Handicapped Showers paid by Medicaid [Archive] - Ceramic Tile Advice Forums - John Bridge Ceramic Tile

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Todd Stull
06-11-2011, 05:03 PM
Anyone have experience with this?? I'm bidding a handicapped shower install with line drain and its paid for by medicade... they want itemized lists of exactly what is used along with drawings etc...
I was told to check my price quotes to the internet as well because the quote will be picked apart and they may try to take stuff out. Other comments I've heard is to make the quote a packaged deal (all or nothing) let me know if I'm on the right track here:biker:

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ceramictec
06-11-2011, 05:10 PM
I had did one for a client a couple years ago.

http://ceramictec.com/accessible-handicap-barrier-free-shower-tampa

I had nothing to do with Medicare. they already had the approval to
repair and fix the bathroom and possibly were paying part.

Todd Stull
06-11-2011, 06:42 PM
Killer shower!!! I'm planning on close to the same layout but with the 60" Noble Freestyle linear drain

ceramictec
06-11-2011, 07:16 PM
sounds good. we have done a fair share of no curb, curbless barrier free showers down here in Florida. it's a little easier on a slab but we do get some wood subfloors to do them on also.

Levi the Tile Guy
06-11-2011, 07:45 PM
I have done a number of curbless also but only once on a slab, usually ours are on wood subfloors. Never billed medicaid though, and I would guess it is kinda like an insurance job - they will try and beat you up over price.

cwilde72
06-11-2011, 08:55 PM
Todd,

Did one for a disabled vet in November that the VA paid for. Getting the bid approved was the easy part-getting paid was the hard part! Finally was paid last month. Total BS! Not only that but the paperwork to get registered as a vendor for the U.S. govt was painstaking as well. Maybe Medicaid will be different, idk, but I'm definitely not going to jump at the opportunity to do another one for the VA.

:goodluck:

Todd Stull
06-11-2011, 09:19 PM
Apparently, they pay 1/2 down up front and once the job is complete all parties must sign off as satisfied and then they start processing the final payment (they don't notorize a time figure for that)
I started this process in October but the caseworker was switched and paperwork was lost and just recently was contacted again to start over... meanwhile, this client is wheelchair bound and has a tub that he can not get in. My daughter is handicapped so I understand his frustration and just want to get the guy under water!:shrug:

Todd Stull
06-11-2011, 09:20 PM
Well, if I get the job, ill post all the pics on this thread
Thanks guys:usflag:

cwilde72
06-11-2011, 09:56 PM
Ya, first they have to put in a request for payment then the next place has to authorize it for payment then the next place has to process the payment and then finally the last place sends the payment. Quite the "fine-tuned" system they got there!

Well at least you'll be getting $$ up front. I had to sit on those materials I had paid for over 5 months. :mad:

TileArt1
06-11-2011, 10:34 PM
Brian - you are getting spam phrases down to a frickin' science! :D

ceramictec
06-11-2011, 11:12 PM
it's becoming my second language ;)

Hank B.
06-11-2011, 11:19 PM
If its anything like their healthcare, you'll be expected to do the job for practically nothing, then turn around and over charge your cash and insurance jobs, to the point where no one can afford tile work, unless subsidized by the government, and that will cause the hard working middle class to pick up the tab making it practically impossible for them to get the tile work they're paying for every one else to have...sorry couldn't resist.

Todd Stull
06-12-2011, 01:32 AM
No offense Hank, but if everyone in America had to cough up an extra buck so this fella could take a shower, I know I wouldn't complain... but I see what your saying. I just finished typing up my proposal and it's a closed offer. No negotiations and it is a packaged price for an installation that will benefit the clients well being. I'm sure without the red tape I could do the job for a little less but that is your government.
This fella received a list in which I was not on it but he got on the net and saw some pics and read some reviews and called me with compliments and desire to help him so, for now, at least I get that satisfaction, win or lose...
Like I said earlier, my daughter is handicapped so I personally know what he's going through. My family literally gets screwed on services for my daughter so it gets confusing but all aside this is a business transaction and if it wasn't for the client, I probably wouldn't want to deal with it, as many others would agree...

Hank B.
06-12-2011, 02:53 AM
Yep. If every one in america coughed up a buck for his shower and you landed the job you'd be one rich ass tile guy;) I was just playing around, recently find out that my family doctor receives around 20$ for a gov.paid visit, 95 for a cash cust., and almost 400$ from an ins company-and every one wonders why ins is sky high.
Seemed liked a good place for my lame joke.

