BSW 737 Services: Vehicle Modifications
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Policy governing coverage, requirements, and limitations for vehicle modifications to enable Montana Big Sky Waiver members' independence, including bidding and prior authorization rules for providers and members.
No material clinical or coverage changes in this revision.
Coverage Criteria for Vehicle Modifications
Medically necessary vehicle modifications
Covered when ALL of the following are met
Includes consultation and training; must be completed by a qualified provider
Not an exhaustive list
Valuation for purchased used vehicles: sales price minus Kelly Blue Book value and depreciated modification value.
This service does not cover adaptations or improvements that are of general utility and are not of direct medical or remedial benefit to the member. Routine or regularly scheduled upkeep and maintenance of a vehicle are not covered, except for upkeep and maintenance of approved modifications. The purchase or lease of a vehicle and partial purchase of a vehicle already modified are excluded from coverage.
Improvements that serve general utility rather than a specific medical/remedial need are not covered. The policy explicitly excludes the purchase or lease of a vehicle. For any proposed vehicle modification costing $5,000 or more, the member must make a reasonable effort to obtain two estimates; modifications in excess of $5,000 require prior authorization and those costing $25,000 or more require prior authorization by the Regional Program Officer. Bids must include detailed cost breakdowns and documentation of attempts to obtain multiple bids is required if fewer than two bids are available.
Medical Necessity — DME-specific Rules
DME-specific necessity for vehicle modifications
Equipment modifications are medically necessary when:
Service includes consultation and training on use of modifications.
Valuation method for purchased used vehicles: subtract Kelly Blue Book value and estimated depreciated modification value from sales price to determine covered modification cost.
Coding and Thresholds
Provider Actions and Authorization Requirements
Obtain prior authorization and follow bidding rules for modifications ≥ $5,000
Members needing vehicle modifications costing $5,000 or more must make a reasonable effort to obtain two estimates or bids and modifications in excess of $5,000 must be prior authorized by the Regional Program Officer. All supplies and labor costs for one modification must be included in a single referral and single prior authorization; a prior authorization cannot be given to the provider before the member receives the service. Provider costs for submitting an estimate or bid are not payable by the Big Sky Waiver program.
- Modifications > $5,000 require prior authorization.
- All supplies and labor for one modification must be in one referral/prior authorization.
- Prior authorization cannot be issued to provider prior to member receiving service.
- Provider bid submission costs are not reimbursed.
Provider responsibilities for bids, documentation, and single-referral rule
Providers must ensure the member attempts to obtain two estimates for projects ≥ $5,000, include those estimates with the prior authorization, and document efforts to secure multiple bids if two cannot be obtained. Providers must submit a single referral/prior authorization that includes all supplies and labor for the modification.
- Include estimates with the prior authorization.
- Document attempts to obtain multiple bids when fewer than two bids are available.
- Ensure the modification is specified in the member's service plan and performed by a qualified provider.
Include two detailed estimates with prior authorization
The prior authorization packet must include at least two estimates or bids that break down costs into materials, labor (number of hours and hourly rate), and other miscellaneous costs; if two bids cannot be obtained, include documentation of the efforts made to secure multiple bids.
- Each bid must list amount of materials.
- Each bid must state labor: number of hours and amount charged per hour.
- Each bid must list other miscellaneous costs.
- If only one bid is available, provide documentation of attempts to obtain additional bids.
Regional Program Officer prior authorization threshold at $25,000
Vehicle modifications costing $25,000 or more must be prior authorized by the Regional Program Officer; situations with only one bid also require Regional Program Officer review and approval.
- Regional Program Officer prior authorization required for modifications ≥ $25,000.
- One-bid situations require Regional Program Officer review/approval.
Documentation Requirements
Submit two detailed estimates and document bid efforts for modifications ≥ $5,000
Provide at least two detailed estimates for any modification costing $5,000 or more and include them with the prior authorization; bids must itemize materials, labor (hours and rate), and miscellaneous costs, and document efforts to obtain multiple bids if two cannot be obtained.
- Two estimates required for modifications ≥ $5,000; include with prior authorization.
- Bids/estimates must include: detailed list of materials; labor hours and hourly rate; miscellaneous costs.
- If two bids cannot be obtained, include documentation of efforts to obtain bids.
Rental and Purchase Rules for Vehicle Modifications
| Item | Rule |
|---|---|
| Purchase option | |
| Modifications may be purchased for new or used vehicles; when a member purchases a used vehicle with modifications already installed, the cost of the modifications is calculated as: sales price minus the Kelly Blue Book value of the vehicle minus the estimated depreciated value of the vehicle modifications; the remainder equals the cost of the modifications covered. | |
| Allowed modification types | |
| Includes, but is not limited to: vehicle lifts, ramps, lowered floors, other wheelchair access modifications, driver-specific adaptations, and remote-start systems; also includes consultation and training on use. | |
| Used vehicle and used equipment conditions | |
| Used vehicle must be structurally sound, in working order without need of major mechanical repairs, and free of rust or deficiencies in areas to be modified; used modification devices are allowable only if purchased from licensed businesses dealing in sale of vehicle equipment. | |
| Exclusions to purchase coverage | |
| Purchase or lease of a vehicle, partial purchase of a vehicle already modified, adaptations or improvements of general utility not of direct medical benefit, and regularly scheduled vehicle upkeep and maintenance (except upkeep and maintenance of modifications) are not covered. | |
| Payment to legally responsible individuals | |
| Payment may be made to legally responsible individuals if program criteria are met (refer to BSW 604-1). |
Definitions
Not Covered
Not covered under this service: the purchase or lease of a vehicle and partial vehicle purchase for an already-modified vehicle. Also excluded are improvements of general utility that do not directly provide medical or remedial benefit, and regular vehicle upkeep and maintenance (except maintenance of approved modifications).
Background
Vehicle modifications are adaptations made to a member’s personal vehicle to increase independence and support community integration. Examples include vehicle lifts, ramps, lowered floors, wheelchair access modifications, driver-specific adaptations, and remote-start systems. The service also includes consultation and training on the modifications and/or their use. Modifications may be made to new or used vehicles, but used vehicles must be structurally sound, free of rust or deficiencies in modified areas, and not in need of major mechanical repairs. Used modification devices are acceptable only when purchased from licensed businesses; valuation for pre-installed used modifications is calculated using the sales price minus Kelly Blue Book value and estimated depreciated modification value.
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