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Transportation Services

Provider Requirements and Service Limitations

From The July 2007 Florida Medicaid Provider Handbook

Transportation - Requirements To Receive

Description

Transportation services are the provision of rides to and from the recipient’s
home and community-based waiver services, enabling the recipient to receive
the supports and services identified on both the support plan and approved cost
plan, when such services cannot be accessed through natural (i.e., unpaid)
supports.
Transportation services funded through the DD waiver shall be used only for
recipients who have no other means to get to a service identified on the support
plan and approved cost plan. Family members, neighbors or friends who
already transport the recipient, or who are capable of transporting the recipient
at no cost to the APD, shall be encouraged to continue their support of the
recipient. Recipients who are capable of using the fixed route public transit
system to access services on their support plan shall be encouraged to use that
method of transportation.
This service is not available for transporting a recipient to school through 12th
grade. Transportation to and from school is the responsibility of the public
school system. For other transportation needs not identified on the recipient’s
support plan and approved cost plan, the recipient should be directed to the
local Community Transportation Coordinator or, if available, the local area’s
fixed route fixed schedule public transit (bus system).
Vehicles shall not carry more passengers than the vehicle’s registered seating
capacity. Driver and driver’s assistant(s) are considered passengers.
Fifteen passenger vehicles that are not lift-equipped shall not carry more than
ten passengers at any given time, and shall follow the National Highway
Transportation Safety Board guidelines for loading such vehicles.
Boarding assistance shall be provided as necessary or as requested by the
recipient being transported. Such assistance shall include opening the vehicle
door, fastening the seat belt, securing a wheelchair, storage of mobility
assistance devices, and closing the vehicle door. Recipients shall not be
carried. Drivers and drivers’ assistants shall not assist passengers in
wheelchairs up or down more than one step, unless it can be performed safely
as agreed by the recipient, recipient’s guardian, or recipient’s representative.
Drivers and drivers’ assistants shall not provide any assistance that is unsafe
for the driver, the driver’s assistant, or the recipient.

Drivers, drivers’ assistants or escorts provided by the provider to accompany
the recipient shall be trained in CPR, disease transmission, and use of the onboard
first aid kit.
In accordance with section 316.613, F.S., children five years of age or younger
must be transported in a federally-approved child restraint device. The provider
must have the installation of the child restraint device and the positioning of the
child checked at a local authorized child safety seat fitting station or by a
certified child seat safety technician. For children from birth through three years
of age, such restraint device must be a separate carrier or a vehicle
manufacturer’s integrated child seat. For children from four through eight years
of age, a separate carrier, an integrated child seat, or a booster seat with
appropriately positioned safety belt, as appropriate for the child’s size and age,
may be used. In Florida, every county sheriff’s office and city police station
serves as a fitting station and every traffic law enforcement officer has been
trained to provide assistance.
In vehicles with passenger-side air bags turned on, children under the age of 12
and any adult or child less than 100 pounds must be transported in the back
seat. In vehicles that also have side-impact air bags, children and adults less
than 100 pounds must be transported as close to the middle of the back as
possible.
A first aid kit equivalent to Red Cross Family Pak #4001 and an A-B-C fire
extinguisher shall be carried on board the vehicle at all times when transporting
recipients.
When the vehicle is in motion, all mobility devices (wheelchairs, scooters, etc.)
shall be secured with appropriate tie-downs, regardless of whether or not a
person is physically positioned in the mobility device; and cell phone, fire
extinguisher, first aid kit, and any other such items that could become airborne
in the event of a sudden stop or accident must be secured.

Limitations

Providers of adult day training, companion services, in-home support services,
personal care assistance, residential habilitation, respite care, specialized
mental health services, support coordination and supported living coaching may
not bill separately for transportation that is an integral part of the provision of
their primary service.
In order for providers of adult day training, companion services, in-home
support services, , personal care assistance, residential habilitation, respite
care, specialized mental health services, support coordination and supported
living coaching to bill separately for transportation provided between a
recipient’s place of residence and the site of a distinct waiver service, or
between waiver service sites when the service at each site is provided by a
different provider, they must qualify for and enroll as a transportation provider.