While I don't have anybody close to me that's in need of a handicapped shower, I've done a couple (lots of curbless, only a couple for some one that actually needs one) its really rewarding to provide some one with something that has the features they desperately need yet still looks great.
Can't give you any advice as it pertains to working with medicaid, but I would think that as with any gov contract-don't take the job if you need the balance to be paid soon after completion.

Shaughnn
06-12-2011, 09:53 AM
Todd,
I'd imagine that the linear drain is going to be the first thing they question. Do you have a strong explanation for it's necessity?
Chad,
The approval process is complicated because these are taxpayer dollars and *we* have demanded that level of oversight. The consequence of having every penny accounted for is an extended approval and payment process. I suspect you might complain if there was just one guy with a rubber stamp too? :)
Shaughnn

Todd Stull
06-12-2011, 11:07 AM
The linear drain is a "must" imo.... the bathroom is small and its a hard right turn toshower from the doorway. This fella is wheelchair bound and cannot stand. He will have to be transferred into a different chair or mobile shower bed and wheeled into the shower and a nurse will have to be there to help so this provides an open format for the equipment and help required...
If they don't like it then, I don't know what to tell them other than its a packaged deal and negotiations on price, changes and deletions will not be accepted. I was told to go on my professional opinion so I figured on a Noble line drain with mudbed, open up the doorway more, moen faucets with hose/slide bar for the attendant to access, all laticrete products and I chose Dal, C. Slate 18" for the floor and 12" for the walls. I figured if anything they would question the tile but I am one to NOT install a system like this with this upperend equipment and prep and then crap out on cheap Box Store tile... I also had to keep in mind about choosing products that will not be discontinued or unavailabe in 4 months in case if it takes them that long to get the ball rolling because they won't let me "requote"....
The client is already stressed out and now they are stressing me out... I just like to go to work:yeah:

Shaughnn
06-12-2011, 11:11 AM
That sounds like a solid explanation to me. :D
Shaughnn

Todd Stull
06-12-2011, 11:19 AM
I should have the final layout today or tomorrow from my designer so I will post those pics along with the before shots and we can all look at them together and I will update the process along the way so we can all learn, for those that never dealt with this process.

Another thing is that I did look into saving some cost on the job..., the ends of the wingwalls and niche will be capped with Schluter Jolly's instead of bullnose which saves a good $200 bux:clap2:

tilejoe
06-12-2011, 12:21 PM
My mom works with disabled kids everyday, the stories I hear about the cost of medical devices....I'm sure whatever your price, it is reasonable!

Hank B.
06-12-2011, 12:24 PM
Sounds reasonable to me, are you talking about real slate-or porcelain look a like-I'd be concerned about maintenance issues associated with a natural product.

Todd Stull
06-12-2011, 12:36 PM
The in-home nurse does all the cleaning as well, but we wanted to make sure that the tile has some grip to it so the nurse, especially, doesn't have a slip hazard while assisting in showering. I will also be providing some approved cleaning materials and accessories to get them started... I always try to cover all basis

custombuilt
06-13-2011, 04:23 PM
So you are putting real stale in? There are plenty of porcelains with rougher grip surfaces. Or if youa re really concerned about traction put in all 2x2 on the floors.

Todd Stull
06-13-2011, 05:41 PM
It's Dal tile Continental Slate Porc. Tile, Noble Line drain etc... I'm getting ready to upload the design from my friend who owns vizyoulizeit. She took pics of the faucets, tile and drain and came up with a pretty good vizual:tup1:

Todd Stull
06-13-2011, 05:44 PM
Here it is:deal:

I tried to learn Google sketchup and not worth my time. Anyone needs a tile designer PM me.

jondon
06-13-2011, 06:34 PM
Todd, that is a really nice design program & layout:tup1:

Beaux
06-13-2011, 09:00 PM
I've done a few for medicaid and a few trust they call it. 1/2 down was the norm before ordering materials. Sent in my company name. Never had a problem getting the last 1/2 . The customer signs a release /fax it over the check in the mail. They do have a cap here in Texas as far as what they will pay. Medicaid that is. So pick the materials accordingly.

