Adaptive Equipment, Assistive Technology, Home and Vehicle Modification Request Process

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.20.001 FINAL

Purpose:

This Information Bulletin is a guide to acquiring Adaptive Equipment, Assistive Technology, and Home and Vehicle Modifications. For more information please contact:

Primary contact: Joyce McGrady at 217.782.3248 or Joyce.McGrady@Illinois.Gov 

HBS funded people, secondary contact: Jim Eddings at 217.557.6335 or Jim.Eddings@Illinois.Gov  

CILA Home Modifications, secondary contact: George Bengel at 217.782.3398 or George.Bengel@Illinois.gov.

Overarching Requirements:

The rule of thumb as to whether or not an Adaptive Equipment, Assistive Technology, and Home and Vehicle Modification request may be eligible for funding through the Division of Developmental Disabilities (DDD) Home and Community Based Services Waiver (HCBSW) is:

  • The modification or equipment must be for the direct benefit of the person and essential to address needs related to the person's developmental disability.
  • The needed modification or equipment is to be clearly documented in the individual's Personal Plan.
  • The modification or equipment will increase independence and/or decrease reliance on supports and services.
  • The modification or equipment is not something that would be considered a "general utility item." (Excluded General Utility Items - See Section III. of the Waiver Manual.)

NOTE: There are also other restrictions and items which are not covered in this summary. Please refer to the HCBS Waiver Manual or CILA User Guide, Cost Center Definitions and Allowance Levels. Links for both are at the end of this document.

Types of Requests:

Individuals may request an array of items and/or modifications through the HCBS waiver. The waiver cannot fund items that can be attained through Medicaid/State Plan such as a wheelchair, shower chair, communication devices, adaptive eating utensils, etc. A list of items available under State Plan can be found here: https://www.illinois.gov/hfs/MedicalProviders/MedicaidReimbursement/Pages/DME.aspx

Some examples that could qualify for possible funding under the waiver, include:


  • Adaptive Equipment & Assistive Technology
    • Weighted blankets or vest
    • Noise cancelling headphones
    • Sensory swing, sensory items, wrist weights
    • Mats, wedges or positioning items
    • Technology to facilitate a person's ability to control the environment they live in such as remote switches.
    • Cost for evaluation, consultation, installation, set-up and/or training to use adaptive equipment and/or assistive technology are allowable when specified as part of the funding request.

  • Vehicle Modifications
    • Vehicle modifications so that a person can access a vehicle with their wheelchair or other mobility device.
    • Wheelchair tie-downs and other safety modifications to secure a person in a wheelchair when in transit.

  • Home Accessibility Modifications
    • Modifications to a bathroom, kitchen, bedroom, etc. to allow an individual more independence
    • Hoyer type lift
    • Ramps or exterior lifts

Maximums:

CILA site modification reimbursement is limited to the maximums specified in the Waiver Manual or CILA User Guide, and are as follows:

  • $5,000: Rented locations with a lease of less than 5 years
  • $7,500.00: New construction
  • $15,000.00: Existing structures which are owned by the person, CILA agency or have a long-term lease of 5 years or greater with a renewal at the end of the lease. NOTE: This means the maximum reimbursement for a CILA site is $15,000.00 not $15,000.00 per person served.


Adult Home-Based Service and/or Community Day Services recipients are limited to $15,000 maximum per participant per five-year period for any combination of Adaptive Equipment/Assistive Technology, Home and Vehicle Modifications. Within the five-year maximum, there is also a $5,000 maximum per address for permanent home modifications for rented homes. See Appendix C-4 of the Adult Waiver and Children's Support Waiver.


Children's Residential Waiver (Children's Group Home - 17D) are limited to a $15,000 maximum per participant per five-year period for any combination of adaptive equipment and assistive technology.


RECOMMENDATION: If the modification request reaches or exceeds the maximum allowance, the CILA provider should focus their modification request for the project(s) or modification(s) with the greatest cost rather than more modifications with less cost in order to maximize funding.


