Medical Transportation

Medical Transportation Pg Service Category Definition, Urban And Rural - Part A 1 Ryan White Part A 2012-2013 Standards of Care 8 2012 Mid-year Outcomes Report - Part A 16 Why is Medical Transportation so Important? Air Ambulance and Medical Flight News, April 2012 20 METROLift Eligibility Information 21

FY 2014 Houston EMA/HSDA Ryan White Part A/MAI Service Definition Page 1 of 22 HRSA Service Category Title: (RWGA use only) Local Service Category Title: Service Category Code: (RWGA use only) Budget Type: (RWGA use only) Estimated Amount Available: Estimated unduplicated Clients to be Served during contract term: (RWGA use only) Budget Requirements or Restrictions: (RWGA use only) Medical Transportation (Van Based) (Revision Date: xx/xx/xx) Medical Transportation a. Transportation targeted to Urban b. Transportation targeted to Rural To Be Determined (TBD) Hybrid Fee for Service TBD $0.00 of which $x.xx is set aside to provide Medical Transportation Services to eligible PLWHA residing in the Rural area of the Houston EMA/HSDA (i.e. residing outside of Harris County). TBD eligible Harris County PLWHA and TBD eligible rural PLWHA for a combined total of TBD unduplicated clients to be served. Units assigned to Urban Transportation must only be used to transport clients whose residence is in Harris County. Units assigned to Rural Transportation may only be used to transport clients who reside in Houston EMA/HSDA counties other than Harris County. Mileage reimbursed for transportation is based on the documented distance in miles from a client s Trip Origin to Trip Destination as documented by a standard Internetbased mapping program (i.e. Google Maps, Map Quest, Yahoo Maps) approved by RWGA. Agency must print out and file in the client record a trip plan from the appropriate Internet-based mapping program that clearly delineates the mileage between Point of Origin and Destination (and reverse for round trips). This requirement is subject to audit by the County. Transportation to employment, employment training, school, or other activities not directly related to a client s treatment of HIV disease is not allowable. Clients may not be transported to entertainment or social events under this contract. Taxi vouchers must be made available for documented emergency purposes and to transport a client to a disability

FY 2014 Houston EMA/HSDA Ryan White Part A/MAI Service Definition Page 2 of 22 HRSA Service Category Definition: (RWGA use only) Local Service Category Definition: hearing, emergency shelter or for a documented medical emergency. Contractor must reserve 7% of the total budget for Taxi Vouchers. Maximum monthly utilization of taxi vouchers cannot exceed 14% of the total amount of funding reserved for Taxi Vouchers. Emergencies warranting the use of Taxi Vouchers include: van service is unavailable due to breakdown, scheduling conflicts or inclement weather or other unanticipated event. A spreadsheet listing client s 11-digit code, age, date of service, number of trips, and reason for emergency should be kept on-site and available for review during Site Visits. Contractor must provide RWGA a copy of the agreement between Contractor and a licensed taxi vendor by March 30, 2014. All taxi voucher receipts must have the taxi company s name, the driver s name and/or identification number, number of miles driven, destination (to and from), and exact cost of trip. The Contractor will add the client s 11-digit code to the receipt and include all receipts with the monthly Contractor Expense Report (CER). A copy of the taxi company s statement (on company letterhead) must be included with the monthly CER. Supporting documentation of disbursement payments may be requested with the CER. Medical transportation services include conveyance services provided, directly or through voucher, to a client so that he or she may access health care services. a. Urban Transportation: Contractor will develop and implement a medical transportation program that provides essential transportation services to HRSA-defined Core Services through the use of individual employee or contract drivers with vehicles/vans to Ryan White Program-eligible individuals residing in Harris County. Clients residing outside of Harris County are ineligible for Urban transportation services. Exceptions to this requirement require prior written approval from RWGA. b. Rural Transportation: Contractor will develop and implement a medical transportation program that provides essential transportation services to HRSA-defined Core Services through the use of individual employee or contract drivers with vehicles/vans to Ryan White