If your slow check in with your local home health or hospice. better than a builder.:shades:

u need to be legit .. insurance, wokerscomp, etc. but there is good money to be made.

just my take

Todd Stull
06-13-2011, 09:03 PM
Thanks Jon:yeah:

My friend does it on some Adobe Photoshop setup. Its not perfect but definately good enough to provide a good visual

bctile601
06-14-2011, 05:55 AM
Did Medicaid pay for the Photoshop ?

:D

jondon
06-14-2011, 05:58 AM
yes I am sure they did, but only 1/2 other 1/2 comes once job is done:shades:

Todd Stull
06-15-2011, 04:44 AM
I submitted the proposal yesterday so we'll see what happens. Looks like a two week wait at this point until I hear something:shrug:

Todd Stull
06-17-2011, 03:32 PM
The UCP approved my bid and design and now it goes to the state. So far, it seems as though things are going smoothly to this point although I'm ready to tear this mother out and hook it up:oyeah:

jondon
07-23-2011, 01:20 PM
Todd, just did a handicap shower down here in Georgia. Was in SC, where my friend lives and the job ended up being in Athens. He had never done a shower pan so I offered to help him with this one and get him Schluterized! Shower was a conversion, actual dimendsions were 59" X 34" on slab.

It was subbed to him through a Plumbing Contractor he does work for. They had to do a little but most of the work was the shower and they made the room dimensions larger for it to qualify as handicapped. So someone came in and did that and finished the drywall before him. We Frankenguezed it with kerdi shower pan and hyrdroban on the cement board.

The biggest thing I wanted to input here on this thread was the cost. The day we were finishing it up the apartment manager came in to take a look. I didn't ask here what it cost to do the conversion but she offered. She said it was 11K to do the whole thing. I estimated what the Plumbing contractor made to what my friend made for the shower installation and I would say they made three times what they paid him. On top a that they made him feel like he was asking too much, the usual.... screw the sub. The shower really turned out nice and he will now be able to take a shower now. Don't know if this was through Medicare, Medicaide, or ?? I just know 11K was way to much with the Plumbing Contractor pocketing most of it for doing very little. It was my friend's fault too for underbidding it way low but at least now he has an idea what he should be bidding. He should bid it 3000 minimum next time. Live and learn but in the end someone handicapped gets to utilize they're shower:tup1::tup1::tup1:

Westside1
07-23-2011, 06:31 PM
Great Story Jon
Always nice to hear about accomplishments like those.

Todd Stull
07-23-2011, 06:54 PM
Sounds like that Plumbing Contractor is a bit unethical with not allowing for the standard commission when subcontracting work.

Its been around a month here on this wait... I have not heard of any approval from the state yet. I just feel for the homeowner who is in need of shower facilities. I'm sure something will give sooner or later.

jondon
07-24-2011, 07:38 AM
Yes unethical is correct, or should we say greedy. Those two seem to go hand in hand. He told me many stories just like this where the owner of the company gets an estimate to have work done on his place in Augusta, and gets his own guys to do the same work for peanuts. My friend should not be working for them when they screw you like this. The usual problem is not enough work to go around and all the well known companies end up getting the work and subbing it out. Same story different place. The larger companies get the work, sub it all out, don't have to pay health insurance, etc. The rich get richer.

Yes, the person who loses is the person who needs the handicap shower and has to wait around for all the red tape. I mean yes it should be checked into on the prices unlike my friend's job. It should be reasonable as for cost and materials used. Like with yours you had to put in an itemized estimate on what you were using for the job. My friend gave the Plumbing Contractor a price, never saw the job. We showed up the first day and the guy had put concrete in the pan around the drain, what a joke. Drove over two hours to see that then drive back with nothing done.

When it comes to a handicapped person using a shower and getting it approved maybe a handicapped person should be the one approving them. They would understand how is it to not be able to take a simple shower, something the rest of us take for granted.

Hammy
07-24-2011, 09:20 PM
I was called to look at redoing a bath tub to a wakl in shower for a Vet. I worked with the VA office on approval. Job estimate was about $6700. Estimate was with VA guide lines for work being done. Stipulation was I needed to be willing to complete job and wait for VA to pay me. Nothing down. Where would I be if the VET went to a nursing home or worse yet died in the process? I said no thanks.

