Documentation that: medical transportation services are used only to enable an eligible individual to access HIV-related health and support service.

Updated March 2013

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MEDICAL TRANSPORTATION

I. DEFINITION OF SERVICE

Funding for Medical Transportation Services that enable an eligible individual to access HIV-related health and support services, including services

needed to maintain the client in HIV medical care, through either direct transportation services or vouchers or tokens.

May be provided through:

 Contracts with providers of transportation services

 Voucher or token systems

 Use of volunteer drivers (through programs with insurance and other liability issues specifically addressed)

 Purchase or lease of organizational vehicles for client transportation programs, provided the grantee receives prior approval for the purchase of a

vehicle

Documentation that: medical transportation services are used only to enable an eligible individual to access HIV-related health and support service.

Documentation that services are provided through one of the following methods:

1.

A contract or some other local procurement mechanism with a provider of transportation services

2.

A voucher or token system that allows for tracking the distribution of the vouchers or tokens

3.

A system of mileage reimbursement that does not exceed the federal per-mile reimbursement rates limited to approved agency staff members.

4.

A system of volunteer drivers, where insurance and other liability issues are addressed

Purchase or lease of organizational vehicles for client transportation, with prior approval from HRSA/HAB for the purchase

II. DESCRIPTION OF SERVICE

SERVICE PERFORMANCE MEASURE/METHOD

MONITORING STANDARD

LIMITATIONS

Funding for Medical Transportation Services that enable an eligible individual to access HIV-related health and support services, including services needed to maintain the client in HIV medical care, through either direct transportation services or vouchers or tokens

Documentation that:

• Medical transportation services are used only to enable an eligible individual to access HIV-related health and support services

Collection and maintenance of data

documenting that funds are used only for

transportation designed to help eligible

individuals remain in medical care by

enabling them to access medical and support

services

May be provided through: • Contracts with providers of

transportation services • Voucher or token systems • Use of volunteer drivers (through

programs with insurance and other liability issues specifically addressed)

Documentation that services are provided through one of the following methods: • A contract or some other local procurement

mechanism with a provider of transportation services

• A voucher or token system that allows for tracking the distribution of the vouchers or

Maintain program records that document:

• The level of services/number of trips

provided

• The reason for each trip and its relation to

accessing health and support services

• Trip origin and destination

Updated March 2013

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vehicles for client transportation programs, provided the grantee receives prior approval for the purchase of a vehicle

tokens

• A system of mileage reimbursement that does not exceed the federal per-mile reimbursement rates

• A system of volunteer drivers, where insurance and other liability issues are addressed

• Purchase or lease of organizational

vehicles for client transportation, with prior approval from HRSA/HAB for the

purchase

• Client eligibility

• The cost per trip

• The method used to meet the

transportation need

Maintain documentation showing that the

provider is meeting stated contract

requirements with regard to methods of

providing transportation:

• Reimbursement methods do not involve

cash payments to service recipients

• Mileage reimbursement does not exceed

the federal reimbursement rate

• Use of volunteer drivers appropriately

addresses insurance and other liability

issues

III. MEDICAL TRANSPORATION SERVICE COMPONENTS

Program Outcome: 75% of clients will arrive at core services as a result of accessing transportation.

Indicator: The number of clients who arrived at core service appointments as a result of Transportation Services.

Service Unit(s): Successful Completed Transport to Core Services Via Bus Token/Pass/Taxi Voucher/Van Ride

Updated March 2013

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Provider agency has a comprehensive Policy & Procedures Manual that contains:

• standardized protocols for transportation service delivery • transportation service limitations • eligibility requirements

• transportation service agreements with transportation service

operators and providers, including: − licensing

− registration − insurance and safety

requirements

− necessary action to be taken in the event of an accident − use of safety belts − child care safety − cell phone usage − vehicle maintenance

Agencies have a Policy & Procedures Manual

addressing comprehensive list indicated

Agencies with

comprehensive Policy & Procedures Manual Number of Agencies providing transportation services Policy & Procedures Manual

