Section 69-10.9 - Prior Approval Requests for Vehicle Modifications

69-10.9 Prior Approval Requests for Vehicle Modifications.

(a) A vehicle modification request may only be made for a vehicle owned by the enrollee or a member of the enrollee's household who has consistent and ongoing contact with the enrollee and provides unpaid primary, long-term support to the enrollee. Proof of ownership of the vehicle by the enrollee or the enrollee's legal representative must be provided to the Fund Administrator. A modification will be approved only if the vehicle is the primary source of transportation for the participant and is used to access services and supports in the community and to improve the enrollee's independence and inclusion in the community.

(b) The vehicle modification request must be accompanied by a Vehicle Modifications and Equipment Evaluation, based on the enrollee's needs, that has been obtained from a Driver Rehabilitation Specialist who has been certified by the Association of Driver Rehabilitation Specialists. The evaluation must specify the most cost effective and least complicated vehicle modification that will ensure safe transportation, and exit from and entrance into the vehicle for the participant, and include a detailed scope of work and specifications.

(c) Modifications can only be made to vehicles that are registered, insured and meet state inspection standards before and after the modifications are completed.

(d) Modifications may be made either to a vehicle that is being purchased by the enrollee or a member of the enrollee's household or to a vehicle that is structurally sound, not in need of mechanical repair as determined by the vehicle modifier, and is less than five years old or registers less than 50,000 miles.

(e) Modifications to a vehicle that the enrollee will not be driving are limited to modifications that are necessary to ensure safe transportation and safe access into and out of the vehicle.

(f) Only contractors that meet Acces-VR's qualifications or, if the enrollee lives in the District of Columbia or a state other than New York, the qualifications required by the district or other state for performing vehicle modifications may submit bids for modifications.

(g) Once the initial request has been reviewed by the Fund Administrator, the Fund Administrator shall notify the enrollee or person authorized to act on the enrollee's behalf in writing which services or items have been approved and/or denied and inform the enrollee or person authorized to act on the enrollee’s behalf of the bidding process that is required prior to the Fund Administrator approving payment for the vehicle modification. The enrollee or person authorized to act on the enrollee’s behalf is then required to obtain a minimum of three acceptable bids from qualified contractors.

(h) Once the Fund Administrator receives from the enrollee or person authorized to act on the enrollee's behalf a minimum of three acceptable bids from qualified contractors, the Fund Administrator shall evaluate the qualifications of each bidder and the content of each bid to determine whether each bid is acceptable. If less than three are submitted, a written explanation of why three accepted bids were not obtained must be provided, as well as a written explanation of how the determination was made that the one or two bids being considered are reasonably priced. In order to be acceptable, a bid must:

(1) be signed by the contractor or a person duly authorized to sign on behalf of the contractor;

(2) specify the scope of work and specifications of the work; and

(3) state that all work will be done in a workmanlike manner, using materials suitable for purposes of the modification.

(i) If the two lowest bids are within ten percent of each other, the enrollee or his or her legally authorized representative may choose one of the two lowest bids. If there is more than a ten percent difference between the two comparable bids, the Fund Administrator shall choose the bid that represents the best overall value for the Fund and the enrollee based on factors including not only the price offered by each bidder but also the quality, durability, extent of any warranties provided, and the safety of the product itself. The successful bidder will be notified after the Fund Administrator or a designee of the Fund Administrator (1) discusses the bids received with the enrollee or the person authorized to act on the enrollee's behalf and the reasons why a particular bid is chosen by the Fund Administrator, and (2) obtains the written consent of the enrollee or the person authorized to act on the enrollee's behalf to have the installation done by that bidder. If the enrollee or person authorized to act on the enrollee's behalf disagrees with the Fund Administrator's decision, the enrollee or person authorized to act on the enrollee's behalf can request a review of the decision. The Fund Administrator will authorize payment to the successful bidder of no more than one-third of the accepted bid amount unless there are extenuating circumstances about which the Fund Administrator receives advance notice such as a project that can be completed in one day or involves the purchase of a product prior to installation.

(j) Any change from the specifications in terms of alternative or substitute equipment or the scope of work involved in the modification that will result in a cost increase from the bid price will require approval from the Fund Administrator.

(k) No additional payment will be authorized until the Fund Administrator has received a post-modification evaluation stating that the vehicle meets or exceeds Acces-VR Vehicle Modification Standards and that the modifications meet the enrollee's functional needs.

(l) Payment for vehicle modifications shall include, in addition to the cost of the vehicle modification itself, the cost of the Vehicle Modifications and Equipment Evaluation, the evaluation of required bids if the Fund Administrator finds it necessary to engage an outside expert, the post-modification evaluation, and reimbursement for travel in those instances in which the enrollee and his or her informal supports must travel outside of the geographic area in which the enrollee's community commonly obtains its medical care and services for fittings and vehicle tests.

Effective Date: 
Wednesday, June 18, 2014
Doc Status: 
Complete