Medical Transportation Services Standards - Virginia

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Virginia Department of HealthDivision of Disease PreventionHIV Care ServicesService Standards: Medical TransportationMedical Transportation Services StandardsDescription:Medical Transportation is the provision of nonemergency transportation services thatenables an eligible client to access or be retained in core medical and support services i.Program Guidance:Medical transportation may be provided through: Contracts with providers of transportation services Mileage reimbursement (through a non-cash system) that enables clients to travel toneeded medical or other support services, but should not in any case exceed theestablished rates for federal programs (Federal Joint Travel Regulations providefurther guidance on this subject) Purchase or lease of organizational vehicles for client transportation programs,provided the recipient receives prior approval for the purchase of a vehicle Organization and use of volunteer drivers (through programs with insurance andother liability issues specifically addressed) Voucher or token systems ii.Costs for transportation for medical providers to provide care should be categorized underthe service category for the service being provided.Unallowable costs include: Direct cash payments or cash reimbursements to clients Direct maintenance expenses (tires, repairs, etc.) of a privately owned vehicle Any other costs associated with a privately owned vehicle such as lease, loanpayments, insurance, license or registration fees.All service provision will comply with the Department of Health and Human Services(HHS) Guidelines and the Commonwealth of Virginia Department of Health (VDH) ServiceStandards for people living with HIV, includin the following:1.0 Intake and EligibilityNational Monitoring Standards: Eligibility determination process requiring documentationin patient medical records of low-income status and eligibility based on a specified percentof the FPL and proof of an individual’s HIV-positive status, residency. Determination anddocumentation of patient eligibility every six months.iii Documentation that medicaltransportation services funds are used only to support eligible activities, including, enablingeligible individuals to access HIV-related health and support services.iv The need forMedical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 20191

medical transportation services should be identified and documented in the client’s HIVservice plan.Human Services and Services Administration (HRSA), the funder for Ryan White HIVServices, prohibits continued HIV services, including medications to clients who are notrecertified for eligibility of services by their specified date; therefore, if a client has notcompleted their annual certification or recertification at six months they may not be eligiblefor Ryan White services.vStandardMeasureReferral1.1) Referral for Medical Transportation Services 1.1) Documentation of referral forby a Ryan White Part B provider is documentedMedical Transportation Services is presentprior to initiation of the service.in the client’s record, signed and dated.Eligibility1.2) The client’s eligibility for Ryan White Part B 1.2) Documentation of the client’sservices is determined.eligibility is present in the client’s record.1.3) To be eligible for this service applicants must: 1.3) Documentation is present in files thata) Be diagnosed with HIVverifies:b) Live in Virginiaa) Client is diagnosed with HIVc) Have an individual or family income at orb) Client lives in Virginiabelow 500% of the Federal Poverty Levelc) Client meets income guidelines(FPL)d) Client Medicaid status (gap ofd) Ryan White Part B is the payer of lastservices)resort and other funding sources must bee) Recertification for continuedvigorously pursued. Providers areeligibility for Part B services everyresponsible to ensure that clients aresix monthsscreened and deemed ineligible for othera) Client agrees to participate inpayer sources covered by Federal or Stateinsurance option that best meetsprograms such as Medicare, Medicaid, alltheir medical needs and for whichother forms of insurance or third partythe client is eligible.payers such as private and commercialinsurance plans, and other payers.e) Provide recertification every six monthswith proof of income, changes ininsurance coverage, or any changes inresidencyf) Client eligibility ensures Part B servicesare used as the payer of last resort.Client must agree to participate in theinsurance option client is eligible and thatbest meets the client’s medical needsregardless of preference.Note: The Part B Program is the payer of lastresort. This is interpreted as "funds received willnot be utilized to make payments for any item orservice to the extent that payment has been made,Medical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 20192

