| Payment for
Transportation for ICF/MR Residents
PDF Version of BQA 00-001
(PDF, 8 KB) - includes attachment
Date: January 3, 2000 -- DSL-BQA-00-001
To: Nursing Homes NH-1,
Facilities for the Developmentally Disabled FDD-1
From: Jan Eakins, Chief, Provider Regulation and Quality Improvement Section
cc: Susan Schroeder, Director, Bureau of Quality Assurance
Attached [below] is information
we received from the federal Health Care Financing Administration Chicago Regional Office.
This information deals with the ICF/MR benefit that includes all medically necessary
services and items that the resident needs. The Bureau feels the enclosed information is
useful in keeping all parties apprised of current events.
If you have any questions regarding this attachment, please contact either Dinh Tran at
(608) 266-6646 or Jean Kollasch at (608) 267-0466.
HEALTH CARE FINANCING ADMINISTRATION
Chicago Regional Office, Midwest Consortium
Electronic Regional Program Letter
Date: April 8, 1999
From: HCFA, Chicago Regional Office, Division of Survey and Certification
Subject: Payment for Transportation for ICF/MR Residents - INFORMATION
To: State Survey Agency Directors
The ICF/MR benefit includes all medically necessary services and items that the
resident needs. Included in the list of needs of each person who lives in an institution
is the need to participate in social activities. Because the person lives in an
institution, a social activities program includes participation in religious activities,
if the client chooses. All needed services must be included in the resident’s care
plan.
Can ICFs/MR require residents to pay for transportation to and from community
activities?
An ICF/MR is required to provide transportation to and from any activity that is
included in a resident’s plan of care. For example, when the facility, as part of a
person’s active treatment, chooses to teach the client "money skills" by
going to McDonald’s for lunch, that activity (including lunch and transportation)
would be paid by the facility. In addition, required social activities such as bowling,
movies, religious services, Special Olympics, that are in the individual’s program
plan (IPP) are a covered service, which includes transportation to and from the activity.
If, however, a resident chooses to participate in a social activity that is not included
in his/her IPP, the cost of the activity and the cost of transportation to and from that
activity is paid for by the client with his/her personal funds.
Another question is whether a provider can refuse to transport residents to
community activities which are independent from the facility’s program; e.g. Special
Olympics, social gatherings, and church activities, and, if the provider does have the
right to refuse to provide transportation, can the provider refuse to assist the resident
to make alternative transportation arrangements?
Under 42 CFR 483.420 and Tag W136 and W122, it is the facility’s responsibility to
actively provide each client choices of activities in which he/she might want to
participate. When a client chooses an activity that is in addition to the social
activities he/she has chosen to have included in the written plan of care, the facility
must provide assistance with transportation commensurate with the resident’s
abilities. This assistance would include utilizing free transportation services, if
available.
And finally, must the facility provide transportation to and from community
employment?
Payment for transportation to and from community employment depends upon the kind of
community employment program used by the facility. Many different arrangements are made by
facilities for a person’s participation in community employment programs. If
vocational training or "community employment" is a part of the client’s
active treatment program and is a facility-arranged program, the facility is required to
provide any needed transportation to and from that activity and payment for transportation
would be included in the FFP for ICF/MR services. If the vocational training or
"community employment" is provided under a separate State or Federal vocational
program in which transportation is provided as a "related service," FFP would
not be provided and it would be a State responsibility to ensure that double payment was
not provided for that service.
We hope that this information is helpful to you. If you have any questions,
please feel free to contact Nadine Renbarger by telephone at (312) 353-2850, or E-mail her
at: NRenberger@cms.hhs.gov.
/s/ Charles Bennett, Branch Manager, Survey and Certification, Coordination and
Improvement
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