FY 2014 Houston EMA/HSDA Ryan White Part A/MAI Service Definition Page 3 of 22 Program-eligible individuals residing in Houston EMA/HSDA counties other than Harris County. Clients residing in Harris County are ineligible for this transportation program. Exceptions to this requirement require prior written approval from RWGA. Essential transportation is defined as transportation to public and private outpatient medical care and physician services, substance abuse and mental health services, pharmacies and other services where eligible clients receive Ryan White-defined Core Services and/or medical and health-related care services, including clinical trials, essential to their well-being. The Contractor shall ensure that the transportation program provides taxi vouchers to eligible clients only in the following cases: To access emergency shelter vouchers or to attend social security disability hearings; Van service is unavailable due to breakdown or inclement weather; Client s medical need requires immediate transport; Scheduling Conflicts. Contractor must provide clear and specific justification (reason) for the use of taxi vouchers and include the documentation in the client s file for each incident. RWGA must approve supporting documentation for taxi voucher reimbursements. For clients living in the METRO service area, written certification from the client s principal medical provider (e.g. medical case manager or physician) is required to access van-based transportation, to be renewed every 180 days. Medical Certifications should be maintained on-site by the provider in a single file (listed alphabetically by 11-digit code) and will be monitored at least annually during a Site Visit. It is the Contractor s responsibility to determine whether a client resides within the METRO service area. Clients who live outside the METRO service area but within Harris County (e.g. Baytown) are not required to provide a written medical certification to access van-based transportation. All clients living in the Metro service area may receive a maximum of 4 non-certified round trips per year (including taxi vouchers). Non-certified trips will be reviewed during the annual Site Visit. Provider must maintain an up-to-date spreadsheet documenting such trips. The Contractor must implement the general transportation program in accordance with the Transportation Standards of Care that include entering all transportation services into the Centralized Patient Care Data Management System (CPCDMS) and providing eligible children

FY 2014 Houston EMA/HSDA Ryan White Part A/MAI Service Definition Page 4 of 22 Target Population (age, gender, geographic, race, ethnicity, etc.): Services to be Provided: Service Unit Definition(s): Financial Eligibility: Client Eligibility: with transportation services to Core Services appointments. Only actual mileage (documented per the selected Internet mapping program) transporting eligible clients from Origin to Destination will be reimbursed under this contract. The Contractor must make reasonable effort to ensure that routes are designed in the most efficient manner possible to minimize actual client time in vehicles. a. Urban Transportation: HIV/AIDS-infected and Ryan White Part A/B eligible affected individuals residing in Harris County. b. Rural Transportation: HIV/AIDS-infected and Ryan White Part A/B eligible affected individuals residing in Fort Bend, Waller, Walker, Montgomery, Austin, Colorado, Liberty, Chambers and Wharton Counties. To provide Medical Transportation services to access Ryan White Program defined Core Services for eligible individuals. Transportation will include round trips to single destinations and round trips to multiple destinations. Taxi vouchers will be provided to eligible clients only for identified emergency situations. Caregiver must be allowed to accompany the HIV-infected rider. Eligibility for Transportation Services is determined by the client s County of residence as documented in the CPCDMS. One (1) unit of service = one (1) mile driven with an eligible client as passenger. Client cancellations and/or no-shows are not reimbursable. Refer to the RWPC s approved FY 2014 Financial Eligibility for Houston EMA Services. a. Urban Transportation: Only individuals diagnosed with HIV/AIDS and Ryan White Program eligible HIV-affected individuals residing inside Harris County will be eligible for services. b. Rural Transportation: Only individuals diagnosed with HIV/AIDS and Ryan White Program eligible HIV-affected individuals residing in Houston EMA/HSDA Counties other than Harris County are eligible for Rural Transportation services. Documentation of the client s eligibility in accordance with approved Transportation Standards of Care must be obtained by the Contractor prior to providing services. The Contractor must ensure that eligible clients have a signed consent for transportation services, client rights and responsibilities prior to the commencement of services. Affected significant others may accompany an HIV-infected person as medically necessary (minor children may accompany their caregiver as necessary). Ryan White Part A/B eligible affected individuals may utilize the services under this contract for travel to Core Services

