Non-Medical Transportation 525-05-30-40

(Revised 1/1/21 ML #3607)

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Purpose

The purpose of HCBS Non-Medical Transportation service is to enable individuals to access essential community resources/services in order to maintain themselves in their home and community. The service of Companionship is considered an essential community resource for Non-Medical Transportation.

Service Eligibility, Criteria for

The individual receiving non-medical transportation service will meet the following criteria:

1. Must be eligible for the Medicaid Waiver for Home and Community Based Services, Technology Dependent Waiver, SPED, or ExSPED.

1. Clients receiving Transitional Living services are limited to eligibility for Non-medical Transportation Driver with Vehicle.
2. Clients who are receiving Non-Medical Transportation Service under the Technology Dependent Waiver are limited to eligibility for Driver with Vehicle.
   
   
2. Is unable to provide his/her own transportation and/or requires assistance with the task(s) for which Non-Medical Transportation is being provided.
   
   
3. Needs a means of obtaining basic necessary community resources and/or services (i.e. grocery, pharmacy, laundromat).
   
   
4. Transportation alternative is NOT available through the informal network.

Service Activities

HCBS Non-Medical Transportation can ONLY be authorized for the client to access basic necessities (which are non-medical related) required in order for the client to remain in their own home, or for the service of Companionship or Transitional Living community integration/social appropriateness. If a provider will be using another individual's vehicle to provide this service, the owner of that vehicle must provide proof of insurance and a written statement that they have given the provider permission to use the vehicle for this purpose.

1. Driver with Vehicle (Non-Medical Transportation Local or Out of Town 15-minute unit rate)

HCBS Non-Medical Transportation service is to be provided from the client's place of residence to the essential service need/access point(s) and/or return.

Non-Medical Transportation Local is authorized for the drive time of transporting the client to and from their home for essential services.

Non-Medical Transportation Out of Town is also authorized for the drive time of transporting the client to and from their home for essential services. If essential services are not available to the individual in their local area, it may be appropriate to authorize Non-Medical Transportation Out of Town for drive time to the nearest town or city where essential services can be accessed.

Non-Medical Transportation (Driver with Vehicle Local or Out of Town)

If a client is utilizing non-medical transportation (NMT) and the QSP needs to use the client’s vehicle, for instance if it’s handicapped-accessible, you may authorize Driver with Vehicle. The intent of the Driver with Vehicle is not only the mileage and wear-and-tear on the QSP’s vehicle, but also their time.

In order to authorize Non-Medical Transportation Driver with Vehicle (Local or Out of Town), the individual must either be impaired in Transportation or impaired in the task for which Transportation is being authorized.

1. To determine whether the individual is impaired in Transportation, refer to Instructions for Completion of the HCBS Comprehensive Assessment 525-05-60-10: consider their ability to negotiate entering and exiting of vehicle. Consider their ability to secure appropriate and available transportation and to know locations of home and essential places. Lack of appropriate and available transportation as needed, will increase the score. Consider cognitive as well as physical ability to use transportation.
   
   
2. To determine whether the individual is impaired with the task for which Transportation Driver is being authorized, consider their ability to independently complete the task for which the transportation is being provided (example: Shopping for essential services as part of Non-Medical Transportation).

Case Example:

An individual does not drive, but has access to public transportation and can board without assistance. They would not be considered impaired in Transportation. However, they require human assistance in completing the task of Shopping, which includes the necessary transportation. It may be appropriate authorize Non-Medical Transportation driver/vehicle for the drive time, as well as Non-Medical Transportation escort for the assistance with the task.

 

Case Example:

An individual does not drive, but has access to public transportation and can board without assistance. They would not be considered impaired in Transportation. They require transportation to access the bank and the pharmacy, but do not require any assistance with completing those actual tasks. It would not be appropriate to authorize any form of Non-Medical Transportation for these tasks, as the individual is independent with Transportation and is also independent with the tasks associated with it.

2. Authorization of Non-Medical Transportation Escort

An escort may be authorized to accompany a client who uses public transportation IF the client requires assistance in boarding and exiting as well as while being transported AND the escort must be needed by the client in completing the activity. An example of escort for completing an activity would be an individual who requires assistance with grocery shopping in the store. This type of assistance would be considered the escort component of Non-Medical Transportation.

3. Authorization of Non-Medical Transportation Driver with Vehicle and Non-Medical Transportation Escort

An individual providing transportation may also be compensated as an escort IF the escort is needed by the client in completing the activity for which the HCBS Non-Medical Transportation is authorized. Compensation for escort must be separate from the compensation for the transportation (driver with vehicle).

Example: A single provider provides both Driver with Vehicle and Escort. The billing time for the escort starts when the vehicle reaches the destination and stops when the client enters the vehicle to return home. A QSP cannot be reimbursed for escort services while driving.

Unallowable Service Activities

• HCBS Non-Medical Transportation CANNOT be used to transport a client to and from work/or school or to facilitate socialization or to participate in recreational activities, (i.e. wellness programs, church activities, etc.) unless it is being authorized in conjunction with the service Companionship or Transitional Living.
  
  
• HCBS Non-Medical Transportation CANNOT be used to transport a client to and from a health care provider or medical facility (doctor, dentist, hospital, physical therapy, etc.).
  
  
• If the client is not able to be transported or participate in the activity (such as grocery shopping), this cannot be billed under Non-Medical Transportation. The service may be covered under Homemaker.

Clients receiving Transitional Living Services are exempt from this limit, service tasks would include transporting clients to/from work or school or to facilitate socialization, or to participate in recreational activities, escort to accompany the individual while they are being transported is not allowed, as it is a component of transitional living services.

With the exception of Companionship, this service is not available when transportation is provided as a component part of another service.