or can reasonably be expected to be made." byanother payment source.viApply through the VDH Central Office or throughagency’s eligibility services.Intake1.4) Eligibility screening and intake to be1.4) Documentation of intake andcompleted within 15 days of initial contact witheligibility screening in record signed andclient.dated.Recertification1.5) Client must be recertified every six months1.5) Documentation of recertification ofto continue to receive Ryan White services.the client’s eligibility every six months isThere is no grace period.present in the client’s record.2.0 Key Services Components and Activities (including assessment and service plan)National Monitoring Standards: Medical Transportation Services are used only to enable aneligible individual to access HIV-related health and support services.viiStandardMeasureDocumentation2.1) Provision of all medical transportation2.1) Documentation of medicalservices is documented by type of transportation, transportation services provided in clients’date of service and purpose.records signed and dated.2.2) Track and document referral sources in the2.2) Is there documentation of referral inclient recordthe client record?2.3) Provide cancellations policy to client2.3) Is there documentation that clients areincluding inclement weather, breakdowns etc.aware of cancellations, inclement weather,breakdowns?2.3) Arranged cab or van transportation for those 2.3) Is there documentation that cab orwith acute medical needsvan transportation is arranged for thosewith acute medical needs?2.4) Medical transportation services provided are 2.4) Documentation of purpose for allused only to enable an individual to access HIV- transportation services provided (e.g.,related health and support services.transportation to/from what type ofmedical or support service appointment)in client’s record.Assessment/Service Plan/Provision of Services2.5) An initial assessment documenting2.5) Documentation of transportation needtransportation need must be completed prior toin client’s record signed and dated.initiation of service.2.6) Within fifteen (15) business days after the2.6) Documentation of service plan ininitial assessment a service plan will beclient’s record signed and dated. Clients’developed and agreed upon by the client andneeds and service plan are reviewed andprovider outlining service goals, objectives, andrevised a minimum of every six months.interventions. This should include clientidentified needs as well as plans for continuity ofMedical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 20193

primary medical care and support services,clients are assessed for: History of accessing primary care andother services and barriers to access,particularly transportation barriers.Staff explains to the client during the firstencounter what services are available at theagency based on the client's identified needs.2.7) Voucher/Token/Bus Pass SystemAgency will have:a) Procedures in place regarding allowableuses and distribution of vouchers, buspasses and tokensb) A tracking system in place to account forthe purchase and distribution of vouchers,tokens, and bus passesc) A security system in place for storage ofand access to vouchers, bus passes, andfees collected.2.7) Documentation of each transportationservice provided signed and dated.Is there documentation that bus tickets/buspasses or gas vouchers are issued by theRyan White Part B case manager or bydesignated staff?2.8) Clients will be notified of transportationcancellations in a timely manner. Alternativetransportation services will be provided asavailable.2.8) Documentation of cancellation andreferral to alternative transportation sourcein client’s record signed and dated.2.9) Transportation agency will be notified byclient and/or provider of transportationcancellations and changes in scheduling as theyoccur.2.10) Direct Transportation – Providers ofTransportation Services2.9) Documentation of changes andcancellations in client’s record signed anddated.Direct Transportation Providers deliver nonemergency transportation services that enablean eligible client to access or be retained incore medical and support services. Clientsare provided with information ontransportation services and instructions onhow to access the services. General transportation procedures: Agency must allow clients toconfirm core or support serviceappointments at least 48 hoursin advance2.10) A signed statement from clientconsenting to transportation servicesand agreeing to safe and properconduct in the vehicle is on file.Documentation of client orientation todirect transportation services inclient’s record.Medical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 20194