FY 2014 Houston EMA/HSDA Ryan White Part A/MAI Service Definition Page 5 of 22 Agency Requirements when the aforementioned criteria are met and the use of the service is directly related to a person with HIV infection. An example of an eligible transportation encounter by an affected individual is transportation to a Professional Counseling appointment. Proposer must be a Certified Medicaid Transportation Provider. Contractor must furnish such documentation to Harris County upon request from Ryan White Grant Administration prior to March 1 st annually. Contractor must maintain such certification throughout the term of the contract. Failure to maintain certification as a Medicaid Transportation provider may result in termination of contract. Contractor must provide each client with a written explanation of contractor s scheduling procedures upon initiation of their first transportation service, and annually thereafter. Contractor must provide RWGA with a copy of their scheduling procedures by March 30, 2014, and thereafter within 5 business days of any revisions. Contractor must also have the following equipment dedicated to the general transportation program: A separate phone line from their main number so that clients can access transportation services during the hours of 7:00 a.m. to 10:00 p.m. directly at no cost to the clients. The telephone line must be managed by a live person between the hours of 8:00 a.m. 5:00 p.m. Telephone calls to an answering machine utilized after 5:00 p.m. must be returned by 9:00 a.m. the following business day. A fax machine with a dedicated line. All equipment identified in the Transportation Standards of Care necessary to transport children in vehicles. Contractor must assure clients eligible for Medicaid transportation are billed to Medicaid. This is subject to audit by the County. The Contractor is responsible for maintaining documentation to evidence that drivers providing services have a valid Texas Driver s License and have completed a State approved Safe Driving course. Contractor must maintain documentation of the automobile liability insurance of each vehicle utilized by the program as required by state law. All vehicles must have a current Texas State Inspection. The minimum acceptable limit of automobile liability insurance is $300,000.00 combined single limit. Agency must maintain detailed records of mileage driven and names of individuals provided with transportation, as well as origin and destination of trips. It is the Contractor s responsibility to verify the County in which clients reside in.

FY 2014 Houston EMA/HSDA Ryan White Part A/MAI Service Definition Page 6 of 22 Staff Requirements Special Requirements: (RWGA use only) A picture identification of each driver must be posted in the vehicle utilized to transport clients. Criminal background checks must be performed on all direct service transportation personnel prior to transporting any clients. Drivers must have annual proof of a safe driving record, which shall include history of tickets, DWI/DUI, or other traffic violations. Conviction on more than three (3) moving violations within the past year will disqualify the driver. Conviction of one (1) DWI/DUI within the past three (3) years will disqualify the driver. Individuals who qualify for transportation services through Medicaid are not eligible for these transportation services. Contractor must ensure the following criteria are met for all clients transported by Contractor s transportation program: Transportation Provider must ensure that clients use transportation services for an appropriate purpose through one of the following three methods: 1. Follow-up hard copy verification between transportation provider and Destination Agency (DA) program confirming use of eligible service(s), or 2. Client provides receipt documenting use of eligible services at Destination Agency on the date of transportation, or 3. Scheduling of transportation services was made by receiving agency s case manager or transportation coordinator. The verification/receipt form must at a minimum include all elements listed below: Be on Destination Agency letterhead Date/Time CPCDMS client code Name and signature of Destination Agency staff member who attended to client (e.g. case manager, clinician, physician, nurse) Destination Agency date stamp to ensure DA issued form.

FY 2014 Houston EMA/HSDA Ryan White Part A/MAI Service Definition Page 7 of 22 FY 2014 RWPC How to Best Meet the Need Decision Process Step in Process: Council Recommendations: 1. Approved: Y No: Approved With Changes: Date: 06/13/13 If approved with changes list changes below: 2. 3. Step in Process: Steering Committee Recommendations: 1. Approved: Y No: Approved With Changes: Date:06/06/13 If approved with changes list changes below: 2. 3. Step in Process: Quality Assurance Committee Recommendations: 1. 2. 3. Approved: Y No: Approved With Changes: Date:05/16/13 If approved with changes list changes below: Step in Process: HTBMTN Workgroup Recommendations: Financial Eligibility: Date: 04/29/13 1. 2. 3.

