NEW MEXICO DEPARTMENT OF HEALTH DEVELOPMENTAL

NEW MEXICO DEPARTMENT OF HEALTH

DEVELOPMENTAL DISABILITIES SUPPORTS DIVISION MEDICALLY

FRAGILE WAIVER (MFW)

ENVIRONMENTAL MODIFICATION SERVICES

Effective July 1, 2019

Environmental Modification includes the purchase or installation of equipment and/or making

physical adaptations to an individual’s residence that are necessary to ensure the health, welfare

and safety of the individual or enhance the individual’s independence. All services must be

provided in accordance with applicable federal, state, and local building codes.

Environmental Modification is available to a person of any age and is coordinated with

the person, guardian, Nurse Case Manager (CM), licensed contractors, and members of the IDT

as necessary to ensure quality of service and meet the standard requirements.

I. SCOPE OF SERVICES

Environmental Modification addresses targeted medical, safety or functional concerns that

incorporate the person’s specific clinical and functional strengths and needs.

1. Examples of Environmental Modification include the following modifications of the

person’s physical environment, the accompanying purchases as well as the necessary

installation services:

a. widening of doorways/hallways;

b. installation of specialized electric and plumbing systems to accommodate medical

equipment and supplies;

c. lifts/elevators;

d. modification of bathroom facilities (roll-in showers, sink, bathtub, and toilet

modifications, water faucet controls, floor urinals and bidet adaptations and

plumbing); turnaround space adaptations;

e. specialized accessibility/safety adaptations/additions;

f. trapeze and mobility tracks for home ceilings;

g. automatic door openers/doorbells;

h. voice activated, light-activated, motion-activated and electronic devices;

i. fire safety adaptations; air filtering devices; heating/cooling adaptations;

j. glass substitute for windows and doors;

k. modified switches, outlets or environmental controls for home devices;

l. and alarm and alert systems and/or signaling devices.

2. Improvements or repairs to the existing home, which do not provide direct medical,

safety, or functional benefit to the person or which should be included as part of routine

home maintenance cannot be approved. Such non-covered adaptations,

modifications or improvements include:

a. carpeting except for repairs to carpet needed due to permitted modification,

e.g., repair to carpet in a door widening;

NEW MEXICO DEPARTMENT OF HEALTH

DEVELOPMENTAL DISABILITIES SUPPORTS DIVISION MEDICALLY

FRAGILE WAIVER (MFW)

b. roof repair;

c. furnace replacement;

d. remodeling bare rooms;

e. other general household repairs;

f. vehicle modifications; and

g. outdoor fences.

3. Duplicate environmental modifications cannot be approved. For example, if the person

has a safe and usable ramp, a replacement ramp cannot be approved.

4. Environmental modifications cannot be used to fund new residential construction, even

if the new dwelling is designed to accommodate the needs of individuals with I/DD.

5. Adaptations that add to the total square footage of the home are excluded from this

benefit except when necessary to complete an adaptation (e.g., in order to improve

entrance/egress to a residence or to configure a bathroom to accommodate a wheelchair).

5. Equipment that is covered under the State of New Mexico’s Medicaid program cannot

be purchased under the MFW.

II. ENVIRONMENTAL MODIFICATION SERVICES PROVIDER AGENCY

REQUIREMENTS

A. The Environmental Agency Services Provider (EMSP) must demonstrate the following:

1. The EMSP must have documentation verifying that the provider and any

subcontractors utilized are bonded and Licensed Building Contractor(s) are authorized to

complete the project by the State of New Mexico.

2. The EMSP must obtain all necessary permits as required by local and state laws.

3. The EMSP must demonstrate knowledge and work history showing the ability:

a. to interpret the principles and practices of architecture, building codes and

standards, building materials and construction methods, structural, mechanical,

plumbing, and electrical systems;

b. to interpret and prepare architectural working drawings and specifications,

mediate contractual problems, and ensure compliance with all laws, rules and

standards of the State of New Mexico, including the federal, state, and local

building codes;

c. to understand and implement contracting practices and procedures,

construction cost estimating and knowledge of comparable costs to accomplish

the adaptations;

d. to incorporate architectural design, standards and technical data relating to

building design and construction; and

e. to interpret, implement and ensure that Federal ADA standards and applicable

guidelines are followed in all environmental adaptations when applicable to the

person’s needs.

NEW MEXICO DEPARTMENT OF HEALTH

DEVELOPMENTAL DISABILITIES SUPPORTS DIVISION MEDICALLY

FRAGILE WAIVER (MFW)

III. SERVICE REQUIREMENTS

A. Environmental Modification Services are available to all qualified participants receiving

MFW services.

