Environmental Modification

ENVIRONMENTAL MODIFICATION

A PRESCRIPTION IS NOT REQUIRED

Environmental modifications are physical adaptations to the individual’s primary home or primary vehicle that are necessary to ensure the health and welfare of the individual, or that enable the individual to function with greater independence. Such adaptations may include, but shall not necessarily be limited to, 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 that are necessary for
the individual. Modifications may be made to a primary automotive vehicle in which the individual is transported if it is owned by the individual, a family member with whom the individual lives or has consistent and ongoing contact, or a non-relative who provides primary long-term support to the individual and is not a paid provider of services.

 

Applicable Waivers

  • Building Independence – which includes supports for adults (18+) who live independently in their own homes. Supports are complemented by non-waiver funded rent subsidies and/or other types of support. Children on the DS Waiver will transition to the Family and Individual Supports
  • Family and Individual – which includes supports for children and adults living with their families, friends, or in their own homes.
  • Community Living – which includes up to 24/7 residential services and additional supports for adults and children with exceptional medical and/or behavioral support needs.  This is the only waiver that provides the sponsored residential and group home residential services options.

 

Limits
Up to $5000 annually

 

Detailed information about the program can be found at:

https://thearcofva.org/resources-services/medicaid-waivers/edcd/

https://thearcofva.org/resources-services/the-new-dd-waiver-program-idd-waiver-redesign/

https://thearcofva.org/wp-content/uploads/2017/10/00Navigating-the-DD-Waivers-Oct-2017-final.pdf

 

Process:

  • Making Strides of Virginia provides environmental modification through the DD Waiver and CCC Plus Waiver-
    • Case Manager goes into WAMS and launches a blank Service Authorization (SA)
    • Case Manager contacts Making Strides to alert them that there is a SA open
      • Phone Number (804) 203-1991
    • SA is completed by therapist and sent back to case manager with request for hours need & required documents (treatment plan).
    • Case manager reviews the SA and sends for approval
    • Approval is seen in WAMS and service can be provided

 

Insurances Accepted: (Please check back frequently as we are continuously adding insurance companies)

  • United Healthcare (UHC)
  • Anthem
  • Tricare
  • Cigna
  •  VA Community Care
        • Patient Centered Community Care (PCCC)
        • Veterans Choice Program (VCP)

 

  • CCC Plus Managed Care Program – Basic Concept of CCC Plus: CCC Plus is managed care, which means that instead of medical and other service providers contracting with Medicaid directly and billing Medicaid directly, each provider will have to go through one of six managed care organizations (MCOs) to enroll, get service authorization, and bill. These MCOs are usually for-profit insurance companies. The move toward managed care is part of a large and growing national trend to contain costs for Medicaid.
    • The 6 MCO’s administering the CCC Plus Waiver are:
      • United Healthcare
      • Anthem Health Keepers Plus
      • Optima Health
      • Magellan Complete Care of VA (Pending)
      • AETNA Better Health of VA (OUT OF NETWORK)
      • Virginia Premier (OUT OF NETWORK)

Detailed information about the program can be found at: https://thearcofnova.org/content/uploads/sites/6/2018/08/Commonwealth-Coordinated-Care-Handout-8.7.18.pdf