Page 8 of 22 2013-2014 HOUSTON ELIGIBLE METROPOLITAN AREA: RYAN WHITE CARE ACT PART A/B STANDARDS OF CARE FOR HIV SERVICES RYAN WHITE GRANT ADMINISTRATION SECTION HARRIS COUNTY PUBLIC HEALTH AND ENVIRONMENTAL SERVICES (HCPHES)

Page 9 of 22 Transportation Services The 2006 Care Act classifies Medical Transportation as a support service that provides conveyance services directly or through voucher to a client so that he or she may access health care services. The Ryan White Part A transportation services include transportation to public and private outpatient medical care and physician services, substance abuse and mental health services, pharmacies and other services where eligible clients receive Ryan White-defined Core Services and/or medical and health-related care services, including clinical trials, essential to their well-being. All drivers utilized by the program must have a valid Texas Driver s license and must complete a Safe Driving course. The contractor must ensure that each vehicle has automobile liability insurance as required by the State and all vehicles have current Texas State Inspection. 1.0 Transportation services are offered to eligible clients to ensure individuals most in need have access to services. 1.1 Client Eligibility In order to be eligible for services, individuals must meet the following: HIV+ Residence in the Houston EMA/HSDA Part A Urban Transportation limited to Harris County Part A Rural/Part B Transportation are limited to Houston EMA/HSDA, as applicable Income no greater than 300% of the Federal Poverty level Proof of identification Documentation of ineligibility for Third Party Reimbursement 1.2 Voucher Guidelines (Distribution Sites) Bus Card Voucher (Renewal): Eligible clients who reside in the Metro service area will be issued a Metro bus card voucher by the client s record-owning agency for an annual bus card upon new registration and annually thereafter, within 15 days of bus pass expiration Bus Card Voucher (Transitional): Eligible clients who have never received a bus voucher and reside in the Metro service area may be issued a transitional bus card voucher by the client s record-owning agency for an annual one time only bus card upon new registration Bus Card Voucher (Value-Based): Otherwise eligible Documentation of HIV+ status, identification, residence and income in the client record Client record indicates guidelines were followed; if not, an explanation is documented Documentation of the type of voucher(s) issued Emergency necessitating taxi voucher is documented Ongoing current (within the last 180 days) medical care is documented in the CPCDMS OR A current (within the last 180 days) copy of client s Viral Load and/or CD4 lab work As of December 13, 2012

Page 10 of 22 clients who are not eligible for a renewal bus card voucher or a transitional bus card voucher may be issued a valuebased bus card voucher per RWGA business rules In order for an existing bus card client to renew their bus card (i.e. obtain another bus card voucher for all voucher types) there must be documentation that the client is engaged in ongoing primary medical care for treatment of HIV disease, or Documentation that the bus voucher is needed to ensure an out-of-care client is re-engaged in primary medical care Gas Card: Eligible clients in the rural area will receive gas cards from their Ryan White Part A/B rural case management provider or their rural primary care provider, if the client is not case managed, per RWGA business rules Taxi Voucher: for emergencies, to access emergency shelter vouchers and to attend Social Security disability hearings only 1.3 Eligibility for Van-Based Transportation (Urban Transportation Only) Written certification from the client s principal medical provider (e.g. medical care coordinator) is required to access van-based transportation and must be renewed every 180 days. (preferred) or proof client is on ART (HIV medications) for clients in medical care with Ryan White or non-ryan White funded providers in client record OR Engagement/re-engagement in medical care is documented in client s case management assessment and service plan, OR (MCC CCM only) client meets criteria of difficult to engage per RWGA policy, and ongoing efforts to engage client in primary medical care are documented in the clinical record including employing harm reduction strategies, motivational interviewing, home visits, etc. to build trust and improve likelihood of client enrolling/engaging in Primary Medical Care. Maximum of 12 months allowed under this option without prior approval from RWGA. Low need/bus Pass Only individuals are not eligible for this option. Client record indicates compliance All clients may receive a maximum of 4 non-certified round trips per year (includes taxi vouchers). 2.0 ACCESSIBILITY Transportation services are offered in such a way as to overcome barriers to access and utilization. 2.1 Notification of Service Availability Program information is clearly publicized Prospective and current clients are informed of service availability, Availability of services, prioritization prioritization and eligibility requirements. policy and eligibility requirements are defined in the information publicized 2.2 Access Agency s policies and procedures for As of December 13, 2012

