Revision 18-2; Effective September 3, 2018

Minor home modifications (MHMs) are those physical adaptations to a member’s home, required by the service plan, that are necessary to ensure the member's health, welfare and safety, or that enable the member to function with greater independence in the home. 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 that are necessary to accommodate the medical equipment and supplies necessary for the member’s welfare. Excluded are those adaptations or improvements to the home that are of general utility, and are not of direct medical or remedial benefit to the member, such as carpeting, roof repair, central air conditioning, etc. Adaptations that add to the total square footage of the home are excluded from this benefit.

All services are provided in accordance with applicable state or local building codes. Modifications are not made to settings that are leased, owned or controlled by providers contracted with the managed care organization (MCO). The state allows a member to select a relative or legal guardian, other than a spouse, to be the member’s provider for this service if the relative or legal guardian meets the requirements to provide this type of service.

6610 Responsibilities Pertaining to Minor Home Modifications

Revision 16-1; Effective March 1, 2016

In order to ensure cost-effectiveness in the purchase of minor home modifications (MHMs), the managed care organization (MCO) must:

  • determine and document the needs and preferences of the member for the MHM; and
  • document the necessity for the MHM.

The MCOs have their own policies and procedures in regards to bidding, awarding contracts, doing inspections and completing MHMs.

6620 List of Minor Home Modifications

Revision 19-1; Effective June 3, 2019

The following minor home modifications (MHM) include the installation, maintenance and repair of approved items not covered by warranty:

  • Purchase of wheelchair ramps;
    • protective awnings over ramps;
  • Modifications or additions for accessible bathroom facilities;
    • wheelchair accessible showers;
    • sink modifications;
    • bathtub modifications;
    • toilet modifications;
    • water faucet controls;
    • floor urinal and bidet adaptations;
    • plumbing modifications and additions to existing structures necessary for accessibility adaptations;
    • turnaround space modifications;
  • Modifications or additions for accessible kitchen facilities;
    • sink modifications;
    • sink cut-outs;
    • turnaround space modifications;
    • water faucet controls;
    • plumbing modifications or additions to existing structures necessary for accessibility adaptations;
    • worktable or work surface adjustments or additions;
    • cabinet adjustments or additions;
  • Specialized accessibility or safety adaptations or additions, including repair and maintenance;
    • door widening;
    • electrical wiring;
    • grab bars and handrails;
    • automatic door openers, doorbells, door scopes, and adaptive wall switches;
    • fire safety adaptations and alarms;
    • medically necessary air filtering devices;
    • light alarms, doorbells for the hearing and visually impaired;
    • floor leveling, only when the installation of a ramp is not possible;
    • vinyl flooring or industrial grade carpet necessary to ensure the safety of the member, prevent falling, improve mobility, and adapt a living space occupied by an individual who is unable to safely use existing floor surface;
    • medically necessary steam cleaning of walls, carpet, support equipment and upholstery;
    • widening or enlargement of garage and/or carport to accommodate primary transportation vehicle and to allow persons using wheelchairs to enter and exit their vehicles safely;
    • 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;
    • porch or patio leveling, only when the installation of a ramp is not possible;
    • safety glass, safety alarms, security door locks, fire safety approved window locks, and security window screens; for example, for persons with severe behavioral problems;
    • security fencing for residence, for those persons with cognitive impairment or persons whose safety would be compromised if they wandered;
    • protective padding and corner guards for walls for members with impaired vision and mobility;
    • recessed lighting with mesh covering and metal dome light covers to compensate for violent aggressive behavior; for example, for persons with autism or mental illness;
    • noise abatement renovations to provide increased sound proofing; for example, for persons with autism or mental illness;
    • door replacement for accessibility only;
    • motion sensory lighting;
    • intercom systems for individuals with impaired mobility; and
    • lever door handles.

Ramps may be installed for improved mobility for use with scooters, walkers, canes, etc., or for members with impaired ambulation, as well as for wheelchair mobility. In some instances and according to supporting documentation, multiple modifications may be needed for accessibility and mobility, such as ramps and hand rails for members with impaired ambulation. There is no limit to the number of wheelchair ramps that can be authorized, provided the total cost does not exceed the cost limit, but documentation must support the justification for additional ramps as related to medical need or health and safety of the member.

Carbon monoxide detectors cannot be purchased under STAR+PLUS Home and Community Based Services (HCBS) program as a "fire safety adaptation and alarm."

Requests for items (or repair of items) or service calls that are considered routine home maintenance and upkeep cannot be approved.

Items that cannot be approved by the service coordinator include:

  • carpeting (other than industrial grade);
  • newly constructed carports, porches, patios, garages, porticos or decks;
  • electric fences;
  • landscaping and yard work or supplies;
  • roof repair or replacement;
  • gutters;
  • leaky faucet repair;
  • elevators;
  • house painting;
  • electrical upgrades and/or electrical outlets, unless needed to power adapted equipment or a safety hazard exists;
  • air duct cleaning and maintenance; and
  • pest exterminations.

Heating and cooling equipment may be approved as an adaptive aid. Installation of approved heating and cooling equipment is included in the cost of the adaptive aid. Support platforms are frequently used to provide support for cooling equipment installed in home windows. The support platforms attach in a clamp-like manner without fasteners. The cost and installation of support platforms are considered as an adaptive aid. The installation of heating and cooling equipment may require modification of the home (for example, additional wiring or widening of the windows). The modification of the home must be authorized as an MHM.

Flooring applications, including vinyl and industrial carpet, may not be authorized for adaptations or improvements to the home that are of general utility and are not of direct medical or remedial benefit to the member.

6630 Minor Home Modification Service Cost Lifetime Limit

Revision 20-2; Effective October 1, 2020

There is a lifetime limit of $7,500 per member for this service and $300 yearly for repairs. Once the $7,500 cost limit is reached, only $300 per year per member, excluding associated fees, will be allowed for repairs, replacement or additional modifications. The managed care organization (MCO) is responsible for obtaining cost-effective modifications authorized on the member's individual service plan (ISP) that is more fully described in 6117, Service Planning, and Title 1 Texas Administration Code (TAC) §353.1153(c)(1). If a member’s ISP includes an identified need for minor home modifications (MHMs) that exceed the lifetime benefit limit, the MCO is permitted to exceed the cost limit without prior approval from Texas Health and Human Services Commission (HHSC). The MCO must not include any costs over the lifetime limit on any cost reports, claims, encounters or financial statistical reports.

If a member changes MCOs, the losing MCO must provide documentation to the gaining MCO related to any MHM expenditures. See 3413, Transferring from One MCO to Another Within Same Service Area.

6640 Landlord Approval for Minor Home Modifications

Revision 16-1; Effective March 1, 2016

When the member has a landlord or when the owner of the home is not the member, written approval prior to the initiation of any requested modification must be obtained.

6650 Time Frames for Minor Home Modifications

Revision 21-1; Effective May 1, 2021

When a minor home modification (MHM) is included in an individual service plan (ISP), the managed care organization (MCO) must ensure completion of the MHM within 90 business days after:

  • the start date of the ISP; or
  • the date of the ISP revision, if the service is added to the ISP after the ISP start date.  

The MCO must document and notify the member of any delay in completing the MHM, the reason for the delay and the new proposed completion date. If the provider does not complete the MHM by the new completion date, the MCO must document and notify the member about the additional delay. Throughout the process, the MCO must continue to meet the member’s health and safety needs. The MCO must work with the provider and member to ensure timely completion of the MHM.