Motor vehicle purchase and modification

1. An order is required from the primary health care provider with documentation of objective medical evidence that supports the necessity for purchase of a specially equipped motor vehicle or modification of an existing motor vehicle directly due to the compensable work injury. a. The order must be obtained and submitted to the organization prior to consideration of a purchase or modification. b. The order must include the date of an in-person office visit that coincides with the date of the order. 2. Prior to any motor vehicle modification or specially equipped motor vehicle purchase, the organization shall complete a review to determine if the most appropriate assistive device is currently being utilized by an injured employee for the injured employee's functional needs. The review by the organization may require the following criteria: a. A primary health care provider shall provide a referral for a mobility assessment. b. The mobility assessment must be performed by a licensed or certified occupational or physical therapist with specific training in rehabilitation mobility or functional evaluations. c. The mobility assessment report must contain clear documentation of functional limits of standing and walking with an assistive device and documentation to support how the other assistive devices were ruled out as not medically appropriate for functional needs. 3. If the appropriate assistive device is determined through the mobility assessment process, the organization may begin the review for a specially equipped motor vehicle purchase or motor vehicle modification eligibility, if appropriate. 4. Upon completion of the mobility assessment, if a manual wheelchair, power mobility device, or both are needed, the following must occur: a. A primary health care provider shall provide a referral for a wheelchair or seating evaluation. b. The wheelchair or seating evaluation must be completed by an assistive technology professional or similarly situated professional, which includes an itemization of all elements needed for the manual wheelchair or power mobility device and matches the functional deficits outlined in the mobility assessment. c. Upon completion of the wheelchair or seating evaluation, an analysis must be completed by the assistive technology professional or similarly situated professional to determine the appropriate vehicle modifications that match the mobility assessment and the wheelchair or seating evaluation. 5. If an existing vehicle cannot be repaired or modified, the organization, in its sole discretion, may approve the purchase of a specially equipped motor vehicle. 6. The organization may request a minimum of two itemized cost quotes. The organization may decrease or add the number of cost quotes needed accordingly. 7. Actual vehicle or modification purchase may not occur until the organization reviews the request and issues recommendations or decisions as to whether eligible for the benefit. 8. Any appeal of a decision under this section must be adjudicated pursuant to North Dakota Century Code section 65-02-20.