Process:

  1. The ISC Agency staff is responsible for submitting the Adaptive Equipment / Assistive Technology / Home and Vehicle Modification Request Cover Sheet (IL462-1301) to the Division of Developmental Disabilities [on the DDD website under forms]. See Link: https://www.dhs.state.il.us/page.aspx?item=61244. The ISC staff will work with the provider, SDA or individual to complete the paperwork as appropriate.
  2. Submit a cover letter explaining the modifications needed/required. In addition, the cover letter should address the following if appropriate:
    1. Home Modifications: If the building is provider owned or rented or if owned or rented by the individual; and if the modification(s) will be new construction or modification to an existing structure.
    2. Sprinklers: If an Office of State Fire Marshal (OSFM) Letter requiring a sprinkler is available, it should be attached. If not, the cover letter should state the people to be served at the CILA site that will not meet the prompt evacuation requirements which necessitates the need for a sprinkler. Note: We strongly encourage having OSFM inspect sites prior to submitting a request for a sprinkler. It is possible a more cost-effective option can be identified by OSFM.
    3. Windows: An Office of State Fire Marshal (OSFM) Letter is required for payment of replacement windows to meet secondary emergency exit requirement specific to the site should be attached.
    4. Accessibility Modifications: An individual must be identified with needs (i.e., non-ambulatory, gait issues, etc.) that require the modification. Documentation could include a detailed statement from a physician, or a Physical or Occupational Therapist report explaining the person's need for accessibility modifications or the ICAP (for those needing to establish non-ambulatory status for instance). Documentation must clearly show the need for the modification.
  3. Secure and attach a minimum of two (2) bids/estimates for the items to be purchased or for the work to be done from different contractors/vendors.
    1. A bid can be submitted from any supplier, vendor, or contractor of the CILA agency or HBS client's choosing. A bid or estimate can be accepted from any supplier, vendor, or contractor.
    2. Bids/estimates MUST be detailed enough to identify the various parts of a request when multiple home modifications are included in one request. For example, if a single contractor is to install fire doors and install a ramp at the CILA site, it can be one bid/estimate, BUT the fire doors need a sub-total cost specified and the ramp also has to have a sub-total cost specified within the one bid.
    3. The contractor(s) and/or vendor(s) who will be doing the work MUST either be, or become, an enrolled Medicaid vendor through IMPACT with the DD Division.
  4. Attach proof of site ownership or long-term lease by either the CILA provider, the CILA resident (Individually Controlled Site), or the HBS client or the HBS client's family:
    1. Proof of ownership has to show street address on the document. If multiple documents are needed to establish ownership, then the documents MUST show a common identifier on all documentation such as the complete street address, a Tax ID Number or Property Identification Number (PIN).
    2. CILA Agencies that have a related corporation that owns the property need to submit sufficient documentation to establish the relationship between the CILA provider and the property owner.
    3. Note: Long-Term Rental or Lease Agreements with a MINIMUM 5-year rental/lease period and include a renewal at the end of the agreement will be treated as agency/individual owned property.
    4. All home modifications where the location is covered by a Rental Agreement must contain prior approval from the landlord that:
      1. modifications to the property can be made; and
      2. assure no increase in rental cost because of the modification, and
      3. agree the property will NOT be returned to its previous condition after the modification is complete.
  5. Once received, DDD staff will review. DDD staff will follow up with questions, as appropriate or needed, to the ISC.
  6. When a request is approved, the Division will award the least expensive estimate or bid provided in the request.
  7. If approved, DDD will also issue an award letter to the:
    1. CILA Agency, or
    2. Community Day Service Provider; or
    3. Self-Directed Advocate (if applicable for HBS); or
    4. HBS individual.
    5. The ISC Agency is copied on all awards.
  8. After the work is complete, or the equipment is delivered, the actual supplier or contractor can submit billing though a paper billing or the CILA or Self-Directed Advocate can bill through the ROCS system.
    1. Billing for reimbursement of a home or vehicle modification, adaptive equipment, or assistive technology can ONLY be done AFTER the completion of the project or the items are delivered. See vendor event billing form can be located at the following link: https://www.dhs.state.il.us/page.aspx?item=63201 
    2. When billing through ROCS the vendor is always the supplier or contractor's FEIN. The payment can be directed to a different payee if the agency entering the ROCS billing enters the FEIN of the payment recipient in the "Alternate Payee" filed in ROCS.
  9. If the CILA provider, Self-Directed Advocate, family or individual is billing through the ROCS system for the vendor or contractor, then the vendor/contractor has to complete and sign the Payee Designation/Authorization Form (IL462-1180). This form MUST be retained by the CILA provider, Self-Directed Advocate or family in their records.
    1. NOTE: There are two sections to the form - one if a CILA provider or Self-Directed Advocate is to bill for another provider and the second is if the payment is to be redirected to any payee other than the provider. See Payee Designation Link: https://www.dhs.state.il.us/page.aspx?item=63107


