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Prepared by Germane SolutionsMEDICAL 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
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Prepared by Germane SolutionsII. 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) • Purchase or lease of organizational
vehicles for client transportation programs, provided the grantee receives prior approval for the purchase of a vehicle
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 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
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
• 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
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Prepared by Germane SolutionsIII. NATIONAL FISCAL MONITORING STANDARDS (HRSA issued April 2013):
SERVICE
PERFORMANCE MEASURE/METHOD
MONITORING STANDARDS
LIMITATIONS
SECTION D: Imposition & Assessment of Client Charges
1. Ensure grantee and subgrantee policies and procedures require a publicly posted schedule of charges (e.g. sliding fee scale) to clients for services, which may include a documented decision to impose only a nominal charge
Review of subgrantee policies and procedures, to determine:
• Existence of a provider policy for a schedule
of charges. A publicly posted schedule of charges based on current Federal Poverty Level (FPL) including cap on charges
• Client eligibility for imposition of charges
based on the schedule
• Track client charges mad and payments
received
• How accounting systems are used for
tracking charges, payments, and adjustments
Establish, document and have available for review:
• Policy for a schedule of charges Current
schedule of charges
• Client eligibility determination in client records
• Fees charged by the provider and the payments
made to that provider by clients
• Process for obtaining, and documenting client
charges and payments through an accounting system, manual or electronic
2. No charges imposed on clients with incomes below 100% of the Federal Poverty Level (FPL)
Review of provider policy for schedule of charges to ensure clients with incomes below 100% of the FPL are not charged for services
Document that:
• Policy for schedule of charges does not allow
clients below 100% of FPL to be charged for services
• Personnel are aware of and consistently
following the policy for schedule of charges. Policy for schedule of charges must be publicly posted.
3. Charges to clients with incomes greater than 100% of poverty are determined by the schedule of charges. Annual limitations on amounts of charge (i.e. cap on charges) for RW services are based on the percent of client’s annual income, as follows:
• 5% for clients with incomes
between 100% and 200% of FPL
• 7% for clients with incomes
between 200% and 300% of FPL
• 10% for clients with incomes
greater than 300% of FPL
• Review of policy for schedule of charges and
cap on charges
• Review of accounting system for tracking
patient charges and payments
• Review of charges and payments to ensure
that charges are discontinued once the client has reached his/her annual cap.
Establish and maintain a schedule of charges and policy that includes a cap on charges and the following:
• Responsibility for client eligibility
determination to establish individual fees and caps
• Tracking of Part A charges or medical
expenses inclusive of enrollment fees, deductibles, co-payments, etc.
• A process for alerting the billing system that
the client has reached the cap and should not be further charged for the remainder of the year
• Personnel are aware and consistently following
the policy for schedule of charges and cap on charges.
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Prepared by Germane SolutionsIV. 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
Standard of Care Outcome Measure Numerator Denominator Data Source Goal/Benchmark
I. Structure
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
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Prepared by Germane Solutions transportation staff is qualified andtrained for the responsibilities of providing transportation and administering the transportation program
and licenses document appropriate qualifications Drivers have valid
Connecticut Driver’s License Staff has a DMV record check at least annually
Number of drivers with valid CT license Number of staff with annual DMV record check Number of drivers Number of staff Copy of valid driver license
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.
II. Process
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.
III. Outcome
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.
“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
V. 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.
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 8a 9 9a 9b 9c 10 10a 10b 10c 10d 10e 11 12 13 14 15 16 17 18
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
Maintain Access to Services & Retention in HIV Medical Care Transportation access & retention in core/support services (separate appts to medical vs. other core support services)
OUTCOME ("What Impact")
Transportation Details
Type of Transportation Documented Gas Card, Taxi Voucher, Van, Other
Bill of Rights/Grievance Procedures Client signed bill of rights, non-‐ discrimination & grievance procedures
Medical Record Release Forms Release forms (as necessary) present, current, & signed by client
Sliding Fee Scale Provider maintains current sliding fee scale per HRSA mandate
Supervision Drivers or Service Operators have documented supervisor
HIV Education All drivers receive 5 hours of HIV E66ducation per year
Recordkeeping Requirements Chart is properly stored & secure; chart is clearly organized; entries legible
DOCUMENTATION
Client Demographics/Eligibility Age, ethnicity, gender, risk/exposure documented; client eligibility assessed at least 2x in measurement year (every 6 mos)
Medical Transportation Tool
STRUCTURE ("Who")
Licensure Drivers or Service Operators have valid, current CT DMV license
Insurance Vehicles used are insured as required by the State of CT STAFF
Provider Agency has a Policy & Procedures Manual that Contains: standardized protocols for transportation service delivery transportation service limitations
eligibility requirements
PROCESS ("How")
Limits on Monthly or Annual Transportation Documented caps of Mileage limits documented
Clients Not Accommodated: Clients that can not be accommodated are referred for other transportation; Case managers are notified.
Triaging of Requests Requests are triaged for medical priority Maintenance Vehicles serviced & maintained every 3,000 miles Handicap Accessible transportation services are available as needed No Shows No Shows are documented; Case Manager is notified of 'no show'
