473 Neb. Admin. Code, ch. 4, § 005

Current through September 17, 2024

Section 473-4-005 - TRANSPORTATION SERVICES

Transportation service is transporting an eligible recipient to and from allowable community resources when the recipient has no other transportation. Service may be provided by an individual, exempt provider, or by common carrier .

005.01TRANSPORTATION DEFINITIONS. The following definitions apply to Transportation services :

005.01(A)COMMON CARRIER. Common carrier means any person who transports passengers by motor vehicle for hire and is licensed as such with the Public Service Commission.

005.01(B)ESCORT SERVICES. Escort Services means an attendant or caregiver accompanying a minor or person who is physically, mentally, or developmentally disabled and unable to travel or wait without assistance or supervision.

005.01(C) EXEMPT PROVIDER. An exempt provider means the carriers are exempted from Public Service Commission licensure by law including those that:

(i) Transport for hire persons who are aged and their spouses and dependents under a contract with a municipality or county;

(ii) Are owned and operated by a nonprofit organization which has been exempted from the payment of federal income taxes as provided by Section 501(c)(4), Internal Revenue Code, and transporting solely those persons over age 60, their spouses and dependents, or persons experiencing disabilities;

(iii) Are operated by a municipality or county as authorized by law in the transportation of persons who are aged;

(iv) Are operated by a governmental subdivision or a qualified public purpose organization having motor vehicles with a seating capacity of 20 or less and are engaged in the transportation of passengers in the state;

(v) Are operated by a governmental subdivision or a qualified public purpose organization having motor vehicles with a seating capacity of 20 or less and are engaged in the transportation of passengers in the state;

(vi) Are engaged in the transportation of passengers and are operated by a transit authority created under and acting pursuant to the laws of the State of Nebraska; and

(vii) Provide escort services under contract with the Department or with any agency organized under the Nebraska Community Aging Services Act.

005.01(D)INDIVIDUAL PROVIDER. An individual provider is a person who is not in the business of providing transportation for hire for example, a friend, neighbor or non-legally responsible relative.

005.01(E)MEDICAL ESCORT. A medical escort is an attendant or caregiver accompanying a minor or persons who are physically, mentally, or developmentally disabled and unable to travel or wait without assistance or supervision to receive a Nebraska Medicaid coverable service.

005.01(F)NEBRASKA MEDICAID COVERED SERVICE. This is a medical service that could be covered by the Nebraska Medical Assistance Program as specified in Nebraska Administrative Code Title 471.

005.01(G)TARIFF. Tariff is the geographic and rate parameters of operation assigned to a particular carrier by the Public Service Commission.

005.02NEED FOR SERVICE. Transportation services are not provided based on the demand of the recipient. Need for a service implies that the provision of that service will assist the recipient in achieving program outcomes. Eligible recipients are required to have the following conditions:

(1) Have no access to a working licensed vehicle or a valid driver's license;

(2) Be unable to drive due to physical or cognitive limitation;

(3) Be unable to secure transportation from relatives, friends, or other organizations at no cost; or

(4) Require transportation to receive a Nebraska Medicaid covered service. Transportations services cannot be authorized if the recipient is eligible for Medicaid .

005.02(A)RESIDENTS OF NURSING FACILITIES OR IMMEDIATE CARE FACILITIES FOR DEVELOPMENTAL DISABILITIES. Residents of nursing facilities or immediate care facilities for development disabilities are not eligible to receive transportation through the Social Services for the Aged and Disabled Program, except for discharge transportation. All other transportation is the responsibility of the facility. Transportation, including moving the individual's household goods or personal property, may not be authorized for these recipients.

005.02(B)MEDICAL ESCORT SERVICES. The following conditions must be met for a recipient to be eligible for escort services:

(i) Be physically or mentally unable to travel alone or wait alone to obtain a Medicaid coverable service;

(ii) Require assistance with personal care; o

(iii) Require supervision; and

(iv) Must not be currently Medicaid eligible.

