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 TO: All Commercial and Non-Commercial Medicaid Transportation Providers (Agency/ Individuals/Non medical Home- and community-based services (HCBS) waiver providers)

FROM: KATHLEEN ALLYN, Deputy Administrator
Division of Medicaid

During the 2000 session, the Idaho Legislature enacted a law, effective April 14, 2000, limiting the number of Medicaid clients for which a noncommercial transportation provider can be reimbursed to five. The Department is in the process of promulgating temporary/proposed rules as a result of the new law. In the interim, because the law is already in effect, the Department has adopted the following policies.

1. CLARIFICATION OF COMMERCIAL VS. NON-COMMERCIAL PROVIDERS

The Department is using the following definitions for transportation providers:

"Commercial Transportation Provider": An entity in the business of non-emergent transportation that is organized to provide, that publicly holds itself out to provide, and that actually provides personal transportation services to the general public. By "holding itself out" to the general public, the provider vigorously and diligently solicits riders from the general populace. By "actually providing" services to the general public, the provider’s riders include substantial numbers of persons whose travel is funded by a source other than Medicaid.

"Non-Commercial Transportation Provider": Any non-emergent transportation provider (either individual or agency) that does not meet the definition of a commercial transportation provider is a non-commercial provider. Agency transporters are entities that provide transportation as well as at least one other service to one or more Medicaid clients. If an agency permits employees to transport clients in employees’ personal vehicles, the agency must ensure that adequate liability insurance coverage is carried for those circumstances. Individual transporters are non-commercial providers who transport a family member, acquaintance, or other person in a personal vehicle.

If the Medicaid clients being transported are also clients of the provider for services such as residential care, mental health, developmental therapy or other services, the provider will be considered a non-commercial provider with respect to those clients, even if the provider otherwise qualifies as a commercial provider. A commercial provider will be considered non-commercial with respect to any Medicaid clients transported, if those clients are receiving any other service from, or are being transported to another service in which the provider has any ownership or control.

2. COMMERCIAL DEMAND RESPONSE PROVIDERS – TEMPORARY HOLD ON RATE INCREASES

During its 2000 session, the Idaho Legislature directed the Department to hold the total expenditure for transportation services to state fiscal year 2000 levels. As one step in implementing this requirement, the Department is not processing any updates after March 1, 2000, of rate schedules of commercial demand response providers. Representatives of the Department have been meeting for a number of months with representatives of these providers to resolve program-related issues, and the group is scheduled to reconvene in October to assess whether the hold on rate updates needs to continue in order to meet the legislative requirements.

3. NON-MEDICAL TRANSPORTATION FOR HOME AND COMMUNITY BASED (HCBS) WAIVERS

Non-medical transportation no longer requires a stand-alone provider agreement. Subsequently, although non-medical transportation will continue to be a covered service under the HCBS waivers, the separate provider specialty for non-medical transportation is being discontinued. Non-medical transportation may be provided by the following specialties: 109 - Commercial providers, 110 - Individual providers, and 111 - Agency providers. Providers billing for non-medical transportation must use the following waiver procedure codes: 0080B - Developmental Disability and Idaho State School and Hospital waivers, 0080P - Aged and Disabled waiver, and 0080T - Traumatic Brain Injury waiver. Non-medical transportation is paid at the current mileage rate identified by the Department.

4. RULE MODIFICATION

Proposed transportation rules will be published in the October Bulletin. Following publication, there is a 21-day period to make comment to the Department on recommended changes to these rules.

5. AMENDMENT TO PROVIDER AGREEMENT AND APPLICATION

An amendment to the Provider Agreement and to your original application is attached to this information release. If you want to continue as an Idaho Medicaid transportation provider, please indicate on the application amendment the specialty that describes your transportation service. Sign and return the amendment to EDS Provider Enrollment at P.O. Box 23, Boise, Idaho 83707 by 9/25/2000. You will also need to attach the following required documentation to justify the type of transportation provider you indicated on the amendment:

Commercial

  • Copy of vehicle liability insurance cover sheet indicating the coverage period and (1) a minimum coverage of $500,000 for bodily injury or death and $500,000 for property damage, or $1,000,000 combined OR (2) the minimum coverage required by the government regulatory body for that transportation service.
  • If the minimum insurance coverage of a government regulatory body is used, a copy of that government regulatory body's insurance requirement.
  • Description of marketing efforts and example of how services are advertised (yellow pages, newspaper ad, brochures, etc.).

Non-Commercial – (Agency or Individual)

  • Agency - copy of vehicle liability insurance cover sheet indicating the coverage period and a minimum coverage of $100,000 per person and $300,000 per occurrence.
  • Individual – copy of vehicle liability insurance cover sheet indicating the coverage period and at least the minimum liability insurance required by Idaho law (currently $25,000 per person, $50,000 per occurrence, and $15,000 property damage).

For further information regarding this release, please contact Jean Christensen, Bureau of Medicaid Programs and Resource Management, at (208) 364-1828.

Thank you for your continued participation in the Idaho Medicaid Program.

