Revision 17-1; Effective November 1, 2017
Home modifications are those services that assess the need to arrange for and provide modifications and/or improvements to the individual's living quarters to allow for community living and ensure safety, security and accessibility. Minor home modifications (MHM) do not include major home renovation, remodeling or construction of additional rooms. By rule, the Community Living Assistance and Support Services (CLASS) program assures that minor home modifications are:
- associated with the related condition;
- necessary to avoid institutionalization;
- provide safe access to the home and community; and
- improve self-reliance and independence.
Approval of all MHMs identified on the Individual Plan of Care (IPC) must include documentation describing why each item is necessary and how it relates to the individual's disability. Form 3660, Request for Adaptive Aids, Medical Supplies, Minor Home Modifications or Dental Services/Sedation, is required for all requested MHMs. Requests for MHMs that require additional information to be provided by the appropriate licensed professional (as listed below) or require bids must accompany Form 3660, as applicable.
All assessments for MHMs requested through the CLASS program must:
- be based on a face-to-face evaluation of the individual by the licensed professional, conducted not more than one year before the date of purchase of the MHM;
- include a description of and a recommendation for a specific MHM listed in this appendix and any associated items or modifications necessary to make the MHM functional;
- include a diagnosis that is related to the individual's need for the MHM (for example, cerebral palsy, quadriplegia or deafness);
- include a description of the condition related to the diagnosis (for example, unable to ambulate without assistance); and
- include a description of the specific needs of the individual and how the MHM will meet those needs (for example, an individual who uses a wheelchair for mobility in his home and the community needs to be able to enter the shower area of his residence safely. In order to achieve this goal, barriers in the bathroom need to be removed and a roll-in shower needs to be created).
Repair and maintenance of items purchased through the CLASS program do not require justification from a medical professional.
The service planning team must:
- consider a written assessment recommending an MHM;
- document any discussion about the recommended MHM; and
- agree that the recommended MHM is necessary and should be purchased.
The case management agency (CMA), direct services agency (DSA) and individual/legally authorized representative (LAR) must complete and sign Form 3849-A, Specifications for Adaptive Aids/Medical Supplies/Minor Home Modifications, to signify agreement with the specifications. Form 3660 is not required to accompany an IPC revision that adds only the cost of obtaining specifications to the IPC.
The DSA must submit Form 3660, along with specifications and bids for any MHM with a cost of $1,000 or higher, to the CMA. The case manager must issue an IPC revision or IPC renewal to obtain a service authorization from the Texas Health and Human Services Commission (HHSC) for the proposed MHM.
For MHMs with a cost of $1,000 or higher, a DSA must obtain comparable bids for the requested MHM from three vendors. Comparable bids describe the MHM and any associated items or modifications identified in an assessment for an MHM. A bid must:
- state the total cost of the requested MHM;
- include the name, address and telephone number of the vendor;
- include a complete description of the MHM and any associated items or modifications as identified in a written assessment, which may include pictures or other descriptive information from a catalog, website or brochure; and
- be obtained within one year after the written assessment.
A DSA may obtain only one bid or two comparable bids for an MHM if the DSA has written justification for obtaining fewer than three bids because the MHM is available from a limited number of vendors.
If a DSA will request authorization for payment for an MHM that is not based on the lowest bid, the DSA must have written justification for payment of a higher bid.
The following are examples of justifications that support payment of a higher bid:
- the higher bid is based on the inclusion of a longer warranty for the MHM; and
- the higher bid is from a vendor that is more accessible to the individual than another vendor.
The only MHMs purchasable by the DSA are listed in this appendix. The maximum amount HHSC authorizes as payment to the DSA for all MHMs purchased for an individual receiving CLASS program services is $10,000. This is a lifetime limit for an individual who receives CLASS program services. After reaching the lifetime maximum cost of $10,000, an individual may receive, during an IPC period, a maximum of $300 for repair and maintenance of an MHM purchased through the CLASS program, needed after one year has elapsed from the date the MHM is complete.
MHMs are provided under this waiver when no other financial resource is available or when other available resources have been exhausted. MHMs will not be used to modify homes that are owned or leased by providers of waiver services. Modifications must be for existing structures and must not increase the square footage of the dwelling. Excluded are those adaptations or improvements to the home that are of general utility and are not a direct medical or remedial benefit to the individual, such as carpeting (except to allow independent mobility for persons using crutches, wheelchairs, three-wheel scooters, and other aids which offer increased personal mobility), roof repair, central air conditioning, etc. If alternative solutions exist, modifications will be approved by staff from HHSC based on considerations of cost and comparable functionality.