1. The need for the Environmental Modification should be identified in the ISP and

supported by a therapy home evaluation.

2. The cost of the Environmental Modification plus the administrative fee cannot exceed

the maximum cost of $5,000.00 every five ISP years.

3. Environmental Modifications to the home owned by the person, owned by the

guardian, owned by the family, or leased homes must be compliant with the MFW

Waiver Standards and should meet the Americans with Disabilities Act (ADA)

applicable guidelines when ADA guidelines will also meet the person’s functional

needs.

B. The CM must obtain a signed Verification of Benefit Availability form from the MFW

Manager prior to approval of this service.

C. Pre- Service Requirements

1. Nurse Case Manager

a. Informs family that the total allowable expenditure for Environmental

Modifications Services (EMS) is a maximum of $5,000.00 that is available to

be added to the MFW budget once every five years. The $5,000 may be used

at once or in portions over the 5-year period that begins on the date of Prior

Authorization approval. If the planned modification exceeds $5,000.00, the

family will be informed that they are responsible for paying all additional

costs.

b. Assures that the ISP reflects the need for EMS to an individual’s residence

that are necessary to ensure the health, welfare and safety of the person and

enhance the individual’s level of independence.

c. Coordinates physician order for a Physical Therapy (PT) or Occupational

Therapy (OT) home evaluation visit. A physician office visit may also be

needed.

d. Coordinates the PT or OT home evaluation visit through the EPSDT benefit

for children or Medicare/Medicaid benefit for adults. The MFW therapy

benefit for adults is the payer of last resort for this evaluation. If it is

necessary to apply the MFW therapy benefit for this evaluation the CM

provides the person with a Secondary Freedom of Choice (SFOC) form to

select a MFW therapy provider.

e. Provides the person/family with a Secondary Freedom of Choice (SFOC)

form to select a MFW Environmental Modifications Services Provider

(EMSP)

NEW MEXICO DEPARTMENT OF HEALTH

DEVELOPMENTAL DISABILITIES SUPPORTS DIVISION MEDICALLY

FRAGILE WAIVER (MFW)

f. Supports ongoing communication between the family, EMSP and the therapist

as needed.

2. Therapist

a. The OT or PT completes the home visit, develops and provides

recommendations and supporting documentation as needed for the

Environmental Modifications to the family and CM, and EMSP.

3. Any authorizations for additional consultation services related to the Modification

will be obtained by the therapist as needed.

4. EMSP

a. Contacts family to set up home visit and informs the family, CM and therapist

of the date and time.

b. Completes the home visit and creates Environmental Modification plan based

on input from the person/family, CM and therapist.

c. Finalizes plans with person/family and therapist to meet the needs of the

person in accordance with the MFW Environmental Modification Standards;

federal, state and local building codes.

d. Submits proposed plan and all costs to the family and the CM within ten

business days after first visit with homeowner/person/guardian.

5. Service may be provided when CM verifies that all preservice requirements are met,

and person/family/homeowner accepts the plan and all required documents are

present.

6. The EMSP completes all proposed work in compliance with the plans and to the

satisfaction of the person/family.

7. After work is completed, the family signs and dates the original Environmental

Modification plan, from the EMSP, verifying the satisfactory completion of work.

8. The EMSP provides copies of the final signed form to the family, CM and the MFW

Manager within 5 business days of signature.

9. The EMSP retains the original forms for their files

10. Claims for services must be received within 90 calendar days of the date of service in

accordance with 8.302.2.11 NMAC.

D. EMSP SERVICE REQUIREMENTS

1. Obtains a copy of the secondary freedom of choice.

2. The EMSP must coordinate planning for the environmental modification with the

CM, the person/ guardian/ family, as applicable and the therapist who conducted the

home assessment.

3. The EMSP must coordinate with the therapist and/or qualified person who provided

the assessment to acknowledge, document and assure planned modifications will

meet the person’s clinical and functional needs:

a. Coordination should occur at an in-person on-site evaluation.

NEW MEXICO DEPARTMENT OF HEALTH

DEVELOPMENTAL DISABILITIES SUPPORTS DIVISION MEDICALLY

FRAGILE WAIVER (MFW)

b. If in-person on-site coordination cannot occur or if this is not needed because

the planned modification is very minor, coordination can occur via e-mail or

phone with MFW Manager approval.

c. Both the evaluator and the EMSP should document what was agreed upon

regarding the Environmental Modification Plan during this meeting or through

alternate communication.

