SPC 107. 20 / 107.21 – Transportation - Community/Non-Medical transportation (car, van, taxi, bus, or lift/ramp equipped vehicle) that is used to transport a member to an activity or authorized service that meets a long-term care outcome. Examples are supported employment, day service, or adult day care. Community transportation is a “curb to curb” service meaning member is picked up and dropped off at the curb of the point of origin and destination, respectively with assistance to board and disembark from the vehicle as needed and referred but not to enter or exit a building at the point of origin or destination. 3.2
SPC 107. 10 / 107.11 – Transportation - Medical transportation (car, van, taxi, bus, or lift/ramp equipped vehicle) other than an ambulance to a Medicaid covered service. Common Carrier is a “curb to curb” service meaning member is picked up and dropped off at the curb of the point of origin and destination, respectively with assistance to board and disembark from the vehicle as needed and referred but not to enter or exit a building at the point of origin or destination. If the member needs a companion along, transportation is provided to the companion free of charge 3.3 SPC 107.60 / 107.61 – Transportation – Specialized Transportation, other (car, van, taxi, bus, or lift/ramp equipped vehicle) that is used to transport a member to a medical service that meets a long-term care outcome. Members eligible for this service must have decision-making authority over a budget for the purchase of such services and cannot be duplicated under another category of service. 3.4 Members must be given the opportunity to direct some or all of their specialized transportation whenever possible to the extent of their ability and desire. Inclusa teams must determine the member’s ability and/or desire to direct services by assessment and by observation and address this in the member’s plan. 3.4 Prior to authorizing payment to family members, the following conditions must be met: 1) The service is authorized by the Inclusa team; 2) The member’s preference is for the family member to provide the service; 3) The Inclusa team monitors and manages any conflict of interest situation that may occur as a result of the family member providing services. 4) The family member meets the MCO’s standards for its subcontractors or employeesproviding the same service; and 5) The family member will either: • Provide an amount of service that exceeds normal family care giving responsibilities for a person in a similar family relationship who does not have a disability; or • Find it necessary to forego paid employment in order to provide the service and is not receiving a pension (including Social Security retirement benefits).
SPC 107. 12 / 107.13 – Transportation - Medical transportation (car, van, taxi, bus or lift/ramp equipped vehicle) other than an ambulance to a Medicaid covered service. Common Carrier is a “curb to curb” service meaning member is picked up and dropped off at the curb of the point of origin and destination, respectively with assistance to board and disembark from the vehicle as needed and referred but not to enter or exit a building at the point of origin or destination. If the member needs a companion along, transportation is provided to the companion free of charge 3.3 Members must be given the opportunity to direct some or all of their specialized transportation whenever possible to the extent of their ability and desire. Inclusa teams must determine the member’s ability and/or desire to direct services by assessment and by observation and address this in the member’s plan. 3.4 Prior to authorizing payment to family members the following conditions must be met: 1) The service is authorized by the Inclusa team; 2) The member’s preference is for the family member to provide the service; 3) The Inclusa team monitors and manages any conflict of interest situation that may occur as a result of the family member providing services; 4) The family member meets the MCO’s standards for its subcontractors or employees providing the same service; and 5) The family member will either: • Provide an amount of service that exceeds normal family care giving responsibilities for a person in a similar family relationship who does not have a disability; or • Find it necessary to forego paid employment in order to provide the service and is not receiving a pension (including Social Security retirement benefits).