Agency provides clients withinformation on transportationlimitations, clients’ responsibilitiesfor accessing and receivingtransportation, and the agency’srole and responsibilities forproviding transportation servicesClients initiate and coordinatetheir own services withtransportation providers followingclient orientation to the agenciestransportation policies, proceduresand client guidelinesAdvocates (e.g. case manager) forthe client may assist clients inaccessing transportation services ifneededAll clients will be screened forother transportation resources(e.g., Medicaid-eligible clients)Accommodations are provided forrelated/affected individuals and/orcaregivers as necessary for thebenefit of the clientClient consent to transportationservices and agreeing to safe andproper conduct in the vehicle is onfile in the client record. Consentincludes the consequences ofviolating the agreement, e.g., suchas removal, suspension and/orpossible termination oftransportation servicesAgency/Driver may refuse serviceto any client with opensores/wounds where blood andother body fluids from clients arepotentially infectious. Driver tonotify the agency immediatelyrelative to any driver refusal toprovide servicesClients and agencies are madeaware of problems immediately(e.g. vehicle breakdown) andnotification documentedMedical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 20195

Clients and Ryan White/StateServices providers are notified ofservice delays and changes inappointments or schedules as theyoccur.2.11) Agency must document the mileagebetween Trip Origin and Trip Destination (e.g.where client is transported to access eligibleservice) per a standard Internet-based mappingprogram (e.g. Yahoo Maps, Map Quest, GoogleMaps) or odometer reading for all clientsreceiving van-based transportation.Documentation of each transportation transactionincludes:viiia) Client eligibilityb) Type of transportation service used tomeet client’s needc) The level of service (e.g., the number oftrips, tokens, passes provided to theclient)d) Reason for each trip in relation tosupporting health and support servicese) Trip origin and destinationf) Cost per trip.2.12) Volunteer DriversVolunteer Drivers provide non-emergencytransportation services that enable an eligibleclient to access or be retained in core medicaland support services.2.13) Purchase or Lease of Agency VehiclesProof of prior approval fromHRSA/HAB/VDH to lease or purchasevehicle.Purchased or leased vehicles providenonemergency transportation services thatenable an eligible client to access or beretained in core medical and support services.2.11) Documentation of eachtransportation transaction in client’srecord signed and dated.2.12) Documentation of eachtransportation transaction inclient’s record signed and dated.2.13) HRSA/HAB prior approvalfor vehicle purchase on file at PartB recipient agency.Documentation of each transportationtransaction in client’s record signed anddated.Medical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 20196

Transition and Discharge2.14) Client discharged when transportation2.14) Documentation of discharge planservices are no longer needed, goals have beenand summary in client’s record with clearmet, upon death or due to safety issues. (see 2.13) rationale for discharge within 30 days ofdischarge, including certified letter, ifPrior to discharge: Reasons for discharge andapplicable.options for other service provision should bediscussed with client. Whenever possible,Is there documentation that the client wasdiscussion should occur face-to-face. If notnotified of their removal to receivepossible, provider should attempt to talk withtransportation services in writing?client via phone. If verbal contact is not possible,a certified letter must be sent to client’s lastknown address. If client is not present to sign forthe letter, it must be returned to the provider.Documentation: Client’s record must include:a) Date services startb) Special client needsc) Services needed/actions taken, ifapplicabled) Date of dischargee) Reason(s) for dischargef) Referrals made at time of discharge, ifapplicable.Transfer: If client transfers to another location,agency or service provider, transferring agencywill provide discharge summary and otherrequested records within 5 business days ofrequest. If client moves to another area,transferring agency will make referral for neededservices in the new location.Unable to Locate: If client cannot be located,agency will make and document a minimum ofthree follow-up attempts on three separate dates(by phone or in person) over a three-monthperiod after first attempt. A certified letter mustbe mailed to the client’s last known mailingaddress within five business days after the lastattempt to notify the client. The letter will statethat the case will be closed within 30 days fromthe date on the letter if an appointment with theprovider is not made.Medical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 20197

