1. (a) An EIDT may elect to provide transportation services to its clients.

2. (b)

   1. (1) The requirements of this part apply to all transportation provided to a client for any reason by any person or entity on behalf of the EIDT regardless of whether the transportation is a billed service.
   2. (2) Notwithstanding the foregoing, if the transportation provided to a client is covered by another Medicaid program, then the transportation requirements applicable to the funding Medicaid program, and not this part, shall apply.

3. (c) An EIDT electing to provide transportation services to clients must maintain an updated list of all vehicles used to transport clients that includes the following information for each vehicle:

   1. (1) Manufacturer:

      1. (A) Name;
      2. (B) Make;
      3. (C) Model; and
      4. (D) Model year;
   2. (2) Vehicle identification number; and
   3. (3) Type of vehicle, for example, a sedan, eight-passenger van, fifteen-passenger van, or wheelchair van.
4. (d) Any vehicle used by an EIDT to transport clients must be available for inspection upon request.
5. (e) Reports or other documentation required to be maintained under this section must be made available for inspection upon request.

6. (f)

   1. (1) An EIDT may use electronic records in addition to or in place of physical records to comply with this section.
   2. (2) An EIDT provider that uses electronic records must take reasonable steps to backup all electronic records and reconstruct its transportation records in the event of a breakdown in the EIDT’s electronic records system.

7. (g)

   1. (1) An EIDT electing to provide transportation services must provide the level of attendant care on each vehicle that is necessary to ensure client safety.

   2. (2)

      1. (A) Notwithstanding the foregoing, a three to one (3:1) minimum client to attendant ratio is required for clients under three (3) years of age on any vehicle used by an EIDT for transportation.
      2. (B) The driver may be counted towards the minimum client to attendant ratio for these purposes, but under no circumstances can the driver be the only adult on a vehicle transporting one (1) or more clients under three (3) years of age.

   3. (3)

      1. (A) An inspection report must be completed for each trip in which a vehicle is used by an EIDT to transport clients.
      2. (B)
8. (i) Each inspection report must include a pre-trip and post-trip inspection that includes at a minimum the:
9. (a) (a) Vehicle used to transport;
10. (b) (b) Date of the trip;
11. (c) (c) A pre-trip check box that is marked to demonstrate that a visual inspection of the exterior of the vehicle was completed prior to the start of the trip;
12. (d) (d) A pre-trip check box that is marked to demonstrate a visual inspection of the interior of the vehicle was completed prior to the start of the trip;
13. (e) (e) A pre-trip check box that is marked to demonstrate that a visual inspection of the tires was completed prior to the start of the trip;
14. (f) (f) A pre-trip check box that is marked to demonstrate that a visual inspection of the windshield was completed prior to the start of the trip;
15. (g) (g) A post-trip check box that is marked to demonstrate that a visual inspection of the exterior of the vehicle was completed after final unloading;
16. (h) (h) A post-trip check box that is marked to demonstrate that a visual inspection of the interior of the vehicle was completed after final unloading;
17. (i) (i) A post-trip check box that is marked to demonstrate that a visual inspection of the tires was completed after final unloading;
18. (j) (j) A post-trip check box that is marked to demonstrate that a visual inspection of the windshield was completed after final unloading; and

19. (k) (k) A section for listing and describing any defect or deficiency discovered or reported during the:

    1. (1) (1) Trip;
    2. (2) (2) Pre-trip inspection; or

    3. (3) (3) Post-trip inspection.

       1. (ii) Each inspection report must include the:
20. (a) (a) Signature of the employee that performed the pre-trip inspection;

21. (b) (b) Signature of the employee that performed the post-trip inspection;

    1. (c) (c) Time the pre-trip inspection was completed; and

       1. (d) (d) Time the post-trip inspection was completed.
       2. (C) An EIDT must maintain all inspection reports for five (5) years from the date of transportation.

