scope of work.
(5) DDA may require an occupational therapist, physical therapist, or other professional to review and recommend an appropriate environmental adaptation statement of work prior to the waiver participant soliciting bids or purchasing adaptive equipment.
(6) Environmental adaptations to the home are excluded if they are of general utility without direct benefit to the individual as related to the individual's developmental disability, such as cosmetic improvements to the home, or general home improvements, such as carpeting, roof repair, or central air conditioning.
(7) Environmental adaptations must meet all local and state building codes. Evidence of any required completed inspections must be submitted to DDA prior to final payment for work.
(8) Environmental adaptations must not be performed while other adaptations or remodeling projects are in process.
(9) Environmental adaptations must not be approved if the existing residence condition is impacted by hazardous mold, asbestos, or home dilapidation.
(10) Location of the home in a flood plain, landslide zone, or other hazardous area may limit or prevent any environmental adaptations at the discretion of DDA.
(11) Written consent from the home's landlord is required prior to starting any environmental adaptations for a rental property. The landlord must not require removal of the environmental adaptations at the end of the waiver participant's tenancy as a condition of the landlord approving the environmental adaptation to the waiver participant's home.
(12) Environmental adaptations must not add to the total square footage of the home, convert nonliving space to living space, or create a new room.
(13) The amount of service you may receive is limited to the dollar amounts for aggregate services in your basic plus waiver, CIIBS waiver, or the dollar amount of your annual IFS waiver allocation.
(14) For core and community protection waivers, annual environmental adaptation costs must not exceed $12,192.
(15) Damage prevention and repairs under the CIIBS, IFS, core, and CP waivers are subject to the following restrictions:
(a) Limited to the cost of restoration to the original function;
(b) Behaviors of waiver participants that resulted in damage to the home must be addressed in a behavior support plan prior to the repair of damages;
(c) Repairs to personal property such as furniture and appliances are excluded; and
(d) Repairs due to normal wear and tear are excluded.
(16) Noncovered environmental adaptations include:
(a) Building fences and fence repairs;
(b) Carpet or carpet replacement;
(c) Air conditioning, heat pumps, generators, or ceiling fans;
(d) Roof repair or siding;
(e) Deck construction or repair; and
(f) Jetted tubs or saunas.
(17) Environmental adaptations are limited to additional services not otherwise covered under the medicaid state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.
[Statutory Authority: RCW 71A.12.030, 71A.12.120, and 42 C.F.R. 441.301 (c)(6). WSR 23-18-035, § 388-845-0910, filed 8/29/23, effective 9/29/23. Statutory Authority: RCW 71A.12.030 and 71A.12.120. WSR 21-19-108, § 388-845-0910, filed 9/20/21, effective 10/21/21; WSR 20-05-080, § 388-845-0910, filed 2/18/20, effective 3/20/20. Statutory Authority: RCW 71A.12.030, 71A.12.120, 42 C.F.R. 441 Subpart G. WSR 18-14-001, § 388-845-0910, filed 6/20/18, effective 7/21/18. Statutory Authority: 2014 c 139, 2014 c 166, 2015 3rd sp.s. c 4, RCW 71A.12.030, and 71A.12.120. WSR 16-17-009, § 388-845-0910, filed 8/4/16, effective 9/4/16. Statutory Authority: RCW 71A.12.030 and 2012 c 49. WSR 13-24-045, § 388-845-0910, filed 11/26/13, effective 1/1/14. Statutory Authority: RCW 71A.12.030, 71A.12.120, 2009 c 194, and 2008 c 329 § 205 (1)(i), and Title 71A RCW. WSR 10-22-088, § 388-845-0910, filed 11/1/10, effective 12/2/10. Statutory Authority: RCW 71A.12.030, 71A.12.120 and Title 71A RCW. WSR 07-20-050, § 388-845-0910, filed 9/26/07, effective 10/27/07. Statutory Authority: RCW 71A.12.030, 71A.12.12 [ 71A.12.120] and chapter 71A.12 RCW. WSR 06-01-024, § 388-845-0910, filed 12/13/05, effective 1/13/06.]