Hammy

jondon
07-25-2011, 07:02 AM
Yes, I can't blame you for that. Once that money is approved there should be some sort of guideline on how you get paid. In other words you don't start the job till the money is available. Then you get 1/2 when you start and 1/2 when the job is complete. What is so difficult about it. For someone who needed a barrier free shower, they don't need it two years from now. Whenever money is needed for a great cause there is someone out there slowing it down, notice I didn't say our "system," someone in the system.

As for our Vets and something like this, they should have some kind of funding set aside for those who have served and are in need. I will say we have some great VA facilities here not far from me maybe some a the best in the US. They all have the handicap showers but then they have the resources. Toughest thing is to get approved to get into the facility, you have to apply way before you are sick to have a chance.

Todd Stull
07-25-2011, 01:42 PM
I just got some feedback today. Apparently there are OBRA regulations with the state for home modifications. And there is a cap. The homeowner cannot afford to pay the difference so this is on hold until the regulations are updated, which was supposed to be done on July 1st but there is a delay so noone knows what is going on.
I can only let this go so long before I have to bow out and void my proposal and services. My supplier already increased their "energy fee" 3% and if this process goes months or years I just can't hold this price. At this point, I'm hanging in there for the homeowner...

jondon
07-25-2011, 10:30 PM
posted by Todd:
Apparently there are OBRA regulations with the state for home modifications. And there is a cap. The homeowner cannot afford to pay the difference so this is on hold until the regulations are updated, which was supposed to be done on July 1st but there is a delay so noone knows what is going on.


The OBRA Waiver is a Home and Community-Based waiver program that provides services to people with developmental physical disabilities to allow them to live in the community and remain as independent as possible.

May I ask what the cap is if you don't mind, only because of the experience I just had down in Georgia when I was shocked on the amount. Of course different states, different systems, etc. Just out of curiosity did they ask you to do anything differently to bring the price of the installation down. I know for the one we just did we used a schluter drain. I know you said you put a linear drain in the proposal and it would work great but....... Just wanted to know if they asked you to make some cuts to bring it down.

Sorry to hear the homeowner is not able to pay the difference and has to wait. If it would help you could have my 200.00 coupon for Noble Company to put towards a linear drain. Of course I would be getting it for you since I am the NTCA member:tup1: I wonder if your supplier or some of our manufacturers would be willing to step up and make some donations with products to help make this happen. I know I'll help you any way I can to help give this person a shower they can use, I am sure others would be willing to help:shrug:

Great thing about this forum, manufacturers who benefit from the networking of this forum are not hesitant to step up and help a JB Forum brother in need:wohoo:

Todd Stull
07-26-2011, 11:21 PM
Thanks Jon for the offer on the Noble drain:clap2:
At this point I'm about a month and a half out... there was a point in time where I could have jumped on it if paperwork would've moved quicker so I'm going to touch base weekly with the UCP for updates. This cap was to be changed on July 1st so I will assume that it could take place sooner than later.
As far as the price, id prefer not to disclose since all regions are varied when cost of living is involved and I took the advice from a few other pro's that had experience with these jobs to where I provided a clause in the proposal for no changes/deletions in price or products. I do not want a pencil pusher gunning me down to use crap depot tile with a custom built shower using Noble and Laticrete products... kinda like throwing a 4 cylinder in a Mustang. With the job at hand, time, labor, products, fuel and so on... this was definately priced fairly.
This homeowner has been waiting since October of last year, smh

jondon
07-28-2011, 11:39 AM
Todd no problem on price, they will vary from city to city and state to state and so many different variables. Like someone coming on here asking for a price per sq. ft to do tile. So many variables to give an estimate without seeing the job and what is involved. I remember too you have a designer in this project, does he or she have a stake in the cost too. I would imagine though you already provided the sketch of the shower. I agree too, I like to do things the right way and once. The cost of the linear drain is much more than say a shluter drain but you save time in the installation not having to slope it. Using large tiles and linear drain takes much less labor so it all equals out.

WWCBuilder
07-31-2011, 03:45 PM
Great advice on the companies willingness to throw in and help.

Give Bob a call @ www.trendingaccessibility.com

These guys are in your area and alway looking to jump in and help. I think you will be impressed.:yipee:

Todd Stull
08-03-2011, 03:02 PM
Shannon,
Thanks for the contact on the distributor:tup2: Looking through the website, it looks as though they don't carry the products that I quoted but I should be recieving a call from Dave at Trending Accessibility sometime today to get an idea of what they offer. It looks like they have alot to offer for these custom shower builds.

