Environmental Modifications Services (E-mods)


Environmental Modifications (E-mods) are internal and external physical adaptations to the home, which are necessary to ensure the health, welfare and safety of the waiver participant. These modifications enable the waiver participant to function with greater independence and prevent institutionalization.

E-mods must be provided where the waiver participant lives. If a waiver participant is moving to a new location which requires modifications, the modifications may be completed prior to the waiver participant's move. If an eligible individual is residing in an institution at the time of the application, the modifications may be completed no more than thirty (30) days prior to the waiver participant moving into the modified dwelling. All modifications must meet State and local building codes.

Modifications may also be made to a vehicle if it is the primary means of transportation for the waiver participant (referred to as vehicle modifications). An E-mod may alter the basic configuration of the waiver participant's home only if this alteration is necessary to successfully complete the modification. All environmental and vehicle modifications must be included in the SP and provided by agencies approved by DOH.

E-mods, including vehicle modifications, have a limit of up to $15,000 per twelve (12) month period. For example: if a participant needs more than one type of E-mod during the twelve (12) month period, the combined cost for this period may not exceed $15,000. E-mods in the amount of $15,000 or more per twelve (12) month period must be approved by DOH.

E-mods do not include improvements to the home (carpeting, roof repair, central air conditioning), which are not medically necessary or are not necessary to the waiver participant's independence in the home or community.

Allowable E-mods

E-mods in the home include the purchase and/or installation of:

  • Ramps
  • Lifts: hydraulic, manual or electric, for porch, bathroom or stairs (Lifts may also be rented if it is determined that this is more cost-effective.)
  • Widened doorways and hallways
  • Hand rails and grab bars
  • Automatic or manual door openers and doorbells

Bathroom and kitchen modifications, additions or adjustments to allow accessibility or improved functioning, include:

  • Roll-in showers
  • Sinks and tubs
  • Water faucet controls
  • Plumbing adaptations to allow for cutouts, toilet/sink adaptations
  • Turnaround space changes/adaptations
  • Worktables/work surface adaptations
  • Cabinet and shelving adaptations

Other home adaptations include:

  • Medically necessary heating/cooling adaptations required as part of a medical treatment plan. (Any such adaptations utilized solely to improve a person's living environment are not reimbursable under the waiver.)
  • Electrical wiring to accommodate other adaptations or equipment installation.
  • Specialized electric and plumbing systems that are necessary to accommodate the medical equipment and supplies that have been determined medically necessary.
  • Other appropriate E-mods, adaptations or repairs necessary to make the living arrangements accessible or accommodating for the participant's independence and daily functioning and provide for emergency fire evacuation and necessary to assure thewaiver participant's health, welfare or safety.

Provider Qualifications

Any not-for-profit or for profit health and human services agency may provide E-mods or may subcontract with a qualified person or entity to provide E-mods. Agencies approved to provide E-mods by the Office of Mental Retardation and Developmental Disabilities (OMRDD) may be approved by DOH to provide this service for the NHTD waiver.

The E-mod provider must ensure that individuals working on the E-mods are appropriately qualified and/or licensed to comply with any State and local rules. All materials and products used must also meet any State or local construction requirements.

Providers must adhere to safety issues addressed in Article 18 of the New York State Uniform Fire Prevention and Building Code Act as well as all local building codes.

Approval Process for E-mods for a Home

STEP 1 The participant, SC, and anyone selected by the participant determines if any E-mods are required during the development of any SP;
STEP 2 A comprehensive assessment must be completed to determine the specifications of the E-mod;
STEP 3 The participant, the SC and anyone selected by the participant must explore all other available resources to pay for E-mods (i.e. informal supports, community resources and State/Federal agencies);
STEP 4 When all other resources have been explored and/or utilized, the SC begins the bid procurement and selection process;
There are two options for obtaining bids:
  1. The SC and participant select a waiver approved E-mod provider to be responsible for planning, oversight and supervision of the project. The provider is then responsible for obtaining three bids from skilled professionals and selecting the contractor; OR
  2. The SC and participant obtain three bids from providers who are responsible for planning, oversight and supervision of the project and have the personnel and expertise to complete the E-mod.
    • For E-mods of less than $1,000, only one bid is necessary.
    • For E-mods of $1,000 or more, three bids are necessary.

      Any combination of these two options can be used to obtain three bids. The lower bid must be selected, unless there is an indication that the contractor did not understand the full scope of the work or is unable to deliver the needed service. Every reasonable effort must be made to acquire the required three bids.
      When the SC determines that the continued delay due to lack of the required number of bids is jeopardizing the participant's health and welfare or is preventing an applicant from leaving an institution, the SC must contact the RRDS. The RRDS will consult with DOH and will notify the SC if they can proceed without the required three bids.
STEP 5 The SC completes and submits the E-mod proposal using the E-mod Description and Cost Projection form (refer to Appendix C - form C.10) to the RRDS for review and approval along with the SP. Information that must be submitted includes but is not limited to:
  1. Justification for the E-mod.
  2. All comprehensive assessments completed to determine the specifications of the E-mod.
  3. Information regarding the residence where the E-mod is proposed, including the name of the home owner or landlord. The owner's approval for the renovations, including any lease or rental contract, must be included (DOH is not responsible for the cost of restoring a site to its original configuration or condition).
  4. If the participant or family is having other renovations or repairs done to the house along with the E-mods, the scope of work should clearly delineate the waiver covered E-mods from modifications being funded by the family;
STEP 6 The RRDS reviews the Environmental Modification Description and Cost Projection form and may request more information. Approval is contingent upon available funding. The RRDS completes and signs the E-mod Description and Cost Projection form. The RRDS sends a copy of the form to the SC with the final determination.
STEP 7 The SC notifies the E-mod provider of the approval and obtains a signed contract from the E-mod provider. The E-mod provider is responsible for coordination of the E-mod, including obtaining necessary permits, supervising the construction, beginning and ending dates, and satisfactory completion of the project.

Signed contracts must be forwarded to the RRDS and must result in a total of less than $15,000 per twelve (12) month period. Any changes in cost must be prior approved by the RRDS through an Addendum to the SP. A contract for E-mods in the amount of $15,000 or more must be approved by DOH.
STEP 8 Upon completion of the E-mod, a summary of the work with actual costs, is documented on the Waiver Services Final Cost form by the E-mod provider. The complete form is submitted to the SC who signs off and submits the form to the RRDS.
STEP 9 The RRDS reviews the Waiver Services Final Cost form, and upon approval completes and signs the RRDS Approval of Final Cost form. The RRDS sends a copy of this form to the E-mod provider and SC.
STEP 10 The E-mod provider seeks reimbursement after receiving a copy of the NOD from the SC.


Repairs for home modifications which are cost effective may be allowed. Modifications that have worn out through normal use (faucet controls, ramps, handrails, etc.) may be replaced using the same E-mod approval process as for new E-mods. Repair and/or replacement may be contingent upon developing and implementing a plan to minimize repeated damage.


E-mods must be provided by a DOH approved provider and included in the SP to be reimbursed. E-mods initiated up to thirty (30) days prior to the initial NOD are reimbursed after the Notice is issued.

This service is reimbursed according to the final cost of the project approved by the RRDS and must be less than $15,000 per twelve (12) month period. If a participant needs more than one type of E-mod during the twelve (12) month period, the combined cost for this period may not exceed $15,000. A contract for E-mods in the amount of $15,000 or more must be approved by DOH.

E-mods for Vehicles

**This Section is currently under review for revisions**