Withdrawal from Service: If client reports thatservices are no longer needed or decides to nolonger participate in the Service Plan, client maywithdraw from services. Because clients maywithdraw for a variety of reasons it may behelpful to conduct an exit interview to ensurereasons for withdrawal are understood, oridentify factors interfering with the client’sability to fully participate if services are stillneeded. If other issues are identified that cannotbe managed by the agency clients should bereferred to appropriate agencies.Administrative Discharge: Clients who engage inbehavior that abuses the safety or violates theconfidentiality of others may be discharged.Prior to discharging a client for this reason, thecase must be reviewed by leadership according tothat agency’s policies. Clients who aredischarged for administrative reasons must beprovided written notification of and reason forthe discharge, and must be notified of possiblealternative resources. A certified letter that notesthe reason for discharge and includes alternativeresources must be mailed to the client’s lastknown mailing address within five business daysafter the date of discharge, and a copy must befiled in the client’s chart.If a client is removed from transportation servicesdue to falsifying the existence of a medicalappointment in order to access service, is theredocumentation of the client being removed fromtransportation services?Case Closure2.15) Case will be closed if client:a) Has met the service goals;b) Decides to transfer to another agency;c) Needs are more appropriatelyaddressed in other programs;d) Moves out of state;e) Fails to provide updateddocumentation of eligibility statusthus, no longer eligible for services;2.15) Documentation of case closure inclient’s record with clear rationale forclosure.Medical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 20198

f) Fails to maintain contact with themedical transportation staff for aperiod of three months despite three(3) documented attempts to contactclient;g) Can no longer be located;h) Withdraws from or refuses fundedservices, reports that services are nolonger needed, or no longerparticipates in the individual serviceplan;i) Exhibits pattern of abuse as definedby agency’s policy.j) Becomes housed in an “institutional”program anticipated to last for aminimum of 30 days, such as anursing home, prison or inpatientprogram; ork) Is deceased.3.0 Client Rights and ResponsibilitiesNational Monitoring Standards: Provision of Part B funded HIV primary medical care andsupport services, to the maximum extent, without regard to either: the ability of the individualto pay for such services, or the current or past health conditions of the individuals served.ixStandardMeasure3.1) Services are available and accessible to any3.1) Written eligibility requirements andindividual who meets program eligibilitynon-discrimination policy on file.requirements.All providers shall be in compliance with allapplicable federal, state, and local antidiscrimination laws and regulations, includingbut not limited to the American’s withDisabilities Act. All providers shall adopt a nondiscrimination policy prohibiting the refusal ofrendering services on the basis of fact orperception of race, color, creed, religion, nationalorigin, ancestry, age, sex, sexual orientation,gender identity, domestic partner status, maritalstatus, height, weight, disability, or HIV/AIDSdiagnosis.Each provider shall make available to clients aprocess for requesting interpretation services,including American Sign Language.Medical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 20199

3.2) Client’s Rights and Responsibilities policyexists which requires each Client to sign & date aform indicating they has been offered: a)explanation of the policy, and b) copy of Client’sRights and Responsibilities and to communicateclient’s understanding of the policy3.3) Explanation of Client’s Rights andResponsibilities is provided to each client.3.2) Written policy on file.3.3) Current Client’s Rights andResponsibilities form signed and dated byClient and located in client’s record.Client rights include:o Be treated with respect, dignity,consideration, and compassion;o Receive services free of discrimination;o Be informed about services and optionsavailable.o Participate in creating a plan of services;o Reach an agreement about the frequencyof contact the client will have either inperson or over the phone.o File a grievance about services receivedor denied;o Not be subjected to physical, sexual,verbal and/or emotional abuse or threats;o Voluntary withdraw from the program;o Have all records be treated confidentially;Have information released only when:o A written release of information is signed;o A medical emergency exists;o There is an immediate danger to the clientor others;o There is possible child or elder abuse; oro Ordered by a court of law.Client responsibilities include:o Treat other clients and staff with respectand courtesy;o Protect the confidentiality of other clients;o Participate in creating a plan of service;o Let the agency know any concerns orchanges in needs;o Make and keep appointments, or whenpossible; phone to cancel or change anappointment time;Medical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 201910

