Non-Medical Transportation (55T)

Purpose:

The Illinois Department of Human Services, Division of Developmental Disabilities (IDHS/DDD) is revising the enrollment and billing procedures for Home-Based Services (HBS) Non-Medical Transportation provided by persons using a privately-owned vehicle. Due to changes in the enrollment process with the implementation of the IMPACT Medicaid provider enrollment system, the Division is providing clarification regarding the various transportation provider types eligible to enroll as an HBS Non-Medical Transportation provider. Information about the billing process and what constitutes an adequate audit trail is included in this bulletin.

Background:

Non-Medical Transport (service code 55T) is an available service option for adults in the home-based services (AHBS) program. If a participant chooses to utilize this service, it must be purchased through the participant's monthly cost limit. Non-Medical Transportation services can be used to help persons gain access to waiver and community activities, services and resources as specified in the Personal Plan. This service should not be duplicative of other services in the Waiver. For example, it can't be used for transportation to and from medical appointments or to or from any community day services or supported employment programs because these services are accounted for in other areas in the Waiver. Whenever possible, transportation services should be provided by family, neighbors, friends or community agencies who can provide this service without charge.

There are three transportation provider types who are eligible to enroll as a DD waiver provider for transportation services based on the screening and enrollment requirements established by the Illinois Department of Healthcare and Family Services (HFS). An explanation of the transportation provider types, enrollment requirements and billing process for each provider type is list below.

• Private Auto (individual driver/Personal Support Worker) - A driver who uses their privately-owned vehicle and is employed by an HBS participant or their representative. Drivers must have a valid license, auto insurance and vehicle registration. The driver is required to pass all required criminal background and registry checks in compliance with Developmental Disabilities CSA Attachment A. Non-Medical Transportation is limited to $500 per month and must fit within the AHBS individual's monthly budget.
  • For individuals who use ACES$ for personal support services, ACES$ is contracted to provide mileage reimbursement through the Non-Medical Transportation service for this provider type.
  • For individuals who don't use ACES$ for personal support services, the Non-Medical Transportation provider will need to enroll directly with the Division of DD and IMPACT to become a provider.
• DD community-based agencies - Already enrolled IMPACT providers that provide CILA, Self-Directed Assistance, Personal Support agencies, Community Day Services (CDS) and Supported Employment (SEP) providers etc. are eligible to enroll for this service. Drivers and vehicles must meet and maintain the Illinois Secretary of State licensing and insurance requirements. The agency is responsible for ensuring all drivers have passed the registry and criminal background checks in compliance with Developmental Disabilities CSA Attachment A. The agency's DD enrollment record in IMPACT must include the transportation specialty "private auto". The provider may submit billing to DHS/DDD in the ROCS billing system. The provider is responsible for maintaining an appropriate audit trail and submitting the documentation upon request by the Division. Note: a reminder that 55T cannot be billed during services being funded by CDS, CILA, SEP or other services that have a transportation component. 
• Bus, taxi, service cars, Medi-Car or other specialized modes of transportation - DD waiver enrollment is contingent upon approval by the Illinois Department of Healthcare and Family Services (HFS). Drivers and vehicles must meet and maintain the licensing, insurance, safety training, fingerprint-based criminal background checks and all other enrollment requirements as determined by the Illinois Department of Healthcare and Family Services. Providers have the option of using a DD community-based agency provider to submit the billing to DHS/DDD on their behalf or they may submit billing directly to the DHS/DDD via the ROCS billing system or by submitting the Request for Payment (IL462-1177) form to the Administrative Voucher Unit for processing. The vendor is responsible for maintaining an appropriate audit trail and submitting the documentation upon request by the Division.

What's changing?

• Instead of the private auto driver having to enroll directly through the IDHS DDD, ACES$ Financial Management Services will provide enrollment, billing and payment services for transportation provided by a private auto driver who is selected and employed by an HBS participant or their representative. This new process will be limited to HBS participants using ACES$ for personal support services.
• If an HBS participant is not purchasing personal support services or opts to purchase the service through a personal support agency, the participant will not be able to use a private auto driver through ACES$. Although the personal support agency could enroll as a provider and bill directly. The service must be provided by a community-based DD waiver agency enrolled to provide Non-Medical Transportation or a bus, taxi, service car or Medi-Car provider approved by HFS and DHS/DDD.
• In the ACES$ system, a Non-Medical Transportation provider will be enrolling as a Personal Support Worker (PSW) even if they're not providing personal support services, therefore, an Employer of Record (EOR) can't be a Non-Medical Transportation provider because the system doesn't allow an EOR to also be a PSW.