MHMs have to be assessed by the most qualified licensed professionals who can justify the need and appropriateness of a requested MHM.
The following licensed professionals may assess the need for an MHM in the CLASS program.
- Audiologist (AU) — A person licensed as an audiologist in accordance with Chapter 401 of the Texas Occupations Code.
- Licensed Psychological Associate (PSA) — A person licensed as a psychological associate in accordance with the Texas Occupations Code, Chapter 501.
- Licensed Professional Counselor (LPC) — A person licensed as a professional counselor in accordance with the Texas Occupations Code, Chapter 503.
- Dietitian (DI) — A person licensed as a dietitian in accordance with Chapter 701 of the Texas Occupations Code.
- Registered Nurse (RN) — A person licensed to practice professional nursing by the Texas Board of Nurse Examiners in accordance with Chapter 301 of the Texas Occupations Code.
- Physician (MD) — A person licensed as a physician in accordance with the Texas Occupations Code, Chapter 155.
- Occupational Therapist (OT) — A person licensed as an occupational therapist in accordance with Chapter 454 of the Texas Occupations Code.
- Ophthalmology (OPH) — A person licensed as a physician in accordance with the Texas Occupations Code, Chapter 155, and certified by the American Board of Ophthalmology.
- Optometrist (OPT) — A person licensed as an optometrist or therapeutic optometrist in accordance with the Texas Occupations Code, Chapter 351.
- Physical Therapist (PT) — A person licensed as a physical therapist in accordance with Chapter 453 of the Texas Occupations Code.
- Psychologist (PS) — A person licensed as a psychologist, provisionally licensed psychologist or psychological associate in accordance with Chapter 501 of the Texas Occupations Code.
- Speech-Language Pathologist (SP) — A person licensed as a speech-language pathologist in accordance with Chapter 401 of the Texas Occupations Code.
Home modifications that may be covered in the CLASS program must be included on the following list and include the installation, maintenance and repair of approved items not covered by warranty.
- Home Modifications
- floor leveling (only in residences owned by the individual and/or family and only when the installation of a ramp is not possible) (OT, PT)
- vinyl flooring or industrial grade carpet necessary to ensure the safety of the individual, prevent falling, improve mobility and adapt a living space occupied by a beneficiary who is unable to safely use existing floor surface (OT, PT)
- medically necessary steam cleaning of walls, carpet, support equipment and upholstery (MD)
- roll-in showers (OT, PT)
- sink modifications (OT, PT)
- sink cut-outs (OT, PT)
- bathtub modifications (OT, PT)
- water faucet controls (OT, PT)
- toilet modifications (OT, PT)
- floor urinal and bidet adaptations (OT, PT)
- plumbing modifications (OT, PT)
- turnaround space modifications (OT, PT)
- worktable/work surface adjustments (OT, PT)
- cabinet development/adjustments (OT, PT)
- Specialized Accessibility/Safety Adaptations/Additions (including repair and maintenance)
- ramps (constructed to provide access into and within the home) (OT, PT)
- protective awnings over ramps (OT, PT, MD)
- door widening (OT, PT, MD)
- widening/enlargement of garage and/or carport to accommodate primary transportation vehicle and to allow people using wheelchairs to enter and exit their adapted vehicles safely (OT, PT)
- installation of sidewalk for access from non-connected garage and/or driveway to residence when existing surface condition is a safety hazard for the person with a disability (OT, PT)
- porch/patio leveling (only when the installation of a ramp is not possible) (OT, PT)
- grab bars and handrails (OT, PT, MD)
- door bells, door scopes and adaptive wall switches (OT, PT)
- safety glass, safety alarms (does not include home security systems), security door locks, fire safety approved window locks, security window screens and visual alert systems (for example, for individuals with behavioral problems) (OT, PT, MD, PSA, LPC)
- medically necessary air filtering devices (MD)
- protective padding and corner guards for walls (OT, PT, MD, PSA, LPC)
- recessed lighting with mesh covering and metal dome light covers for individuals with behavior problems (OT, PT, MD, PSA, LPC)
- emergency back-up gas-powered generators (limited to critical medical equipment) (OT, PT, MD)
- medically necessary noise abatement renovations to provide increased sound proofing for people with sensory impairments (OT, PT, MD, PSA, LPC)
- lever door handles (OT, PT, MD, RN)
- door replacement only when required for accessibility (OT, PT, MD)
- intercom systems for people with limited mobility or visual impairment (OT, PT, OPT, OPH)
- Video monitoring for individuals with limited mobility and to ensure health and safety (OT, PT, PSA, LPC, MD)
- Repair and maintenance of items on the authorized list above as allowable by rule.