4. The EMSP must develop an Environmental Modification assessment of the home and

the scope of work needed to complete the modification.

5. The EMSP must provide an itemized price quote to the CM within ten business days

after first visit with homeowner/person/guardian.

6. The EMSP must provide or secure licensed contractor(s) or vendor(s) to provide

construction and/or remodeling services.

7. The EMSP must ensure that proper design criteria are addressed in planning and

design of the adaptation.

8. The EMSP must interpret codes and clarify building procedures to the person,

guardian, homeowner or other family members, CM, and Provider Agencies and

DDSD prior to construction activities.

9. The EMSP must review plans submitted by sub-contractors, if applicable, for

environmental modifications to ensure that the plans are architecturally sound,

address functional needs outlined in the Environmental Modification Evaluation, and

comply with state and local building codes and standards.

10. The EMSP must provide administrative and technical oversight of construction

projects.

11. When requested, the EMSP must provide consultation to the person, guardian,

homeowner or family, CM, and DDSD concerning environmental modification

projects to the person’s residence prior to or during construction activities.

12. The EMSP must ensure inspection of the final environmental modifications to ensure:

a. compliance with all local, state, and federal codes and requirements

b. the adaptation (s) meet the approved plan submitted for environmental

adaptation.

13. The EMSP must meet reasonable timelines for completion of environmental

modifications.

14. The EMSP must contact person/guardian/homeowner within one business week of

being notified of the signed SFOC to schedule the initial site visit.

15. The EMSP must complete all modifications within six weeks of the approved budget.

A waiver of this time-line must be sought from DDSD if extraordinary circumstances

prevent the EMSP from meeting this requirement.

16. The EMSP must review accuracy of construction costs submitted by sub-contractors,

if applicable.

NEW MEXICO DEPARTMENT OF HEALTH

DEVELOPMENTAL DISABILITIES SUPPORTS DIVISION MEDICALLY

FRAGILE WAIVER (MFW)

17. The cost of the Environmental Modification plus the administrative fee cannot exceed

the maximum cost of $5,000.00 every five ISP years. Administrative costs of the

environmental Modification Service Provider (EMSP) will not exceed fifteen percent

(15%) of the total cost of the environmental modification project managed by the

Provider Agency.

18. The EMSP must provide a minimum of a one-year written warranty of the work

completed, including both materials and labor, to person, guardian, family,

homeowner and CM.

19. Withholding or denial of final payment may occur if the person in service or his/her

guardian files a dispute to the MF Waiver Manager regarding the quality of work and

the MFW Manager agrees with the complaint.

E. Cost of Materials:

1. Materials utilized in projects must be of Medium Grade and meet industry construction

standards while considering the personal preferences of the homeowner.

2. MF Waiver funds may not be used for upgrades in materials that do not offer

functional benefits to the person.

3. Purchase receipts for all materials must be kept in the EMSP file and must

be furnished to the CM.

F. Documentation for Environmental Modification Services will be maintained by the MF

CM. The EMS documentation will include: ISP section related to the need/goals for the

EMS, the DDSD Benefit Verification form, the therapist’s EMS Evaluation, secondary

freedom of choice form(s), EMS Plan, EMSP detailed cost report and documentation of

work completion and acceptance/satisfaction by the individual/guardian/homeowner.

G. EMS documentation will be retained by the CM program and provided by MFW Manager

upon request.

IV. USE OF FUNDS

A. Cost estimates, items and project plans are required to specifically identify the materials

to be purchased and the labor costs associated with the expenditure of MFW versus non-

MFW funds.

B. MFW funds may not be utilized to upgrade fixtures or other construction materials solely

based on aesthetic qualities or personal preferences when lower cost fixtures or materials

can provide the same or similar functional benefit to the person.

C. EMSP's may not provide any materials/services not in the original approved bid.

D. MFW funds cannot be used to repair environmental modification upgrades or other

augmentations to environmental modifications when MFW funds did not cover the

original environmental modification.

E. Any augmentation or upgrade to the MFW funded portion of the environmental

modification may void any warranties in place.

NEW MEXICO DEPARTMENT OF HEALTH

DEVELOPMENTAL DISABILITIES SUPPORTS DIVISION MEDICALLY

FRAGILE WAIVER (MFW)

F. When one or more individual(s) in Waiver services, are family members and will benefit

from an environmental modification, each impacted participant may equally divide the cost

of the environmental modification from their respective ISP budget.