Documentation that: medical transportation services are used only to enable an eligible individual to access HIV-related health and support service.
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1 MEDICAL TRANSPORTATION I. DEFINITION OF SERVICE Funding for Medical Transportation Services that enable an eligible individual to access HIV-related health and support, including needed to maintain the client in HIV medical care, through either direct or vouchers or tokens. May be provided through: Contracts with providers of 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 programs, provided the grantee receives prior approval for the purchase of a vehicle Documentation that: medical are used only to enable an eligible individual to access HIV-related health and support service. Documentation that are provided through one of the following methods: 1. A contract or some other local procurement mechanism with a provider of 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 Purchase or lease of organizational vehicles for client, with prior approval from HRSA/HAB for the purchase II. DESCRIPTION OF SERVICE SERVICE PERFORMANCE MEASURE/METHOD MONITORING STANDARD LIMITATIONS Funding for Medical Transportation Documentation that: Collection and maintenance of data Services that enable an eligible individual Medical are used documenting that funds are used only for to access HIV-related health and support only to enable an eligible individual to designed to help eligible, including needed to access HIV-related health and support individuals remain in medical care by maintain the client in HIV medical care, enabling them to access medical and support through either direct or vouchers or tokens May be provided through: Contracts with providers of Voucher or token systems Use of volunteer drivers (through programs with insurance and other liability issues specifically addressed) Documentation that are provided through one of the following methods: A contract or some other local procurement mechanism with a provider of A voucher or token system that allows for tracking the distribution of the vouchers or Maintain program records that document: The level of /number of trips provided The reason for each trip and its relation to accessing health and support Trip origin and destination Updated March Collaborative Research, LLC
2 Purchase or lease of organizational vehicles for client programs, provided the grantee receives prior approval for the purchase of a vehicle 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, with prior approval from HRSA/HAB for the purchase Client eligibility The cost per trip The method used to meet the need Maintain documentation showing that the provider is meeting stated contract requirements with regard to methods of providing : 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 III. MEDICAL TRANSPORATION SERVICE COMPONENTS Program Outcome: 75% of clients will arrive at core as a result of accessing. 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 Updated March Collaborative Research, LLC
3 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 service delivery service limitations eligibility requirements service agreements with 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 Provider agency ensures that staff is qualified and trained for the responsibilities of providing and administering the program Vehicles used in are routinely serviced and maintained every 3,000 miles. Vehicles used in are insured as required by the State of CT. Agencies have a Policy & Procedures Manual addressing comprehensive list indicated Job descriptions, resumes, and licenses document appropriate qualifications Drivers have valid Connecticut Driver s License Staff has a DMV record check at least annually Vehicles used in have maintenance records and all repair information. Vehicles used in transport carry current insurance policies. Agencies with comprehensive Policy & Procedures Manual qualified staff drivers with valid CT license staff with annual DMV record check vehicles with maintenance/repair records vehicles with current insurance policies Agencies providing staff drivers staff vehicles vehicles Policy & Procedures Manual Staff file Copy of valid driver license Vehicle records & Inspection Checklist Current insurance policies on vehicles All agencies have a Policy and Procedures Manual that addresses comprehensive list indicated 100% of job descriptions, resumes & licenses document appropriate qualifications 100% of drivers valid CT Driver s License 100% of staff has a DMV record check annually 100 % of vehicles have maintenance records and all repair information 100% of vehicles that carry current insurance policies. Updated March Collaborative Research, LLC
