Rule 5160-46-09 | Ohio home care waiver: vehicle modification service.
This rule sets forth the definition of the vehicle modification service as well as the provider requirements and specifications for the delivery of the service. Providers are also subject to the conditions of participation set forth in rule 5160-44-31 of the Administrative Code. Services are reimbursed in accordance with rule 5160-46-06 of the Administrative Code.
(A) "Vehicle modifications" are adaptations or alterations to an automobile that is identified as the individual's primary means of transportation, that are needed in order to accommodate the needs of the individual. Vehicle modifications are authorized when necessary to enable the individual to function with greater independence, integrate more fully into the community, and to ensure the health, welfare, and safety of the individual.
(B) Vehicle modifications include but are not limited to:
(1) External handling devices and carriers.
(2) Operating aids, such as assistive equipment and technologies.
(3) Raised or lowered floors or roofs.
(4) Raised doors.
(5) Scooter/wheelchair hoists, hitches, and tie downs.
(6) Lifts.
(7) Maintenance, repair, or replacement of a previous vehicle modification funded by the individual's waiver that does not meet reimbursement criteria through another source.
(8) Transfers of adaptable equipment from one vehicle to another for use by the same individual in accordance with this rule.
(9) Factory-installed adaptations when documented on a separate, itemized invoice associated with the purchase of a new vehicle that is not pre-owned or pre-leased. Such modifications are payable upon proof of transfer of vehicle ownership from the dealer into the name of the allowable owner of the vehicle as described in this rule.
(C) Vehicle modifications do not include:
(1) Modifications that are available through another funding source.
(2) Routine auto care and maintenance of general utility unrelated to the vehicle's modification.
(3) Replacement or repair of previously approved vehicle modifications damaged because of apparent misuse, abuse, or negligence.
(4) Payment for purchase of a vehicle except as set forth in paragraph (B)(9) of this rule.
(5) Permanent modifications to leased vehicles.
(6) Vehicle insurance costs.
(7) Services performed which exceed what is specified on the individual's person-centered services plan.
(8) Removal of a modification except set forth in paragraph (B)(8) of this rule.
(9) Repairs needed to a vehicle before a modification can be installed.
(D) Limitations:
(1) Service authorization is limited to ten thousand dollars per calendar year per individual.
(2) Vehicle modifications will only be made to a vehicle owned by one of the following:
(a) The individual,
(b) A relative of the individual who provides primary long-term support, whether paid or non-paid, or
(c) A non-relative who provides primary long-term support to the individual and is not a paid provider.
(3) Vehicle modifications are not allowed for vehicles owned by business entities or provider agencies.
(E) Service authorization process
(1) Prior to the service being authorized, the individual, and if applicable any person(s) who will operate the vehicle will provide the Ohio department of medicaid (ODM) or its designee with the following documentation:
(a) The valid driver's license for the person(s) who will be operating the vehicle, with appropriate endorsements;
(b) Proof of ownership and current title or registration of the vehicle to be modified;
(c) Written consent from the vehicle owner to modify the vehicle, including acknowledgment that the vehicle owner understands that ODM is not responsible for returning the vehicle to its prior condition;
(d) Written attestation from the individual or the individual's parent or guardian, as applicable, that identifies the vehicle to be modified as the individual's primary means of transportation; and
(e) Proof of active collision and liability insurance for the vehicle being modified.
(2) ODM or its designee may require the completion of an evaluation by an occupational therapist (OT) or physical therapist (PT). The evaluation will determine the appropriate vehicle modification and the individual's capacity to utilize the vehicle modification.
(3) In consultation with the individual and any person(s) who will be operating the vehicle, ODM or its designee, or the OT or PT will develop a vehicle modification referral that is intended to address the individuals needs.
(4) All submitted proposals will be reviewed by the individual, the individual's parent or guardian, as applicable, the owner of the vehicle if other than the individual, and ODM or its designee.
(5) The service will be awarded to the provider who proposes the lowest cost alternative that meets the individual's assessed need.
(F) Vehicle modification provider:
(1) Vehicle modification providers will submit a fixed cost proposal to ODM or its designee.
(a) The proposal is developed to meet the individual's needs as identified in the evaluation and includes the following:
(i) A description of the work to be performed;
(ii) A drawing or diagram of the modification(s);
(iii) Itemized materials and associated costs;
(iv) Year, make, and model of the vehicle being modified;
(v) Documentation from an automotive service excellence-certified professional stating the vehicle is in good operating condition including that it is structurally sound;
(vi) Estimated time needed to complete the modification;
(vii) A written statement of warranties provided, including a warranty lasting at least one year from date of final acceptance of work against defective workmanship; and
(viii) A written guarantee that all materials furnished and modifications installed perform their intended function.
(b) A fixed proposal may be adjusted with good cause only if the job specifications are modified in writing, and the adjustment is approved by ODM or its designee.
(2) Upon completion of a vehicle modification, but before submitting a claim, the vehicle modification provider will:
(a) Perform all necessary inspections and submit documentation to verify the repair, modification, or installation was completed in accordance with applicable federal, state, and local laws;
(b) Document that the vehicle modification was tested, is in proper working order, and is safe to be operated by the individual or his or her caregiver;
(c) Attest that the individual and if applicable, any other person(s) who will operate the vehicle modification, was instructed on the usage of the modification;
(d) Attest the vehicle modification was completed in accordance with the agreed upon specifications using all the materials and equipment described in the proposal; and
(e) Obtain final written confirmation from the individual, the individual's parent or guardian as applicable, and the owner of the vehicle if other than the individual, that the vehicle modification has been completed to their satisfaction.
(3) Request for reimbursements include:
(a) Itemized cost of material and labor as identified in the approved proposal and
(b) Any approved adjustments made per paragraph (F)(2)(b) of this rule.
(G) The authorization of vehicle modifications may be combined with other waiver services to meet the assessed needs of the individual. In such instances, individual waiver service limits as described in paragraph (D)(1) of this rule still apply.
Last updated September 22, 2025 at 7:45 AM
Supplemental Information