Transportation between habilitation sites operated by the same provider or
transportation that is an integral part of the service being received by the
recipient is included in the rate paid to the providers of the appropriate types of
waiver services.
Transportation services are available through the Medicaid Non-Emergency
Transportation Program state plan services to transport recipients to Medicaideligible
medical appointments and services. DD waiver funds shall not be used
when the recipient’s trip is for a Medicaid State Plan service.
When a transportation provider is paid by the Medicaid State Plan to transport a
Medicaid recipient to an eligible service, the recipient will be charged a
copayment, for which the recipient is responsible. DD waiver funds cannot be
used to pay any copayment for Medicaid funded transportation services.
When the recipient uses a DD waiver provider for transportation to a service
listed on the support plan and current approved cost plan and the provider is
paid with DD waiver funds, the provider shall not charge the recipient a
copayment.
Providers may bill for their service by the mile, by the one-way trip, or by the
month. Regardless of how services are billed, all providers, except limited
service providers, must during the rate-setting process define the charges for
their services in terms of cost per vehicle mile. Providers must ensure group
trips, ride sharing and multi-loading to the greatest extent possible. If more than
one recipient is being transported, the mileage charge will be shared among the
number of waiver recipients transported. When a provider is reimbursed by the
trip, a recipient shall receive no more than four one-way trips per day, or 80 per
month of this service. Only providers that want to bill for actual expenses
incurred may bill by the month. Limited transportation providers, i.e., family
members, friends or neighbors, will be reimbursed at the state mileage rate.

Documentation Requirements
Reimbursement* and monitoring documentation to be maintained by the
provider:
1. *Copy of claim(s) submitted for payment; and
2. *Trip logs.
The provider must submit a copy of trip logs, monthly, to the waiver support
coordinator.

The APD Area Offices must maintain a database for each enrolled provider to
include:
The names of the recipients being transported by that provider;
The beginning and ending date of each recipient’s service;
The destination and distance of each recipient’s authorized trip;
The cost per vehicle mile; and
The amount authorized to be billed monthly for each recipient.
This information may be obtained from the recipient’s service authorizations and
verified by trip logs and quarterly operating or service reports submitted by
providers.
Transportation providers that are not CTCs, public fixed-route, fixed-scheduled
bus systems, or limited transportation providers must, at the time of enrollment,
be able to show proof of current Florida driver’s licenses for all drivers who will
be transporting recipients, vehicle registration for all vehicles to be used in the
provision of this service and 100/300 vehicle liability insurance coverage in
accordance with section 768.28, F.S.
Fixed-route, fixed-schedule bus systems must at the time of enrollment provide
the APD Area Office with proof of their status as the local Public Transit
Authority.
Limited transportation providers shall at the time of enrollment provide the APD
Area Office with proof of a current Florida driver’s license, vehicle registration,
possess a vehicle that is in safe operating condition, and maintain at least
minimum vehicle liability insurance coverage as required by Florida law (PIP).
Subsequent to enrollment, all providers are responsible for keeping drivers’
licenses, vehicle registrations, and insurance up-to-date. Drivers shall be at
least 18 years of age and possess a current, valid commercial or noncommercial
driver’s license appropriate to the vehicle and for the purpose it is
being used, in accordance with Chapter 316, F.S.
*Indicates reimbursement documentation.

Place of Service

This service is provided anywhere in the community.

Special Considerations
When a recipient must have an escort to provide assistance, the transportation
provider may be paid for transporting both the recipient and the escort, unless it
is the policy of the transportation provider to allow an escort to ride free of
charge. Some county coordinated transportation systems do not charge for an
escort to ride with a recipient with a disability.
Providers shall not be paid separately for transportation services provided as an
integral part of performing the following services: adult day training, companion
services, in-home support services, personal care assistance, residential
habilitation, respite care, specialized mental health services, support
coordination and supported living coaching. Group and foster homes that
provide transportation as a component of their long-term residential care
services shall not be paid separately for the transportation service.
When paid vendors are also family members, controls must be in place to
ensure that the payment is made to the relative only in return for specific
services rendered; and there is adequate justification as to why the relative is
the paid vendor of the service, rather than a natural support.

