woodbury

 

Transportation Services

Provider Requirements and Service Limitations

From The May 2010 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 reference 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 on-board 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 Medicaid-eligible medical appointments and services. DD waiver funds shall not be used when the recipient’s trip is for a Medicaid State Plan service.

Transportation services are available through the Medicaid Non-Emergency Transportation Program state plan services to transport recipients to Medicaid-eligible 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 non-commercial 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, inhome 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

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 for-profit, 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, fixed-schedule 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 fixedroute 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 not-for-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.