005.03NON-MEDICAL TRANSPORTATION. The services are authorized for the following needs:

(A)APPLYING FOR BENEFITS AND SERVICES:

(i) Public assistance

(ii) Social Security; or

(iii) Veteran's benefits ; or

(B) SHOPPING FOR FOOD AND ESSENTIAL ITEMS:

(i) Shop for food;

(ii) Receive commodities or food pantry services;

(iii) Obtain clothing or personal care items;

(iv) Obtain legal services, receive legal counsel from legal aid societies, private attorneys, county attorneys and other professional legal sources; or

(v) Allow the recipient to obtain financial services and to take care of financial matters; or

(C)SECURING HOUSING. A recipient may be approved to locate, secure or retain adequate housing or independent living arrangement. Transportation may be provided for a recipient to return home from a hospital or nursing home; or

(D)RECEIVE SOCIAL SERVICES FOR THE AGED AND DISABLED. Transportation to allow the transporting of a recipient to and from congregate meals and adult day services; or

(E) ARRANGE EDUCATION OR TRAINING. The recipient may make arrangements for participation in a formal educational or employment skill training program directed toward a self-support goal; or

(F)SECURE EMPLOYMENT. The recipient is allowed transportation to locate, apply for or secure paid employment or training leading to paid employment, but they are not allowed transportation to and from employment.

005.04TRANSPORTATION SERVICE PROVIDER STANDARDS. The Department approves provider agreements with common carriers, exempt providers, escort providers, and individual providers. To be approved, providers must meet all general provider standards in addition to the service specific standards. Annual reviews for provider agreements are required to renew the agreement. The provider must continue to meet all provider standards and service specific standards.

005.04(A)COMMON CARRIER STANDARDS. Public Service Commission certifies common carriers. Taxis and van companies are certified by the Public Service Commission as common carriers.

005.04(B)EXEMPT PROVIDER STANDARDS. Exempt providers must ensure that their employees meet the individual provider standards.

005.04(C)ESCORT PROVIDER STANDARDS. The provider must;

(1) Be an individual aged 19 or older;

(2) Have training or experience in working with persons who are aged or who have a disability;

(3) Have training or experience in providing personal assistance;

(4) Agree to have his or her driving records reviewed, if the escort will drive;

(5) Maintain information on specific needs of each recipient served; and

(6) Report all changes observed to the recipient's services coordinator.

005.04(C)(i) The escort provider who personally drives the recipient must also meet all individual provider standards. The escort provider is required to complete the individual transportation provider self-certification.

005.04(C)(ii) If the recipient requires an escort and the escort will not drive, sufficient transportation units for both the recipient and the escort are authorized with another suitable transportation option.

005.04(D)INDIVIDUAL PROVIDER STANDARDS. Provider agreements with individual providers by Neb. Rev. Stat. § 75-303.03 can be authorized only if the driver and vehicle standards are met at all times when the individual is providing transportation for a client.

005.04(D)(i)DRIVER STANDARDS. The individual provider requirements include:

(1) Have been chosen by the recipient or the usual caregiver to provide transportation;

(2) Be age 19 or older;

(3) Possess a current and valid driver's license;

(4) Have no more than three points assessed against their Nebraska driver's license, or meet a comparable standard in the state where they are licensed to drive;

(5) Currently have no limitations that would interfere with safe driving;

(6) Personally drive their own vehicle to transport the recipient;

(7) Use seat belts and child passenger restraint devices as required by law;

(8) Not smoke while transporting the recipient;

(9) Not transport the recipient while under the influence of alcohol or any drug that impairs the ability to drive safely;

(10) Not provide transportation if they have a communicable disease which poses a threat to the health and well-being of the recipient;

(11) Have and maintain the minimum automobile liability and medical insurance coverage as required by law; and

(12) Report disqualification from any Department program for intentional program violation.

005.04(D)(ii)VEHICLE STANDARDS. The individual provider's vehicle requirements are:

(1) Currently licensed and registered as required by law;

(2) Kept at all times in proper physical and mechanical conditions;

(3) Equipped with operable seat belts, turn signals, lights, and horn;

(4) Equipped with proper child passenger restraint devices as required by law when transporting children; and

(5) Equipped to provide comfortable temperature and ventilation conditions.