All agencies have a Policy and Procedures Manual that addresses comprehensive list indicated

Provider agency ensures that transportation staff is qualified and trained for the responsibilities of providing transportation and administering the transportation program

Job descriptions, resumes, and licenses document appropriate qualifications

Drivers have valid

Connecticut Driver’s License Staff has a DMV record check at least annually

Number of qualified staff

Number of drivers with valid CT license Number of staff with annual DMV record check Number of staff Number of drivers Number of staff Staff file Copy of valid driver license 100% of job descriptions, resumes & licenses document appropriate qualifications

100% of drivers valid CT Driver’s License

100% of staff has a DMV record check annually Vehicles used in transportation

services are routinely serviced and maintained every 3,000 miles.

Vehicles used in

transportation services have maintenance records and all repair information.

Number of vehicles with maintenance/repair records Number of vehicles Vehicle records & Inspection Checklist 100 % of vehicles have maintenance records and all repair information

Vehicles used in transportation services are insured as required by the State of CT.

Vehicles used in transport services carry current insurance policies.

Number of vehicles with current insurance policies

Number of vehicles Current insurance policies on vehicles 100% of vehicles that carry current insurance policies.

Updated March 2013

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Provider agency ensures that all transportation operators understand their responsibilities and agree to follow agency policies.

Signed letters of understanding by each operator

Number of staff with signed letter of understanding

Number of staff Personnel file 100% of personnel files document signed letter of understanding by operator

Clients that can not be accommodated are referred for other transportation options and Case Managers are notified

Clients not provided transportation are referred to other transportation options with documented contact notifying Case Managers.

Number of clients needing alternate transport

Number of client Case Managers notified Number of clients referred to other services Number of clients not receiving transportation Transportation log 100% of clients not provided transportation are referred to other transportation options

100% of client Case Managers notified when not provided

transportation Handicap accessible transportation

services are available as needed.

Handicap clients have available services

Drivers demonstrate ability to use handicap equipment and assist disabled riders as needed.

Number of handicapped clients requesting service Number of drivers that properly use equipment

Number of clients using handicapped transport Number of drivers Handicap certification Demonstration of drivers to use equipment 100% of clients needing handicap services have them available

100% of drivers use handicap equipment and assist disabled riders as needed.

Updated March 2013

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Services provided include one-way & round-trip transportation to & from home, to Ryan White-funded services & to non-Ryan White-funded services that provide services in Ryan White categories (ex: drug treatment to a non-RW funded facility). Services also include transit tokens, passes and vouchers. Transportation services are triaged for medical care as first priority.

Transportation service to/from home, RW-funded services & non-RW-funded services in RW categories. Transportation requests are triaged for medical priority.

Number of clients showing appropriate use of transportation

a) % trips for medical care

b) % trips for other core services (Mental Health, Substance Abuse, Oral Health, Medical Case Mgt.)

c) % trips for Support Services (Housing Assistance, EFA) d) % trips for pharmacy access Number of clients using transport services Number of transportation trips Transportation Log Database 95% of charts document transportation service to/from home, RW-funded services & non-RW-funded services in RW categories. 100% of transportation requests are assessed for medical priority.

Service provider will document in client files/transportation logs a completed eligibility assessment of the client for Transportation services

Percentage of clients who receive transportation support services with completed eligibility assessment

Number of clients accessing transportation services that were assessed for eligibility

Number of clients accessing transportation services Transportation Log Database, Client chart 100% of clients accessing Transportation support services have a completed eligibility assessment on file

“No Shows” are documented in a Transportation Log and case managers are notified.