Special Notes:

  • All requests require prior approval. This means the request must be submitted, and on file, in the Bureau of Reimbursement and Program Support (BRPS) before the project is started. (DDD will not approve any request which has already had work initiated or completed prior to submission and approval of service.) Prior Approval Criteria can be located on the DHS Website at:  https://www.dhs.state.il.us/page.aspx?item=53193
  • The CILA provider or HBS client/family is strongly encouraged to ask for and check a contractor's or vendor's references before entering into any agreement or contract. The modification is an agreement between the Provider and the Client. The Provider and the Client enter into an agreement to enable the modification to proceed ; DHS/DDD is not a party to this agreement. As a result, any dispute that arises under the agreement between the Client and the Provider, including concerns over the quality of the work performed by the Provider, shall be resolved solely between the Provider and the Client.
  • The DD Division is ONLY a possible source of reimbursement and has no liability for the workmanship by the contractor(s) and vendor(s). The CILA provider or HBS client/family is strongly encouraged to ask for and obtain a copy of the contractor's:
    • License(s) to perform work such as contractor, roofing, plumbing, electric, etc.; and
    • Certificate of Liability Insurance; and
    • Proof of Worker's Compensation Insurance before entering into any agreement or contract
    • The CILA provider or HBS client/family is responsible for ensuring any home modifications meet all federal, state and local l building and zoning codes, and necessary permits or approvals as required by local applicable authorities, have been secured.
  • It is the CILA provider's or HBS client/family responsibility to assure ALL vendor(s)/contractor(s) are enrolled as Medicaid Vendors through the IMPACT system with the DD Division.
  • It is strongly recommended the CILA provider or HBS client/family assures the vendor/contractor is enrolled or has submitted the paperwork to become an enrolled vendor PRIOR to signing an agreement, contract or accepting a bid. Medicaid now requires the vendor, supplier, or contractor be an enrolled Medicaid Vendor BEFORE the item is purchased or work is undertaken. The DDD is PROHIBITED to enroll a vendor, supplier or contractor retroactively in Medicaid.
  • If after-the-fact the vendor/contractor declines to become enrolled after the work is completed or the item(s) are delivered there is NO reimbursement even though an award letter may have been issued.  If the CILA provider or HBS client/family has any doubt or question whether the vendor/contractor is enrolled they can contact Janene VanBebber at 217.782.3719 or Janene.VanBebber@Illinois.Gov  
  • See Provider Enrollment Link:  https://www.dhs.state.il.us/page.aspx?item=47336


Rules & Regulations:

The DDD's Home and Community Based Services Waivers for Individuals with Developmental Disabilities has the most information about these requests.

See Link: https://www.dhs.state.il.us/page.aspx?item=45227


Pertinent Sections within the Waiver Manual for Home Modifications include:

Section III. E.  Section VII. A.  Section VII, Table 6

Section VII. 5. Section X, Table 7.


The CILA User Guide, Cost Center Definitions and Allowance Levels, Revised January 2002, Appendix #17 See Link: https://www.dhs.state.il.us/page.aspx?item=16043.


For questions on any of these issues, please contact the DDD Region Staff in your geographic area. You may access the list of Region Staff at: https://www.dhs.state.il.us/page.aspx?item=48541.


The information contained herein should not be considered a substitute for the appropriate official statutes, rules, regulations, or the advice of legal counsel.

Effective Date:

Upon Final Posting