005.04(D)(iii)REGISTRY CHECKS. The following registries are checked:

(a) Adult Protective Services Central Registry;

(b) Central Register of Child Protection Cases; and

(c) Nebraska State Patrol Sex Offender Registry.

005.04(D)(iii)(1) If the potential provider does not reside in Nebraska, or has resided in Nebraska for less than one year, the Department must check registries in the state of residence or previous residence.

005.04(D)(iii)(2) The Department will not approve a provider agreement with the potential individual provider if a report of abuse or neglect concerning the individual provider has been determined to be Court Substantiated or Department Substantiated on the Adult Protective Services Central Registry or Court Substantiated, Court Pending, or Inconclusive on the Central Registery of Child Protection Cases.

005.04(D)(iii)(3) The Department will not approve a provider agreement with a potential individual provider if the individual's name appears on the Nebraska State Patrol Sex Offender Registry.

005.04(D)(iv)CRIMINAL BACKGROUND CHECKS. The Department is required to:

(a) Obtain a criminal history statement from the potential individual provider; and

(b) Perform a criminal history check of the potential individual provider.

005.04(D)(iv)(1)GENERAL CRIMINAL HISTORY. The Department must not approve a provider agreement with a potential individual provider if a history of convictions for misdemeanor or felony actions that endanger the health and safety of any client is indicated. This includes crimes against a child or vulnerable adult, crimes involving intentional bodily harm, crimes involving the illegal use of a controlled substance, and crimes involving moral turpitude on the part of the potential provider, or any major traffic violations.

005.04(D)(iv)(2)SPECIFIC CRIMINAL HISTORY. A provider agreement will be denied or terminated when conviction has occurred in the following areas:

(a) Child pornography;

(b) Child or adult abuse;

(c) Driving under the influence: a driving under the influence conviction within the past eight years;

(d) Domestic assault;

(e) Shoplifting after age 19 and within the last three years;

(f) Felony fraud within the last 10 years;

(g) Misdemeanor fraud within the last five years;

(h) Termination of provider status for cause from any Department program within the last 10 years;

(i) Possession of any controlled substance within the last five years;

(j) Possession of a controlled substance with intent to deliver within the last 10 years;

(k) Felony or misdemeanor assault without a weapon in the last 10 years;

(l) Felony or misdemeanor assault with a weapon in the last 15 years;

(m) Prostitution or solicitation of prostitution within the last five years;

(n) Felony or misdemeanor robbery or burglary within the last 10 years;

(o) Rape or sexual assault; or

(p) Homicide.

005.04(D)(iv)(3) Pending charges are reviewed by the Department to determine whether the recipient's safety is in jeopardy. Other convictions are weighted to similar offenses included in the aforementioned list .

005.04(D)(v)INDIVIDUAL PROVIDER APPROVAL PROCESS. A copy of the individual's current driver's license, insurance card, and vehicle registration is required. The provider must complete and sign the provider self-certification and the provider agreement. In addition to having no more than three points assessed against their driver's license, each provider's past eight-year driving history must be considered. If a license has been suspended or revoked, the provider must not be approved for eight years from the date of suspension or revocation.

005.04(D)(v)(1) RENEWAL. The provider self-certification and the provider agreement is renewed annually. The registry checks and criminal history checks will be completed for each renewal. Department staff must obtain a copy of the individual's current driver's license, insurance card, and vehicle registration. No provider agreement with a provider whose name appears on the registries, or whose criminal history check indicates any convictions, will be renewed.

005.04(D)(v)(2)TERMINATION. The provider agreement will be terminated if the individual provider is found to be in violation of any of the regulatory standards. Any provider agreement with a provider whose name appears on the registries or whose criminal history check indicates any convictions will be terminated.

005.05AUTHORIZATION PROCEDURES. Before authorizing transportation or escort services, the use of family, neighbors, friends, or community agencies that will provide this service without charge, whenever possible, will be explored .