Page 11 of 22 Clients must be able to initiate and coordinate their own services with the transportation providers in accordance with transportation system guidelines. This does not mean an advocate (e.g. social worker) for the client cannot assist the client in accessing transportation services. Agency must obtain a signed statement from clients regarding agreement on proper conduct of client in the vehicle. This statement should include the consequences of violating the agreement. transportation services describe how the client can access the service Review of agency s complaint and grievances log Signed agreement in client s records 2.3 Handicap Accessibility Transportation services are handicap accessible. Agency/Driver may refuse service to client with open sores/wounds or real exposure risk. Agency must have a policy in place regarding training for drivers on the proper boarding/unloading assistance of passengers with wheel chairs and other durable health devices. 2.4 EMA Accessibility Services are available throughout the Houston EMA as contractually defined in the RFP. 2.5 Service Availability The Contractor must ensure that general transportation service hours are from 7:00 AM to 10:00 PM on weekdays (non-holidays), and coverage must be available for medical and health-related appointments on Saturdays. 2.6 Service Capacity Agency will notify RWGA and other Ryan White providers when transportation resources are close to being maximized*. Agency will maintain documentation of clients who were refused services. * Maximized means the agency will not be able to provide service to client within the next 72 hours. 3.0 Timeliness and Delays: Transportation services are provided in a timely manner Agency compliance with the Americans with Disabilities Act (ADA) Agency documentation of reason for refusal of service Documentation of training in personnel records Review of agency s Transportation Log and Monthly Activity Reports for compliance Review of Transportation Logs Transportation services shall be available on Saturdays, by pre-scheduled appointment for core services Review of agency policy and procedure RWGA will be contacted by phone/fax no later than twenty-four (24) working hours after services are maximized Agency will document all clients who were denied transportation or a voucher As of December 13, 2012

Page 12 of 22 3.1 Timeliness There is minimal waiting time for vehicles and vans; appointments are kept Waiting times longer than 2 hours will also be documented in the client record If a cumulative incident of clients kept waiting for more than 2 hours reaches 75 clients in the contract year, this must be reported in writing within one business day to the administrative agent Review of agency s complaint and grievance logs Client interviews and client satisfaction survey 3.2 Immediate Service Problems Clients are made aware of problems immediately (e.g. vehicle breakdown) and notification documented. 3.3 Future Service Delays Clients and Ryan White providers are notified of future service delays, changes in appointment or schedules as they occur. 3.4 Confirmation of Appointments Agency must allow clients to confirm appointments at least 48 hours in advance. 3.5 No Shows No Shows are documented in Transportation Log and client file. Waiting times longer than 60 minutes will be documented in Delay Incident Log. Review of Delay incident log Review of client s record Review of Delay Incident Log, Transportation Refusal Log and client record indicates compliance Review of agency s complaint and grievance logs Client interviews and client satisfaction survey Review of Delay Incident Log, Transportation Refusal Log and client record indicates compliance Review of agency s complaint and grievance logs Client interviews and client satisfaction survey Documentation exists in the client record Review of agency s transportation policies and procedures indicates compliance Review of agency s complaint and grievance logs Client interviews and client satisfaction survey. Review of agency s transportation policies and procedures indicates compliance Documentation on Transportation Log As of December 13, 2012

Page 13 of 22 Passengers who do not cancel scheduled rides for two (2) consecutive times or who no show for two (2) consecutive times or three times within the contract year may be removed from the van/vehicle roster for 30 days. If client is removed from the roster, he or she must be referred to other transportation services. One additional no show and the client can be suspended from service for one (1) year. 3.6 System Abuse If an agency has verified that a client has falsified the existence of an appointment in order to access transportation, the client can be removed from the agency roster. If a client cancels van/vehicle transportation appointments in excess of three (3) times per month, the client may be removed from the van/vehicle roster for 30 days. Agency must have published rules regarding the consequences to the client in situations of system abuse. Documentation in client record Documentation in the client record of verification that an appointment did not exist Documentation in the client record of client cancellation of van/vehicle appointments Availability of agency s published rules Written documentation in the client file of specific instances of system abuse 3.7 Documentation of Service Utilization Transportation Provider must ensure: Follow-up verification between transportation provider and destination service program confirming use of eligible service(s) or Client provides proof of service documenting use of eligible services at destination agency on the date of transportation or Scheduling of transportation services by receiving agency s case manager or transportation coordinator In order to mitigate Agency exposure to clients who may fail to follow through with obtaining the required proof of service, Agency is allowed to provide one (1) one-way trip per client per year without proof of service documentation. Documentation of confirmation from destination agency in agency/client file Client s original receipt from destination agency in agency/client file Documentation in Case Manager s progress notes Documentation in agency/client file of the one (1) allowable one-way trip per year without proof of service documentation As of December 13, 2012

