Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 122. Community Waiver Services for Individuals with Developmental Disabilities

12VAC30-122-440. Employment and community transportation service.

A. Service description. This service is offered in order to enable individuals to gain access to an individual's place of employment or volunteer activity, other community services or events, activities and resources, homes of family or friends, civic organizations or social clubs, public meetings or other civic activities, and spiritual activities or events as specified by the support plan and when no other means of access is available. The goal of this service is to promote the individual's independence and participation in the life of the individual's community. Use of this service shall be related to the individual's desired outcomes as stated in the ISP. This service is offered in addition to medical transportation required under 42 CFR 431.53 and transportation services under the State Plan, defined at 42 CFR 440.170(a), and does not replace them.

B. Criteria and allowable activities.

1. The service may include transportation in a private vehicle by a person such as a coworker or other community member or the purchase of tickets for public transportation such as bus or subway. In either case, an administering agency shall coordinate and bill DMAS.

2. Up to three individuals may be transported in a single, private vehicle per trip.

3. The administering agency will ensure that pertinent information about the individual is relayed to the driver.

C. Service units and limitations.

1. This service shall not be authorized or reimbursed for individuals who can access transportation through the State Plan or other waiver services that include a transportation component. The individual or legal guardian shall attest that he does not have sufficient personal financial resources (e.g., through wages) to cover the cost of the transportation himself.

2. Private transportation is reimbursed according to a "trip," which is reimbursed for the round-trip, and the number of individuals being transported to the location (maximum of three). There are three trip rates depending on the one-way distance traveled:

a. Less than 10 miles.

b. Between 10 and 20 miles.

c. Over 20 miles.

3. When a private driver is transporting more than one individual to a single destination, the trip rate for all individuals is the same and is determined by the distance between the first individual picked up and the final destination.

4. The purchase of tickets for public transportation and dissemination to the individual is coordinated by the administering agency.

5. A provider delivering other waiver services to an individual may not utilize staff to provide Employment and community transportation (ECT) and may only bill ECT if the transportation would not be a normally required element of service provision.

D. Provider qualifications and requirements.

1. The service may be provided by the individual's family member or legally responsible person, but may not be the guardian, parent, step-parent of an individual younger than 18 years of age, or spouse of an adult who is receiving the service.

2. The service shall be offered through an administering agency that possesses any DBHDS license to provide services to individuals with developmental disabilities, an employment service organization, or a center for independent living. Administering agencies shall be enrolled with DMAS through a participation agreement, to provide these services.

3. In the case of private transportation, the administering agency shall be responsible for screening community persons to drive the individual to designated locations according to the ISP.

4. The private driver shall:

a. Be 18 years of age or older;

b. Possess a valid driver's license; and

c. Possess and maintain at a minimum:

(1) A satisfactory driving record defined as no reckless driving charges within the past 24 months, and

(2) Proof of general liability insurance coverage in compliance with federal or state statutory requirements The insurance shall insure the driver or the passengers (i) against loss from any liability imposed by law for damages; (ii) against damages for care and loss of services because of bodily injury to or death of any person; (iii) against injury to or destruction of property caused by accident and arising out of the ownership, use, or operation of such motor vehicle within the Commonwealth, any other state in the United States, or Canada; (iv) subject to a limit or exclusive of interest and costs, with respect to each motor vehicle of $25,000 because of bodily injury to or death of one person in any one accident and, subject to the limit for one person, to a limit of $50,000 because of bodily injury to or death of two or more persons in any one accident; and (v) subject to a limit of $20,000 because of injury to or destruction of property of others in any one accident.

5. The administering agency shall be responsible for screening community persons to drive the individual to designated locations according to the ISP. This includes verification of the private driver's:

a. Possession of a current, valid driver's license and no reckless driving charges within the past 24 months;

b. Possession of car insurance;

c. Ensuring that the driver meets the minimum age requirement of age 18; and

d. Completion of an attestation signed by the private driver, the individual, and the individual's guardian or authorized representative, as appropriate, that the driver has disclosed any relevant felonies and if listed on any registry. The administering agency shall ensure that the driver is not listed on the Virginia Sex Offender Registry.

6. Initially and annually the administering provider shall verify and document that each private driver possesses a current, valid driver's license, and car insurance.

E. Documentation requirements for service providers.

1. Providers shall include in each individual's record:

a. A copy of the completed, standard, age-appropriate assessment form as described in 12VAC30-122-200.

b. The provider's plan for supports in the form of the ECT Trip Plan form.

c. Documentation of the trip distance estimate in the form of a MapQuest, Google Maps, or similar printout with point of origin, destination, and mileage.

d. Documentation to support units of service delivered in the form of a monthly trip log signed by the individual recording trips taken that shall correspond with billing. Providers shall maintain separate documentation for each type of service rendered for an individual.

e. A written review, supported by documentation in the individual's record, shall be submitted to the support coordinator quarterly, during any quarters in which the service was provided and if modified, with the plan for supports. This written review shall list the dates and destinations of trips taken and a statement about the individual's satisfaction with the service.

f. For private drivers, (i) copies of valid drivers' licenses, (ii) copies of the automobile insurance policies, (iii) copies of driving records, and (iv) criminal records attestations and Virginia Sex Offender Registry record checks. The driver is responsible for notifying the agency if there are any changes to previously submitted attestations or significant driving record changes, versus requiring the agency to have to obtain these every year (or whatever time period).

g. For public transportation, receipts for purchases of bus tickets, or fare cards.

h. All correspondence to the individual and the individual's family/caregiver, as appropriate, the support coordinator, DMAS, and DBHDS.

i. Written documentation of all contacts with family/caregiver, physicians, formal and informal service providers, and all professionals regarding the individual.

j. The written attestation by the individual or legal guardian that the individual does not have sufficient personal financial resources (e.g., through wages) to cover the cost of the transportation himself.

2. Provider documentation shall support all claims submitted for DMAS reimbursement. Claims that are not supported by appropriate documentation shall be subject to recovery by DMAS as a result of utilization reviews and audits.

Statutory Authority

§ 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.

Historical Notes

Derived from Virginia Register Volume 37, Issue 14, eff. March 31, 2021.

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