o Stay in contact with the agency byinforming the agency of change in addressand phone number, responding to phonecalls and mailo Avoid subjecting the agency’s staff tophysical, sexual, verbal and/or emotionalabuse or threats.4.0 Grievance ProcessStandardMeasure4.1) Grievance policy exists which requires eachclient to sign & date indicating they has beenoffered: a) explanation of the policy, and b) copyof Grievance Procedure c) communication ofclient’s understanding of the policy.4.1) Written grievance procedure on file,available in languages and formatsappropriate to populations served.Policy shall describe the process for resolvingclient grievances, including identification ofwhom to contact and applicable timelines.Policy shall be available in languages andformats (e.g. for persons with disabilities)appropriate to populations served.4.2) Explanation of Grievance Procedure isprovided to each client.Clients may file a grievance if their request forservices is denied or if they have any complaintor concern about the services received.4.3) Grievance process shall be fair andexpeditious for resolution of client grievances.4.4) Review the grievance policy yearly withclient signature.4.2) Current Grievance Procedure formsigned and dated by client and located inclient’s record.4.3) Documentation of client grievances,status and resolution.4.4) Current Client’s Rights andResponsibilities form signed and dated byclient and located in client’s record.5.0 Personnel Qualifications (including licensure)Direct transportation services may be provided by transportation agencies employingcommercial/professional drivers or agencies using volunteer drivers.xStandardMeasure5.1) All professional drivers must have a current5.1) Copy of current Virginia DriverVirginia Driver License or Virginia CommercialLicense/Virginia Commercial DriverDriver’s License (CDL) if needed and be insured.Medical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 201911

license and insurance coverage in driver’spersonnel file.5.2) Direct TransportationAgency staff and volunteers providing medicaltransportation through direct transportation mustmaintain appropriate vehicle insurance, liability,licenses, and training as follows:.a)b)c)d)e)5.2) Signed statement agreeing tomaintain confidentiality and safe drivingpractices in driver’s personnel file.Individual/transportation agency vehicleinsurance on file with agency providingAgency maintains correct level of liability transportation services.insurance for all drivers as required by theCommonwealth of VirginiaDocumentation of training completed inAll drivers have current Virginia driver’s personnel file at agency providinglicenses appropriate for the type oftransportation services.vehicle drivenDrivers must have verified drivingrecords, receive a drug screen andbackground checkDriver has maintained a clean drivingrecord for the past year with less than3 convicted traffic moving violationsand no DUIStaff and Drivers for agencyconveyance will have receivedtraining in universal precautions andinfection control appropriate to theirduties.5.3) Newly employed professional drivers mustcomplete the following training within 30 days ofhire: Agency orientation Confidentiality, client’s rights, grievanceprocedures & sensitivity CPR and First Aid5.3) Documentation of training completedin personnel file.5.4) All professional drivers must maintain a safedriving record and maintain current certificationfor CPR and First Aid.5.5) All professional drivers must complete 2hours of annual OSHA training on seatbelt,restraint and wheelchair safety annually.5.4) Documentation of annual assessmentof driving record and annual training inthe personnel file.5.5) Documentation of training completedin personnel file.Medical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 201912