Page 14 of 22 The content of the proof of service will include: Agency s letter head Date/Time CPCDMS client code Name and signature of Agency s staff who attended to client Agency s stamp 4.0 Safety/Vehicle Maintenance: Transportation services are safe 4.1 Vehicle Maintenance and Insurance Vehicles are in good repair and equipped for adverse weather conditions. All vehicles will be equipped with both a fire extinguisher and first aid and CPR kits. A file will be maintained on each vehicle and shall include but not be limited to: description of vehicle including year, make, model, mileage, as well as general condition and integrity and service records. Inspections of vehicle should be routine, and documented not less than quarterly. Seat belts/restraint systems must be operational. When in place, child car seats must be operational and installed according to specifications. All lights and turn signals must be operational, brakes must be in good working order, tires must be in good condition and air conditioning/heating system must be fully operational. Driver must have radio or cell phone capability. 4.2 Emergency Procedures Transportation emergency procedures are in place (e.g. breakdown of agency vehicle). Written procedures are developed and implemented to handle emergencies. Each driver will be instructed in how to handle emergencies before commencing service, and will be in-serviced annually. 4.3 Transportation of Children Children must be transported safely. When transporting children Inspection of First Aid/CPR kits indicates compliance Review of vehicle file Current vehicle State Inspection sticker. Fire extinguisher inspection date must be current Proof of current automobile liability and personal injury insurance in the amount of at least $300,000.00 A copy of each in-service and sign-in roster with names both printed and signed and maintained in the driver s personnel file Review of Transportation Log indicates As of December 13, 2012

Page 15 of 22 under the age of two (2) 4, operational car seats are made available. Necessity of a car seat should be documented on the Transportation Log by staff when appointment is scheduled. Children 15 years old or younger must be accompanied by an adult caregiver in order to be transported. compliance Review of client records indicates compliance 5.0 Records Administration: Transportation services are documented consistently and appropriately 5.1 Transportation Consent Prior to receiving transportation services, clients must read and sign the Transportation Consent. 5.2 Van/Vehicle Transportation Agency must document daily transportation services on the Transportation Log. 5.3 Mileage Documentation Agency must document the mileage between Trip Origin and Trip Destination (e.g. where client is transported to access eligible service) per a standard Internet-based mapping program (e.g. Yahoo Maps, Map Quest, Google Maps) for all clients receiving Van-based transportation services. Review of client records indicates compliance Review of agency files indicates compliance Log must contain driver s name, client s name or identification number, date, destinations, time of arrival, and type of appointment. Map is printed out and filed in client chart 4 Texas Department of Public Safety, Texas Traffic Law Handout TRC545.412 Child Passenger Safety Seat Systems. As of December 13, 2012 61

Page 16 of 22 FY 2012 MID-YEAR YEAR OUTCOMES REPORTS HIGHLIGHTS RYAN WHITE GRANT ADMINISTRATION HARRIS COUNTY PUBLIC HEALTH & ENVIRONMENTAL SERVICES (HCPHES)

Page 17 of 22 Ryan White Part A OUTCOME MEASURES RESULTS FY 2012 Mid-Year Report Transportation Outcome Measure Indicator Data Collection Method 1.0 Knowledge, Attitudes, and Practices 1.1 Increased/maintained utilization of primary care services Van-Based Transportation: a. A minimum of 50% of clients will utilize Part A/B/C/D primary care services after accessing van transportation services. Bus Pass Transportation: b. A minimum of 50% of clients will utilize Part A/B/C/D primary care services after accessing bus transportation services. CPCDMS A. Van-Based Transportation: From 3/1/2012 through 8/31/2012, 175 clients utilized Part A van transportation services. According to CPCDMS, 85 (49%) of these clients accessed primary care at least once during this time period after utilizing van transportation services, and 3 (1.7%) clients accessed primary care for the first time after utilizing van transportation services. B. Bus Pass Transportation: From 3/1/2012 through 8/31/2012, 1,209 clients utilized Part A bus pass services. According to CPCDMS, 416 (34%) of these clients accessed primary care at least once during this time period after utilizing bus pass services.

