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What is an Environmental Modification?

An Environmental Modification is a service available to waiver participants through certain Medicaid waivers. Environmental Modifications are physical adaptations to the home, which are necessary to ensure the health, welfare and safety of the participant or which enable the participant to function with greater independence in the home.

Examples of Environmental Modifications include: installation of ramps or grab-bars, widening of doorways, modification of bathroom and floor covering to facilitate wheelchair access. Environmental modifications may also include consultation and assessments to determine the specific needs, and follow-up inspections upon completion of the project.

What are the requirements for Environmental Modifications?

The home to be modified must be a privately owned home in which the waiver participant lives. Rental homes may be modified with the landlord’s permission if the landlord is willing to make the needed modification.

All Environmental Modifications must be provided in accordance with applicable state and local building codes.

South Carolina State Procurement Law must be followed when obtaining an environmental modification. This means that if the cost of the modification is greater than $10,00, written quotes for the modification must be received from at least three licensed contractors. A contractor must be directly enrolled with Medicaid as a provider to be eligible to complete a modification. The qualified, licensed, Medicaid enrolled contractor who submits the lowest bid will be awarded the modification.

If you have additional questions regarding the procurement process, your case manager can assist you, or you can refer to the appropriate waiver manual chapter.

What are the limits?

Environmental modifications do not include adaptations or improvements to the home which are of general utility and are not of direct medical or remedial benefit to the individual.

Examples of non-covered items: general home maintenance, repairs, carpeting, central air conditioning, awning additions, pools, decks, stairs, elevators, breezeways, carports, hot tubs/whirlpools and washer/dryer connections. Funding limits for Environmental Modifications vary according to the specific waiver. Your case manager will provide information to you regarding the limits of the waiver in which you are enrolled.

How do I start?

There are two options for completing Environmental Modification Assessments from which the participant/legal guardian may choose:

  1. The participant/family may choose to arrange their own waiver funded Environmental Modification Assessment and work with their Case Manager to procure the modification. See PDF 5. CM/Participant Directed Modification for more information.
  2. The participant/family may choose to have the SCDDSN Professional Design Team (PDT) complete the modification specifications. See PDF 6. Professional Design Team Option for more information.

Your case manager will provide you with a copy of the Environmental Modifications Chapter from the appropriate waiver manual. You will be able to refer to this and ask questions of your case manager before deciding which option to choose.

CM/Participant Directed Modification

The participant/family may choose to arrange their own waiver funded Environmental Modification Assessment and work with their Case Manager to procure the modification. Using this option, the participant/family can select an approved provider, such as a rehabilitation engineer, to complete an assessment which will outline the specifications of the necessary modification.

The cost of assessing the needed modifications will be deducted from the service limit imposed by the waiver. The case manager will request bids from contractors of the waiver participant’s choosing and the modification will be awarded to the lowest bidder. The contractor must be directly enrolled with Medicaid to be eligible to provide the service.

If this option is selected, the participant/legal guardian will be required to sign a Release of Liability form and the Case Manager will monitor the installation of the modification to ensure it is completed according to the specifications outlined in the assessment.

The advantage of using this option is that there is no processing list for this option, which means the case manager can assist with obtaining specifications prepared by a qualified assessor right away.

Professional Design Team Option

The participant/family may choose to have the SCDDSN Professional Design Team (PDT) complete the modification specifications. Using this option, the cost for the PDT is covered by DDSN and does not count as part of any service limit imposed by the waiver. The PDT will write the specifications for the modification and develop the plans, and a Project Manager will follow the construction process to ensure work is completed according to the specifications. If this option is selected, the PDT will also complete the procurement process and monitor the modification. Based on the current referral list for this option, the wait time from identification of the need to completion of the modification is approximately one year. Due to demand, utilization of the PDT requires the waiver participant/guardian and Case Manager to be responsive to firm deadlines in the process.

If you have decided to use the DDSN Professional Design Team, your case manager will complete a pre-assessment form, explaining the type of environmental modification required to meet your need. This will be forwarded to DDSN Central Office, where the PDT maintains a referral list.

If a bathroom modification is requested, information about the type of shower chair currently used, or recommended by a Physical Therapist or Assistive Technology Professional should be included. If you do not have this information, your case manager can help you obtain an assessment for the type of shower chair needed.

Requests for environmental modifications are assigned to the PDT in the order in which they are received.

Members of the PDT will need to make a visit to your home to view the area to be modified and take measurements that will allow them to write specifications for your modification. At the point your name is next on the referral list, a member of the PDT will contact your case manager to schedule this home visit. Your Case Manager will also be requested to be present for the visit.

The PDT will make the home visit and develop plans. Your case manager will be provided a copy of the plans to review with you. Any questions you may have can be forwarded to the PDT for a response.

Once you have approved the plans, the PDT will be notified and will begin soliciting bids for the modification. This will include written requests for quotes, and possibly advertisement of the modification per state procurement policy. Please inform your case manager if you have a specific contractor (or contractors) that you would like to bid on the modification, and the PDT will request a bid from your chosen contractor.

Once the bids are received, you will be notified of the lowest responsive and responsible bid and your case manager will request funding through the waiver for the modification.

If the cost of your modification exceeds the funding available through your waiver, the modification cannot proceed unless you have funding available to cover the difference and any other unanticipated costs that might arise during construction.

When waiver funding has been approved, a Pre-Construction Meeting will be scheduled. This meeting will include you, the contractor who will be completing the modification, and a member of the PDT. In this meeting, expectations related to the modification will be discussed, including the length of time the modification is expected to take. You will also be offered choice of materials such as flooring and paint colors. Only in stock options will be offered, as special order materials will delay construction.

The PDT will monitor the progress of the work while in process. Upon completion, a member of the PDT will inspect the work to ensure it is completed according to the specifications.

Your case manager will monitor your satisfaction with the work. If there are any questions or concerns about the work, you should notify your case manager. The PDT will work to resolve concerns or issues you may have.