Transportation Services Provider Requirements

Transportation Services Provider Requirements

Provider Qualifications
In order to provide and be reimbursed for transportation under the Medicaid DD
Waiver, transportation providers may be Community Transportation Coordinators
(CTC) for the Transportation Disadvantaged; limited transportation providers;
Public Transit Authorities that run the community’s fixed-route, fixed-schedule
public bus system; group homes and other residential facilities in which the
recipients being transported live; adult day training programs to which the
recipients are being transported; and other public, private for-profit and private
not-for-profit transportation entities. The manner in which each of these types of
providers may be used is specified in Chapter 427, F.S., and described below.
Pursuant to Chapter 427, part I, F.S., transportation services shall be purchased
from Community Transportation Coordinators utilizing the public, private forprofit,
or private not-for-profit transportation operators within each county’s
coordinated transportation system.
Limited transportation providers are relatives, friends and neighbors. They are
not “for hire” entities. They are reimbursed at the state mileage rate. The Area
is not required to contact or obtain authorization from the CTC in order to use the
services of a limited transportation provider. The CTC has no responsibility for
overseeing service delivery of such providers. The Area is responsible for this
oversight.
When transportation providers are also relatives, controls must be in place to
ensure that the payment is made to the relative only in return for specific
services rendered, and that there is adequate justification as to why the relative
is being paid for the service, rather than being a natural support.
Public Transit Authorities that operate the community’s fixed-route, fixedschedule
public bus system may enroll in the DD Waiver to facilitate the
purchase of monthly or other frequency bus passes. If natural supports are
unavailable, this transportation option is to be used for recipients who can use
the fixed-route, fixed-schedule public bus system to go to some or all of their
waiver services. Bus passes are to be purchased for recipients who can utilize
the bus system to go to their waiver service sites whenever the cost of the trips
to be taken during the month, if taken by Para transit, would exceed the cost of
the monthly bus pass. Public Transit Authorities are required to adhere to
minimum safety standards set forth in Chapter 14-90, F.A.C. The Area is not
required to contact or obtain authorization from the CTC in order to use the
services of the fixed-route fixed-schedule bus system. Drivers of fixed-route,
fixed-schedule buses are not considered direct service providers within the
context of Chapter 393, F.S. Therefore, they are not required to be level 2
background screened. The CTC has no responsibility for overseeing service
delivery of such providers.

Group homes or other residential facilities in which recipients live may enroll as
transportation providers to transport the recipients to and from their waiver
services. Adult day training agencies that recipients regularly attend may enroll
as transportation providers to transport the recipients to and from the agencies’
programs. In order to use group homes, residential facilities, or adult day
training (ADT) agencies as transportation providers, the Area must obtain written
authorization from the CTC. The authorization will result in a written agreement
that sets forth the roles and responsibilities of the CTC, the group home,
residential facility or ADT agency and the Area for complying with vehicle and
passenger safety standards, adhering to, monitoring and overseeing service
delivery and any necessary reporting to ensure compliance with Chapter 427,
F.S. This arrangement will benefit the providers by enabling them to purchase
new or replacement vehicles on state contract through the Department of
Transportation.
Transportation providers that are not part of the coordinated transportation
system may transport waiver recipients; however, the reason the Area needs to
use them as a provider determines what APD must go through in order to use
the provider and the roles and responsibilities of APD and the CTC, as follows.
If the CTC determines it is unable to provide or arrange the required
transportation for a recipient, transportation providers who operate outside the
coordinated transportation system (e.g., taxi companies, private for-profit or notfor-
profit transportation companies) may be used to transport the recipient to and
from their waiver services.
The CTC has no responsibility for monitoring adherence to driver, vehicle and
passenger safety standards or overseeing service delivery of such providers.
The Area is responsible for such oversight. The provider and Area are
responsible for complying with reporting requirements of Chapter 427, F.S.,
through the APD Director’s designee on the Commission for the Transportation
Disadvantaged.
If the Area Office wishes to utilize a transportation provider that is not a part of
the coordinated transportation system, the Area must contact the CTC in the
recipient’s county of residence and follow their procedures for use of alternative
providers, as required by the Florida Commission for the Transportation
Disadvantaged. This authorization will be issued to the Area. These providers
must meet the driver, vehicle and passenger safety standards of overseeing
service delivery of such providers. The provider and Area are responsible for
complying with reporting requirements of Chapter 427, F.S., through the APD
Director’s designee on the Commission for the Transportation Disadvantaged.