Page 18 of 22 Outcome Measure Indicator Data Collection Method 1.0 Knowledge, Attitudes, and Practices 1.2 Increased/maintained utilization of other core medical services Van-Based Transportation: A minimum of a. 35% of clients will utilize oral health care services after accessing van transportation services. b. 10% of clients will utilize professional counseling services after accessing van transportation services. c. 35% of clients will utilize Part A/B LPAP services after accessing van transportation services. Bus Pass Transportation: A minimum of d. 20% of clients will utilize Part A/B LPAP services after accessing bus pass services. e. 20% of clients will utilize oral health care services after accessing bus pass services. f. 65% of clients will utilize any RW Part A/B/C/D or State services after accessing bus pass services. CPCDMS From 3/1/2012 through 8/31/2012, 175 clients accessed Part A van transportation services. A. Oral Health Care: According to CPCDMS, 113 (65%) of these clients accessed oral health care at least once during this time period after utilizing van transportation services, and 21 (12%) clients accessed oral health care for the first time after utilizing van transportation services.

Page 19 of 22 B. Mental Health Services: According to CPCDMS, no clients were found to have accessed mental health services during this time period after utilizing van transportation services. C. Local Pharmacy Assistance Program (LPAP): According to CPCDMS, 78 (45%) of these clients accessed LPAP services at least once during this time period after utilizing van transportation services, and 6 (3.4%) clients accessed LPAP services for the first time after utilizing van transportation services. From 3/1/2012 through 8/31/2012, 1,209 clients accessed Part A bus pass services. D. Local Pharmacy Assistance Program (LPAP): According to CPCDMS, 224 (19%) of these clients accessed LPAP services at least once during this time period after utilizing bus pass services. E. Oral Health Care: According to CPCDMS, 302 (25%) of these clients accessed oral health care at least once during this time period after utilizing bus pass services. F. Ryan White or State Services: According to CPCDMS, 933 (77%) of these clients accessed Ryan White or State Services at least once during this time period after utilizing bus pass services. 56

Why is Medical Transportation so Important? Air Ambulance News and... http://air-ambulance-news.com/2012/04/03/why-is-medical-transportatio... Page 20 of 22 April 3, 2012 Uncategorized Medical transportation is now becoming a necessity for society because of increased dependence of sick or injured individuals on this service. Lack of this type transportation is a serious is an obstacle to better health care and increased costs. The medical ansportation industry faces challenges as the population is growing and funds are decreasing. Appropriate coordination w transportation service providers and medical care management is required to overcome the challenges. Often one can come across situations when in case of serious illness or injury feasible means of transportation is not available. Health transport is essential at this point to provide medically equipped transport facility to individuals in need of medical attention. In the recent years such transport has achieved growing recognition and is a vital part of any medical care program. Developments have now put forth a non emergency medical transportation facility in this business as well. Lack of medical transportation in many communities is standing in the way of receiving adequate medical attention for individuals. If individuals have difficulty in accessing the appropriate means of health transport it leads to difficulty in the following aspects: - Unable to access health care on time - Worsened health conditions - Greater expenditure on transportation i.e. higher per trip costs - Missed health care opportunities Health transportation is important in encouraging the greater use of preventive medical cares. The biggest benefit is the reduced overall health cost which is a major factor for people avoiding proper health treatments. Where medical transport service has grown over the past years it is now facing challenges based on increasing population and funding. According to a recent study the US population will double between 2000 and 2030 and this will include about 21% people who are over 65 years. Seniors typically require more health care. An inability to keep up with the rising population will put individuals at transportation disadvantage. There will be more demand for transport services that are efficient in response to the individual needs. Similarly significant financial implications are to be faced by medical care programs since inadequate funds will provide fewer chances for the transportation service to grow. Individuals will then be more dependent on the non emergency health transportation service which will put them at a cost risk. The non emergency health transport business is generally for those individuals who are not in any emergency situation but require medical assistance while travelling. This transportation is a sort of a taxi service for disabled or elderly people. The transportation is conformed to the safety standards and customized to add accommodations like the hydraulic lift. Although this is an innovation in the medical transportation business but it might be costlier for some individuals. Medical transportation benefits those who need medical assistance while travelling. Where the industry is facing multiple challenges based on coordination, increasing the number of vehicles and upgrading them the well designed and well coordinated transportation systems can help control the health while traveling and save medical costs. The local business and medical programs are now putting forward partnerships for better provision of transportation facility.