4 Standard of Care Outcome Measure Numerator Denominator Data Source Goal/Benchmark II. Process Provider agency ensures that all operators understand their responsibilities and agree to follow agency policies. Clients that can not be accommodated are referred for other options and Case Managers are notified Handicap accessible are available as needed. Signed letters of understanding by each operator Clients not provided are referred to other options with documented contact notifying Case Managers. Handicap clients have available Drivers demonstrate ability to use handicap equipment and assist disabled riders as needed. staff with signed letter of understanding needing alternate transport client Case Managers notified handicapped clients requesting service drivers that properly use equipment staff Personnel file 100% of personnel files document signed letter of understanding by operator referred to other not receiving using handicapped transport drivers Transportation log Handicap certification Demonstration of drivers to use equipment 100% of clients not provided are referred to other options 100% of client Case Managers notified when not provided 100% of clients needing handicap have them available 100% of drivers use handicap equipment and assist disabled riders as needed. Updated March Collaborative Research, LLC
5 III. Outcome Services provided include one-way & round-trip to & from home, to Ryan White-funded & to non-ryan White-funded that provide in Ryan White categories (ex: drug treatment to a non- RW funded facility). Services also include transit tokens, passes and vouchers. Transportation are triaged for medical care as first priority. No Shows are documented in a Transportation Log and case managers are notified. Transportation increases access & maintenance in medical care, mental health & substance abuse Transportation service to/from home, RW-funded & non-rw-funded in RW categories. Transportation requests are triaged for medical priority. Transportation Logs document no-shows and Case Manager notification Maintenance in medical care &/or mental health & substance abuse showing appropriate use of a) % trips for medical care b) % trips for other core (Mental Health, Substance Abuse, Oral Health, Medical Case Mgt.) c) % trips for Support Services (Housing Assistance, EFA) d) % trips for pharmacy access no-show clients documented in Transport Log no-show clients with documentation that case managers are notified maintained in care using transport trips noshow clients Transportation Log Database Transport Log Transportation Log Surveys, Provider input 95% of charts document service to/from home, RWfunded & non- RW-funded in RW categories. 100% of requests are assessed for medical priority. 100% of Transportation Logs document no-shows 100% of Case Managers are notified for no-show clients 85% of client charts document maintenance in medical care &/or mental health/ substance abuse IV. 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. The Chart Audit Tool for Medical Transportation is attached on the next page. Updated March Collaborative Research, LLC
6 PROGRAM SITE: REVIEWER(S): New Haven Ryan White Part A HIV Chart Review: Transportation CHART #s: REVIEW DATE: STRUCTURE ( Who ) STAFF 1 Licensure: Drivers or Service Operators have valid, current CT DMV license 2 Insurance: Vehicles used are insured as required by the State of CT? 3 Supervision: Drivers or Service Operators have documented supervisor 4 HIV Education: All drivers receive 5 hours of HIV Education per year DOCUMENTATION Recordkeeping Requirements Chart is properly stored & secure; chart is clearly organized; entries legible 6 Bill of Rights/Grievance Procedures Client signed bill of rights, non-discrimination & grievance procedures 7 Medical Record Release Forms Release forms (as necessary) present, current, & signed by client Client Demographics/Eligibility 8 Age, ethnicity, gender, risk/exposure documented; client eligibility assessed at least 2x in measurement year (every 6 months) 9 Provider agency has a Policy & Procedures Manual that contains: a standardized protocols for service delivery b service limitations eligibility requirements c 10 Transportation service agreements with service operators document: a licensing b registration insurance and safety requirements c necessary action to be taken in the event of an accident d use of safety belts e cell phone usage f vehicle maintenance PROCESS ( How ) Transportation Details Type of Transportation Documented Gas Card, Taxi Voucher, Van, Other 12 Limits on Monthly or Annual Transportation Documented Caps or Mileage Limits documented 13 Clients Not Accommodated Clients that can not be accommodated are referred for other Case Managers are notified 14 Triaging of Requests: Requests are triaged for medical priority 15 Maintenance: Vehicles routinely serviced and maintained every 3,000 miles? 16 Handicap accessible are available as needed No Shows 17 No Shows are documented Case Manager is notified of no show OUTCOME ( What Impact ) Maintain Access to Services & Retention in HIV Medical Care Transportation access & retention in core/ support (separate appts to medical vs. other core vs. support ) PROGRAM MONITORING STANDARDS Y = Yes N= No NC=Non-Compliant N/A=Not Applicable (to patient or program/facility)
7 2013 CHART AUDIT OR MONITORING TOOLS Transportation clients: Trips provided one-way: # trips for Medical Care # trips for Mental Health # trips for Substance Abuse # trips for Oral Health # trips for Medical Case Mgt # trips for Housing Assistance # trips for EFA # trips for Pharmacy Access Trips provided round-trip: # trips for Medical Care # trips for Mental Health # trips for Substance Abuse # trips for Oral Health # trips for Medical Case Mgt # trips for Housing Assistance # trips for EFA # trips for Pharmacy Access New addition Program Monitoring Standards HAB Measures Indicates National HIV/AIDS Strategy Goal Refers to Scope of Services Outcome 7 P age Collaborative Research, LLC
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