Process for using a Private Auto provider for Non-Medical Transportation Service through ACES$:

NOTE: ACES$ will be conducting outreach and training to the HBS participants, families and service providers.

• Individually controlled 55T providers will enroll with ACES$ as a PSW. If you are already enrolled as a PSW with ACES$, you will not have to enroll again.
• Employers who oversee cases for adults in the HBS program who have the need for Non-Medical Transportation services identified in their Person-Centered Plan will contact ACES$.
• Enrollees (private auto drivers) will complete an ACES$ enrollment form for the Non-Medical Transportation services program.
• Enrollees will provide a copy of their valid driver's license, proof of insurance, and vehicle registration.
• Non-Medical Transportation is an online, web-based program through ACES$.
• ACES$ will enroll PSWs in IMPACT under Transportation.
• Once PSWs have been approved in IMPACT for Transportation, ACES$ will notify employers.
• Providers will complete training from ACES$ on the process for billing and the billing system.
• Billing for mileage is used when transportation is provided with a personally owned vehicle. Mileage tracking must be maintained to meet audit trail documentation requirements.
• Mileage tracking forms, receipts, and/or logs for tracking events should be completed daily to ensure accuracy.
• This service is limited to $500 per month and must fit within the AHBS individual's monthly budget.
• DDD will continue to conduct compliance reviews to ensure the integrity of paid bills and Medicaid claims.

Process for using Private Auto provider for Non-Medical Transportation Service who use agency-based staffing for PSW services:

• Enrollees (private auto drivers) must complete the enrollment process with DDD and IMPACT to become a Non-Medical Transportation services provider.
• Enrollees will provide a copy of their valid driver's license, proof of insurance, and vehicle registration.
• Once providers have been approved in IMPACT for Transportation, they can begin providing and billing for services.
• Billing for mileage is used when transportation is provided with a personally owned vehicle. Mileage tracking must be maintained to meet audit trail documentation requirements.
• Mileage tracking forms, receipts, and/or logs for tracking events should be completed daily to ensure accuracy.
• Self-Direction Assistance services can assist an individual with using this service.
• This service is limited to $500 per month and must fit within the AHBS individual's monthly budget.
• DDD will continue to conduct compliance reviews to ensure the integrity of paid bills and Medicaid claims.

Billing when using DDD community-based agencies and Bus, taxi, service cars, Medi-Car or other specialized modes of transportation provider types:

• Billing per event is used when the transportation service is provided through an enrolled HBS Non-Medical Transportation provider. These include providers such as a DD community-based agency, bus, taxi, service car, Medi-Car or other specialized modes of transportation. For instance, when taking a cab or bus to an activity, the taxicab or bus company must be enrolled in IMPACT to provide HBS Transportation and per event billing can be used. Proof of the purchase by way of a receipt or a log tracking the event must be used to determine the per-event billing total and the receipt or log must be maintained to meet audit trail documentation requirements. Per event billing is not completed through ACES$.

Audit Trail and Supporting Documents:

The Division of Developmental Disabilities is required to review billings selected via a statistically valid random sample of individuals receiving waiver services. It is the provider's responsibility to take steps to ensure the accuracy of their bills. Dates of service, number of miles, and the program(s) being billed must be accurate. The service provider is responsible for submitting complete and accurate billings. These records must be kept on file to establish an audit trail for individuals receiving Medicaid waiver community-based services and must be maintained for at least six years from the date of service.

DDD provides the following guidance as reference to appropriate documentation.

• Mileage forms with a beginning odometer reading, ending odometer reading and total miles traveled; or
• Per-event expense with receipts. These receipts would consist of cab fare, bus tokens, etc.

Effective Date:

9/28/2021