_______________________________________________________________________

NOTICE OF AMENDMENT
AND
AMENDMENT TO MEDICAID TRANSPORTATION PROVIDER AGREEMENT

Effective April 14, 2000

The Idaho Legislature has enacted a law that requires the Department of Health and Welfare to treat Medicaid transportation services differently than it has in the past. Consequently, certain additional terms must be made in the Medicaid transportation provider agreements to fulfill the intent of the law. Pursuant to clause 11 of the Medicaid Provider Agreement, notice is hereby given that the following terms and conditions are added to the Provider Agreement, effective April 14, 2000:

  1. Elimination of Non-Medical Transportation Provider Agreement. Non-medical transportation no longer requires a stand-alone provider agreement, and the separate provider specialty for non-medical transportation is being discontinued. Non-medical transportation may be provided by the following specialties: 109 - Commercial providers, 110 - Individual providers, and 111 - Agency providers.
  2. Definitions. The following definitions of "commercial transportation provider" and "non-commercial transportation provider" shall apply:
2.1  "Commercial Transportation Provider": An entity in the business of non-emergent transportation that is organized to provide, that publicly holds itself out to provide, and that actually provides personal transportation services to the general public. By "holding itself out" to the general public, the provider vigorously and diligently solicits riders from the general populace. By "actually providing" services to the general public, the provider’s riders include substantial numbers of persons whose travel is funded by a source other than Medicaid.

2.2  "Non-Commercial Transportation Provider": Any non-emergent transportation provider (either individual or agency) that does not meet the definition of a commercial transportation provider is a non-commercial provider. Agency transporters are entities that provide transportation as well as at least one other service to one or more Medicaid clients. If an agency permits employees to transport clients in employees’ personal vehicles, the agency must ensure that adequate liability insurance coverage is carried for those circumstances. Individual transporters are non-commercial providers who transport a family member, acquaintance, or other person in a personal vehicle. If the Medicaid clients being transported are also clients of the provider for services such as residential care, mental health, developmental therapy or other services, the provider will be considered a non-commercial provider with respect to those clients, even if the provider otherwise qualifies as a commercial provider. A commercial provider will be considered non-commercial with respect to any Medicaid clients transported, if those clients are receiving any other service from, or are being transported to another service in which the provider has any ownership or control.

  1. Insurance Requirements

3.1  Commercial. Commercial transportation providers shall carry vehicle liability insurance with (1) a minimum coverage of $500,000 for bodily injury or death and $500,000 for property damage, or $1,000,000 combined OR (2) the minimum coverage required by the government regulatory body for that transportation service.

3.2  Non-Commercial.

3.2.1  Agency. Agency transportation providers shall carry vehicle liability insurance with a minimum coverage of $100,000 per person and $300,000 per occurrence.

3.2.2  Individual. Individual transportation providers shall carry vehicle liability insurance with at least the minimum liability insurance required by Idaho law (currently $25,000 per person, $50,000 per occurrence, and $15,000 property damage).
  1. Provider Application Documentation Requirements. Applicants to become Medicaid transportation providers shall submit and maintain the following documentation:

4.1  Commercial Transportation Provider.

4.1.1  Copy of vehicle liability insurance cover sheet indicating the coverage period and (1) a minimum coverage of $500,000 for bodily injury or death and $500,000 for property damage, or $1,000,000 combined OR (2) the minimum coverage required by the government regulatory body for that transportation service.

4.1.2  If the minimum insurance coverage of a government regulatory body is used, a copy of that government regulatory body's insurance requirement.

4.1.3  Description of marketing efforts and example of how services are advertised (yellow pages, newspaper ad, brochures, etc.)

4.2  Non-Commercial – (Agency or Individual).

4.2.1  Agency. Copy of vehicle liability insurance cover sheet indicating the coverage period and a minimum coverage of $100,000 per person and $300,000 per occurrence.

4.2.2  Individual. Copy of vehicle liability insurance cover sheet indicating the coverage period and at least the minimum liability insurance required by Idaho law (currently $25,000 per person, $50,000 per occurrence, and $15,000 property damage).

  1. Limitation on Reimbursement Per Vehicle. Reimbursement for non-commercial transportation will be limited to no more than five (5) Medicaid eligible passengers per vehicle during any trip or leg of a trip.

  2. Hardship Exception. The Department may grant an exception on the basis of hardship in order for a provider to be reimbursed for more than five (5) passengers at a time. The provider must submit information to show at minimum that its costs of vehicle operation exceed the five-passenger reimbursement rate. In evaluating requests for exception, the Department will consider factors such as alternative forms of services and transportation available in the area, the cost of alternatives, the appropriateness of the vehicles utilized and the benefit to clients. The Department may limit the exception including the amount of additional reimbursement and the time duration of the exception.

 

 

AMENDMENT TO PROVIDER APPLICATION
(choose one only)

 

______ Commercial Transportation Provider

Required Documentation:

  • Copy of vehicle liability insurance cover sheet indicating the coverage period and (1) a minimum coverage of $500,000 for bodily injury or death and $500,000 for property damage, or $1,000,000 combined OR (2) the minimum coverage required by the government regulatory body for that transportation service.
  • If the minimum insurance coverage of a government regulatory body is used, a copy of that government regulatory body's insurance requirement.
  • Description of marketing efforts and example of how services are advertised (yellow pages, newspaper ad, brochures, etc.)

 

_______ Non-Commercial Agency Transportation Provider

Required Documentation:

  • Copy of vehicle liability insurance cover sheet indicating the coverage period and a minimum coverage of $100,000 per person and $300,000 per occurrence.

 

______ Non-Commercial Individual Transportation Provider

Required Documentation:

  • Copy of vehicle liability insurance cover sheet indicating the coverage period and at least the minimum liability insurance required by Idaho law (currently $25,000 per person, $50,000 per occurrence, and $15,000 property damage).

 

I have indicated above the provider specialty that applies to the transportation service with the name and Idaho Medicaid provider number indicated below. I have attached all required documentation pertinent to the applicable provider specialty.

_________________________________________
Printed Provider Name

_________________________________________
Medicaid Provider Number

 

_________________________________________ __________________
Provider Signature Date

 

PLEASE SIGN AND RETURN THE AMENDMENT TO EDS PROVIDER ENROLLMENT AT 
P.O. BOX 23, BOISE, IDAHO 83707 BY 9/25/2000