22. (h)

    1. (1) A separate transportation log must be maintained for each trip in which a vehicle is used by an EIDT to transport a client, and that log must include:

       1. (A) Each transported client’s:

          1. (i) Name;
          2. (ii) Age;
          3. (iii) Date of birth;
          4. (iv) Medicaid ID number;
          5. (v) Exact address of pickup and drop-off; and
          6. (vi) Exact time of pickup and drop-off;
       2. (B) The driver of the vehicle;
       3. (C) Each attendant or any other persons transported; and

       4. (D) The odometer reading on the vehicle at the:

          1. (i) Pickup of the first client on the trip; and
          2. (ii) Drop-off of last client on the trip.
    2. (2) The transportation log shall be used to check clients on and off the vehicle at pickup and drop-off.
    3. (3) The driver or attendant who conducts the walk-through required by subsections (i) and (j) of this section must sign the transportation log once it is confirmed that all clients exited the vehicle.

    4. (4) An EIDT must maintain all transportation logs for five (5) years from the date of transportation.

       1. (i)
    5. (1) Any vehicle with a maximum capacity of seven (7) or fewer passengers and one (1) driver that is used by an EIDT to transport clients must have the driver or an attendant walk through the vehicle and conduct a visual inspection of each seat on the vehicle upon arrival at the final unloading destination.
    6. (2) The driver or attendant who conducts the walk-through inspection upon arrival must sign the transportation log required to be maintained under subsection (h) of this section.

23. (j) Any vehicle with a maximum capacity of more than seven (7) passengers and one (1) driver that is used by an EIDT to transport clients must have the driver or an attendant complete a walk-through inspection of each seat on the vehicle in one (1) of the following ways upon arrival at the final unloading destination:

    1. (1)

       1. (A) The driver or an attendant must:

          1. (i) Unload all clients from the vehicle;
          2. (ii) Walk or otherwise move through the interior of the vehicle to ensure that no client remains on board; and
          3. (iii) Deactivate the vehicle’s safety alarm device.
       2. (B) This option can only be used if all clients are able to unload from the vehicle in less than one (1) minute;

    2. (2)

       1. (A)

          1. (i) An attendant supervises the clients while unloading.
          2. (ii) The driver remains on the vehicle during unloading to walk through the interior of the vehicle to ensure that no clients remain on board.
          3. (iii)
24. (a) (a) The driver deactivates the safety alarm device upon reaching the back of the vehicle.

25. (b) (b) The individual who deactivates the safety alarm device must remain near the safety alarm device deactivation switch until all clients have unloaded to ensure that no client is left on board.

    1. (B) This option will require at least two (2) individuals, one (1) to supervise the clients exiting the vehicle and one (1) to remain near the safety alarm device deactivation switch; or

    2. (3)

       1. (A) The driver or an attendant deactivates the safety alarm device and unloads all clients immediately upon arrival.

       2. (B)

          1. (i) Immediately after unloading, the driver will start the vehicle and move it to a different location for final parking, which must reactivate the safety alarm device.
          2. (ii) Once parked the driver:
26. (a) (a) Walks or otherwise moves through the interior of the vehicle to ensure that no clients remain on board; and
27. (b) (b) Deactivates the safety alarm device.

28. (k) An EIDT providing transportation services to a client must maintain the client’s emergency contact information within the vehicle during transport.

    1. (l) Each driver of a vehicle that is transporting clients on behalf of an EIDT must meet each of the following requirements:

    2. (1) Meet the higher of the following age requirements:

       1. (A) Twenty-one (21) years of age; or
       2. (B) The minimum age required by the applicable vehicle insurance;
    3. (2) Hold a current valid driver’s license;
    4. (3) If required by state law for the transporting vehicle, hold a commercial driver’s license;

    5. (4) Obtain and maintain in good standing the following credentials:

       1. (A) Cardiopulmonary resuscitation (CPR) certification from the:

          1. (i) American Heart Association;
          2. (ii) Medic First Aid; or
          3. (iii) American Red Cross; and

       2. (B) First-aid certification from the:

          1. (i) American Heart Association;
          2. (ii) Medic First Aid; or
          3. (iii) American Red Cross; and

    6. (5) Have successfully completed training courses on the following:

       1. (A) Defensive driving;
       2. (B) Child passenger safety; and

       3. (C) If applicable:

          1. (i) Lift operation; and
          2. (ii) Wheelchair securement.
          3. (m) The following individuals are prohibited from driving a vehicle transporting EIDT clients:
    7. (1) Any individual who has had a suspended or revoked driver’s license for a moving violation within the last five (5) years;
    8. (2) Any individual who has been convicted of an alcohol, drug, or substance abuse offense within the last five (5) years; and

    9. (3) Any individual who has received at least two (2) of any combination of the following citations within the prior twelve (12) months:

       1. (A) Citations for moving vehicle violations; and
       2. (B) Citations for accidents where the individual was found to be at fault.