5.6) Staff Supervisiona) Each agency must have and implement awritten plan for supervision of all staffb) Supervisors must review monthlytransportation logs for completeness,compliance with these standards, and qualityand timeliness of service deliveryc) Staff must be evaluated at least annually bytheir supervisor according to written Agencypolicy on performance appraisals.5.6) Documentation of completed staffsupervision plan at agencies providingtransportation services.Documentation of monthly transportationlog at agencies providing transportationservices.Documentation of annual staffperformance evaluations.6.0 Cultural and Linguistic CompetencyStandard6.1) Health services are culturally andlinguistically competent, client-guided andcommunity based. At a minimum, provider’sdocumentation should include:Measure6.1) Documentation of cultural andlinguistic competence as reported inannual Cultural and LinguisticCompetency Report.a) Experience with providing services to thediverse ethnic, linguistic, sexual orcultural populations targeted;b) Capacity of staff, including volunteersand Board, to design, provide andevaluate culturally and linguisticallyappropriate services;c) List of cultural competency trainingscompleted by staff.6.2) Easy-to-understand print and multimedia6.2) Culturally and linguisticallymaterials and signage in the languages commonly appropriate materials and signageused by the populations in the service area shallaccessible.be available.xi7.0 Privacy and Confidentiality (including securing records)Standard7.1) Client confidentiality policy exists whichinclude: 1) Release of information requirements,and b) Health Insurance Portability andAccountability Act.7.2) Client’s consent for release of information isdetermined.Measure7.1) Written client confidentiality policyon file at provider agency.7.2) Current Release of Information Formsigned and dated by client and providerrepresentative and located in client’srecord. Each release form indicates whomay receive the client’s information andMedical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 201913

has an expiration of not more than 12months from date of signature.7.3) Each client file is stored in a secure location.Electronic client records are protected fromunauthorized use.7.3) Files stored in locked file or cabinetwith access limited to only appropriatepersonnel. Electronic files are secure withpassword protection and access is limitedto appropriate personnel.7.4) Annual submission of Verification of Receipt 7.4) Documentation of signed Verificationof Assurance of Key Requirements document byof Receipt of Assurance of Keyall staff that handle client identifyingRequirement forms.information.8.0 Quality ManagementNational Monitoring Standards: Implement a Clinical Quality Management Program(CQM) to include: a) written QM plan; b) quality expectations for providers and services; c)method to report and track expected outcomes; d) monitoring of provider compliance withHHS treatment guidelines and Part B Program’s approved Standards of Care.xiiStandardMeasure8.1) Measure and report client health outcomes8.1) Performance measurement data onusing Medical Transportation Services measures the following indicators:approved by VDH. Percentage of people living with HIVand receiving Transportation Services,regardless of age, who will have atleast two care markers in a 12 monthperiod that are at least 6 months apart(Care marker defined as evidence of aHIV medical care visit date, a CD4count and test date, a viral load valueand test date, and/or an antiretroviralmedication prescription and date). Percentage of people enrolled in RWPart B-funded Program living withHIV and receiving TransportationServices, regardless of age, who willhave an HIV viral load less than 200copies/mL at last HIV viral load testduring the measurement year.Medical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 201914

HRSA/HAB HIV/AIDS Program Services: Clarifications on Eligible Individuals & Allowable Uses ofFunds, Policy Clarification Notice 16-02 ( revised 10/22/18)iiiHRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards for Part A and BGrantees: Universal (April, 2013), p. 4.iv HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards — Program Part B(April, 2013), p.38.v HRSA/HAB Ryan White HIV/AIDS Program Services: Clarifications on Ryan White Program EligibilityDeterminations and Recertification Requirements Policy Clarification Notice #13 -02vi Public Health Service Act; Sections 2605(a)(6), 2617 (b) (7) (F), 2664 (f) (1), and 2671 (i).vii HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards — Program Part B(April, 2013), p.38.viii HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards —Program Part B(April, 2013), p.38.ix HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards —Program Part B(April, 2013), pp. 61-62.x HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards —Program Part B(April, 2013), p.38.xi National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and HealthCare. Available pdfs/EnhancedNationalCLASStandards.pdfxii HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards —Program Part B(April, 2013), p. 71.iiiMedical Transportation ServicesVDH Standards of Services Revised: June 2015, November 2017 and January 201915

Transportation Services Direct Transportation Providers deliver non-emergency transportation services that enable an eligible client to access or be retained in core medical and support services. Clients are provided with information on transportation services and instructions on how to access the services. General transportation procedures:

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