005.05(A)NON-MEDICAL TRANSPORTATION. For areas where exempt providers are available, or the recipient has chosen to use an individual provider, the recipient will not be allowed to use common carriers unless the exempt, or individual provider, cannot provide the service.

005.05(A)(i)AUTHORIZATION OF EXEMPT PROVIDERS. The Department will approve a provider agreement with, and authorize services for a provider who is exempt from Public Service Commission licensure as appropriate to meet a recipient's needs. The availability of a common carrier does not limit the use of an exempt provider.

005.05(A)(ii)MEDICAL ESCORT. The following is the criteria to determine when to authorize an hourly rate for medical escort services:

(a) The escort is not a legally responsible member of the recipient's family;

(b) The recipient is not able to secure an escort at no cost; and

(c) The escort is not receiving payment from another source.

005.05(A)(ii)(1)UTILIZATION OF EXEMPT PROVIDERS AS THE DRIVER. When transportation is provided by an exempt provider, the cost of the escort's transportation is authorized only if there is an extra charge for the escort's transportation, such as with air fares, rural transit system, or city bus systems.

005.05(A)(ii)(2)UTILIZATION OF COMMON CARRIER. When transportation is provided by common carrier provider, the provider may not charge an extra cost for transporting the escort.

005.05(A)(ii)(3)UTILIZATION OF INDIVIDUAL PROVIDERS AS THE DRIVER. When transportation is provided to a recipient and an escort by an individual provider, the provider will not be paid an additional amount for transporting the escort.

005.05(B)INDIVIDUAL PROVIDERS. An individual can be authorized as the provider if the following criteria are met:

(i) The recipient has chosen the individual provider;

(ii) The individual will personally drive the vehicle; and

(iii) The individual meets provider standards.

005.06TRANSPORTATION SERVICES RATES, FREQUENCY, AND MAXIMUM ALLOWABLE UNITS. The following regulations apply to transportation services:

005.06(A)CONDITIONS FOR PAYMENT. The Department will pay for transportation services only:

(i) When the recipient is actually in the vehicle; and

(ii) Using the most direct and logical route from the recipient's residence to the service location.

005.06(B)UPPER LIMITS. The Department establishes transportation rates according to the following limits:

005.06(B)(i)COMMON CARRIERS. Neb. Rev. Stat. § 75-303.02 limits the distance rates for common carriers at a rate no greater than three times the state employee mileage rate. The maximum reimbursement rate does not apply when the carrier:

(1) Transports the recipient wholly within the corporate limits of the city or village where the transportation of the recipient originated; or

(2) Transports a disabled person as defined by the federal Americans with Disabilities Act of 1990 in a vehicle that is compliant with the regulations for the transportation of the disabled person.

005.06(B)(ii)TAXIS. Taxi rates may be no greater than 95% of published rates.

005.06(B)(iii) EXEMPT PROVIDERS. The Department will establish rates for exempt providers.

005.06(B)(iv)ESCORT PROVIDERS. The mileage rate for escort providers must not exceed the state employee mileage rate unless the escort is a certified carrier. The hourly rate is set by the Department.

005.06(B)(v)INDIVIDUAL PROVIDERS. As provided in Neb. Rev. Stat. § 75-303.03, the Department will reimburse the individual provider for costs incurred in transportation at a rate no greater than that paid for reimbursement of state employees under Neb. Rev. Stat. § 81-1176.

005.06(C)FREQUENCY. The frequency for medical and non-medical transportation is by miles or trip. The frequency for medical escort services is by:

(i) The hour(s) and miles; or

(ii) The hours and trip.

005.06(D)MAXIMUM ALLOWABLE UNITS. Transportation units must be authorized based on the recipient's need not to exceed the following limits:

(i) Non-medical Transportation:

(1) 50 miles per one way trip;

(2) One round trip per week for shopping for food and essential items;

(3) Two round trips per month for necessary business; or

(4) One round trip per day for congregate meals.

(ii) Medical Transportation: Based on needed treatment and care.

473 Neb. Admin. Code, ch. 4, § 005

Adopted effective 7/11/2021