Tomorrow I will be talking to the case worker for the job over some details and find out if changes to the job will buy time for this home owner to keep the process going... we'll see:scratch: If not, then it seems as fighting the system is like:deadhorse although either way the job will get done

Todd Stull
08-03-2011, 03:12 PM
Jon,
The designer is a great friend of mine so she does designs for me up front at no cost and if I get the job she gets paid $150.00 for her time and efforts... if I don't get the job, then she gets what I get:yummy:

When I have clients that want multiple views etc... I will work with her first to get the basics done on room layout or shower size and then she will work directly with the customer after that as far as payment and will not release any drawings or designs until the 3 day recission period has lapsed when contracts are endorsed.
Its a great relationship for me and allows me to be free of getting too bogged down on pencil drawings and learning programs that always change.

Todd Stull
08-04-2011, 07:19 PM
Today was a POW-WOW with the UCP. The rep is a great person and doing all she can although things are moving slow and the state is understaffed... We chatted over a few things and I gave her my next schedule opening to where I can start since another job was posponed/rescheduled which would start me either right before or after Labor Day.
I started over and repriced the whole job including changing the tile to a less expensive tile which was the worst part for me although all things will work, with all that I reduced the job price to meet the cap and the rep will be trying to push this through.
All numbers did not work out when making changes for the job at hand but I also spoke with Henry this morning and he offered up some options to help out and Jon offered in his Noble coupon toward the 60" slot... Thanks guys:tup2: I have a feeling this will go through and I can get this homeowner in a shower since I had to move at em on the aggressive side.

Todd Stull
08-08-2011, 10:23 PM
Shannon,
Thanks for the tip on the products that the website offers...:deadhorse
No specs, too expensive and so on... I thought they were a full distributor of sorts but they really only carry those joist mounted shower kits which are substandard in my book.
This is a custom build with Laticrete thinsets and 3701 Fortified mortar bed. The job was origionally spec'd for PermaColor but I may switch to SpectraLock and sub out the grouting segment to Jon since I'm allergic to epoxies. The waterproofing will be the Noble Seal TS or Dal Seal in which this will be the best option for this job when tying in the Noble Drain, other than that, NO kits:talk: I stick to the Noble and Laticrete products and sometimes use the Quartz Lock 2 grout... I ran into a salesman pushing these kits at my plumbing supplier and the sales tactics were shady and horrible...

jondon
08-09-2011, 08:08 PM
Todd, I followed the other thread with Shannon pushing these kits and in this case I really don't see how they would help your situation unless they are willing to give you one a these kits. Even then it looks like mud will still be the ticket cause you are using a linear drain so you need to customize the pan.

I don't see why he is pushing these so much unless he has something to gain, on the other thread he certainly looks like he works in sales or if he is a builder he is making money somehow to be pushing them like he is.

I am sure for the tile person who doesn't know how to do a mud bed or a DIYer this product would be there only option if they don't want to hire someone. But I don't see how you would benefit whatsoever or the handicapped person you want to do this for:shrug: You are trying to bring the cost down, not raise it.

posted by Todd:
I ran into a salesman pushing these kits at my plumbing supplier and the sales tactics were shady and horrible...

Kinda sounds familiar now that you mention that, not to mention any names of course!

Todd Stull
02-19-2012, 08:43 AM
http://www.aloneeagle.com/bathroom-remodeling-contractor-in-pennsylvania/barrier-free-showers-and-wet-rooms/

I wrapped up this job at the end of November and my client was happy to take his first real shower in years the day after I took this video footage which I uploaded to my website.

TileArt1
02-19-2012, 10:00 AM
Todd - you're doin' it wrong. It should be like this:

ADA accessible barrier-free showers in Pennsylvania (http://www.aloneeagle.com/bathroom-remodeling-contractor-in-pennsylvania/barrier-free-showers-and-wet-rooms/)

Make your text something people are likely to type into search engines then link that to the page. :D

Nice job, by the way.

Todd Stull
02-19-2012, 10:05 AM
LOL, I need someone to teach me how to do the hyperlinks. I was just following up the thread and I never actually took final photos so the video clip was all that I had.

Hammy
02-19-2012, 02:50 PM
Video was fine. I find small showers are hard to photograph and do the showers any justice.

Hammy

Todd Stull
02-19-2012, 02:58 PM
Thanks Hammy! It was kind of hard to get a good position for photos