Transportation Logs

document no-shows and Case Manager notification Number of no-show clients documented in Transport Log Number of no-show clients with

documentation that case managers are notified

Number of clients

Number of no-show clients

Transport Log 100% of Transportation Logs document no-shows 100% of Case Managers are notified for no-show clients

Transportation increases access & maintenance in medical care, mental health & substance abuse services

Maintenance in medical care &/or mental health & substance abuse services

Number of clients maintained in care

Number of clients Transportation Log

Surveys, Provider input

85% of client charts document maintenance in medical care &/or mental health/ substance abuse services

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IV. DATA REPORTING

Part A service providers are responsible for documenting and keeping accurate records of Ryan White Program Data/Client information,

units of service, and client health outcomes.

Reporting units of service are a component of each agency’s approved workplan. Please refer to the most current workplan, including any

amendments, for guidance regarding units of service.

Summaries of service statistics by priority will be made available to the Planning Council by the Grantee for priority setting, resource

allocation and evaluation purposes.

HIV Chart Review: Transportation

PROGRAM SITE: CHART #s:

REVIEWER(S): REVIEW DATE:

STRUCTURE (“Who”)

STAFF

1 Licensure: Drivers or Service Operators have valid, current CT DMV license

2 Insurance: Vehicles used are insured as required by the State of CT? 3 Supervision: Drivers or Service Operators have documented supervisor 4 HIV Education: All drivers receive 5 hours of HIV Education per year

DOCUMENTATION 1 2 3 4 5 6 7 8 9 10

5 Recordkeeping Requirements

Chart is properly stored & secure; chart is clearly organized; entries legible 6 Bill of Rights/Grievance Procedures _{Client signed bill of rights, non-discrimination & grievance procedures} 7 Medical Record Release Forms

Release forms (as necessary) present, current, & signed by client

8

Client Demographics/Eligibility

Age, ethnicity, gender, risk/exposure documented; client eligibility assessed at least 2x in measurement year (every 6 months) 9

a b c

Provider agency has a Policy & Procedures Manual that contains:  standardized protocols for transportation service delivery  transportation service limitations  eligibility requirements 10 a b c d e f

Transportation service agreements with service operators document:  licensing

 registration

 insurance and safety requirements

 necessary action to be taken in the event of an accident  use of safety belts

 cell phone usage  vehicle maintenance

PROCESS (“How”)

Transportation Details 1 2 3 4 5 6 7 8 9 10

11 Type of Transportation Documented Gas Card, Taxi Voucher, Van, Other

12 Limits on Monthly or Annual Transportation Documented _{Caps or Mileage Limits documented}

13

Clients Not Accommodated

Clients that can not be accommodated are referred for other transportation Case Managers are notified

___ ___ ___ ___ __ __ __ __ __ __ 14 Triaging of Requests: Requests are triaged for medical priority

15 Maintenance: Vehicles routinely serviced and maintained every 3,000 _miles? 16 Handicap accessible transportation services are available as needed 17

No Shows

No Shows are documented

Case Manager is notified of ‘no show’

___ ___ ___ ___ __ __ __ __ __ __

OUTCOME (“What Impact”) 1 2 3 4 5 6 7 8 9 10

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Maintain Access to Services & Retention in HIV Medical Care Transportation access & retention in core/ support services (separate appts to medical vs. other core vs. support services)

PROGRAM MONITORING STANDARDS

8 | P a g e C o l l a b o r a t i v e R e s e a r c h , L L C

Number of Transportation clients: ____________

Trips provided one-way:

# trips for Medical Care

____________

# trips for Mental Health

____________

# trips for Substance Abuse

____________

# trips for Oral Health

____________

# trips for Medical Case Mgt

____________

# trips for Housing Assistance

____________

# trips for EFA

____________

# trips for Pharmacy Access

____________

Trips provided round-trip:

# trips for Medical Care

____________

# trips for Mental Health

____________

# trips for Substance Abuse

____________

# trips for Oral Health

____________

# trips for Medical Case Mgt

____________

# trips for Housing Assistance

____________

# trips for EFA

____________

# trips for Pharmacy Access

____________

Program Monitoring Standards HAB Measures

Indicates National HIV/AIDS Strategy Goal Refers to Scope of Services Outcome