METROLift Eligibility Information http://www.ridemetro.org/services/lift/eligibility.aspx Page 21 of 22 No service alerts at this time. En Español Search Home Schedules & Maps Trip Planners Services METRO Q Card & Fares About METRO News Safety & Security Community Opportunities Current Projects Financial & Audit Information ELIGIBILITY INFORMATION Who Is Eligible? There are two categories for METROLift eligibility. 1. 2. Persons with disabilities who are unable, without the assistance of another person, to board, navigate, ride or disembark from an accessible local bus. Persons with disabilities who are prevented from getting to and from the local bus due to their disability. Eligibility is based on a functional limitation preventing the patron from walking or rolling to a bus stop without assistance from others. Eligibility & Recertification Process Eligibility cannot be granted based solely on the lack of curb cuts or other environmental barriers, distance to the bus stop or because METROLift is perceived to be safer or more convenient than local bus service. Healthcare professionals certify the applicant s disability. METRO makes the final eligibility decisions based upon the applicants functional abilities to navigate the fixed-route bus and light-rail system in accordance with the Americans with Disability Act (ADA). You must complete and submit a METROLift application for a certification of eligibility form to become certified to use METROLift services. It is important that the eligibility form is completed properly. Please complete your personal information on the METROLift eligibility form, including your signature on the line marked Applicant s Signature. Then you must have your doctor or other METRO-approved healthcare professional complete and sign the physician section of the METROLift eligibility form. The doctor must describe in detail (using lay terminology) why your disability prevents you from boarding, navigating, riding, or disembarking from the local bus, even if the local bus provides accessible features such as a wheelchair lift, ramp, bus and stop announcements, and infrastructure improvements at bus stops. You also must ask the doctor to submit an additional signature on his or her professional letterhead or prescription form, verifying completion of your METROLift eligibility form. Remember, both the eligibility form (completely filled out) and the doctor s additional signature must be submitted to METROLift for processing. Failure to do so will delay the processing of your application. Call METROLift Customer Service at 713-225-0119 (TDD 713-652-8969) between 10 a.m. and 5 p.m., Monday - Friday, and ask that a METROLift application for certification of eligibility be mailed to you. 1 of 2

METROLift Eligibility Information http://www.ridemetro.org/services/lift/eligibility.aspx Page 22 of 22 Applications are available at the METRO RideStore at 1900 Main at St. Joseph. Send the completed application to: METROLift P.O. Box 61429 Houston, TX 77208-1429 After the properly completed eligibility form has been received by METROLift, you will receive a letter explaining how to make an appointment for your in-person interview. The in-person interview will help METRO determine which of the METRO services will provide you with the greatest mobility. Applicants can schedule in-person eligibility interview appointments Monday-Friday, 10 a.m. to 5 p.m., by calling 713-225-0119. Interview appointments must be scheduled in advance, walk-ins will not be accepted. Applications are considered incomplete if applicants do not call to schedule or fail to keep their in-person eligibility interview appointments and no further processing will be made by METRO. After the in-person interview has been conducted, a decision regarding eligibility will be furnished in writing within 21 days. If a decision is not made within this time period, the patron has the right to use the service until a decision is made. Process for Eligibility Appeals Applicants who are denied METROLift service have the right to appeal METRO s decision. Appeals must be received within 60 days and mailed to the following address: METROLift Eligibility Appeals P.O. Box 61429 Houston, TX 77208-1429 Appeals will be forwarded to the METROLift Appeals Committee for review and final ruling. The Appeals Committee is comprised of an independent group of people with disabilities and advocates for people with disabilities. Patrons have the right to use the service if the appeal decision is not made within 30 days after all required information to process the appeal has been received by the Appeals Committee. Application is available at METRO RideStore, 1900 Main St., or by calling METROLift Customer Service at 713-225-0119 or download PDF and download application letter (PDF). Get Adobe Acrobat Reader free software for viewing and printing PDF files. Home Privacy Policy Contact Us Comments Site Map Webmaster 713-635-4000 1900 Main St. Houston, TX 77002 Copyright 2008. All rights reserved. 2 of 2