29. (n) In addition to those requirements in 20 CAR § 537-304, an EIDT must maintain the following documentation for each employee who drives a vehicle transporting clients:

    1. (1) A copy of an employee’s driving record for the previous three (3) years from the Division of Arkansas State Police or Arkansas Wireless Information Network that is updated annually;
    2. (2) Documentation of all reported complaints involving the employee;
    3. (3) Documentation of all accidents or moving violations involving the employee, for example, copies of tickets, police reports, etc.; and
    4. (4) Documentation evidencing the completion of all required training and credentials.

30. (o) Each attendant to a vehicle transporting clients on behalf of an EIDT must meet each of the following requirements:

    1. (1) Be at least eighteen (18) years of age;

    2. (2) Have successfully completed training courses on the following:

       1. (A) Defensive driving;
       2. (B) Child passenger safety; and

       3. (C) If applicable:

          1. (i) Lift operation; and
          2. (ii) Wheelchair securement; and

    3. (3) Obtain and maintain in good standing the following credentials:

       1. (A) CPR certification from the:

          1. (i) American Heart Association;
          2. (ii) Medic First Aid; or
          3. (iii) American Red Cross; and

       2. (B) First-aid certification from the:

          1. (i) American Heart Association;
          2. (ii) Medic First Aid; or
          3. (iii) American Red Cross.

31. (p) Each driver and attendant in a vehicle that is used by an EIDT to provide transportation services to a client must:

    1. (1) Wear or have visible an easily readable identification demonstrating they are employees of the EIDT;
    2. (2) Carry a valid driver’s license or, if a nondriving attendant, other government-issued identification;
    3. (3) Abide by all infection control directives or guidance issued by the Department of Health;

    4. (4) When picking up a client:

       1. (A) Identify and announce their presence at the entrance of the pickup location if the client is not waiting curbside upon arrival;
       2. (B) Provide assistance to a client, as necessary, from the pickup location to the vehicle;

       3. (C) If necessary, assist a client in the process of:

          1. (i) Seating;
          2. (ii) Fastening their seatbelt; and
          3. (iii) Otherwise safely securing the client prior to departure;
       4. (D) Assist any client in a wheelchair, or who is mobility-limited, with entering and exiting a vehicle;
       5. (E) Ensure that clients in wheelchairs are properly secured in their wheelchair;
       6. (F) Ensure all wheelchairs are properly secured in the vehicle prior to departure; and
       7. (G) Ensure all folding wheelchairs and other mobility aides being transported are safely and securely stowed away on the vehicle prior to departure; and

    5. (5) When arriving at the client’s drop-off location:

       1. (A) Provide a client with assistance, as necessary, in:

          1. (i) Exiting the vehicle; and
          2. (ii) Traveling from the vehicle to the entry of the client’s drop-off location; and
       2. (B) Ensure the client is safely transitioned at the drop-off location in accordance with the client’s needs.

32. (q)

    1. (1) Any vehicle used to transport a client must meet the safety and mechanical operating and maintenance standards for the make and model of vehicle.

    2. (2) Each vehicle used to transport a client must have:

       1. (A) Up-to-date registration with the Office of Motor Vehicle; and
       2. (B) All other licenses, permits, and certificates required by state and federal law.

33. (r)

    1. (1) Commercial insurance coverage must be maintained on any vehicle that is used to transport a client.

    2. (2) Commercial insurance must have the following minimum coverage amounts:

       1. (A) One million dollars ($1,000,000) combined single-limit liability coverage;
       2. (B) One hundred thousand dollars ($100,000) for uninsured motorist;
       3. (C) One hundred thousand dollars ($100,000) for underinsured motorist; and
       4. (D) Five thousand dollars ($5,000) personal injury protection for each passenger based on the number of passengers the vehicle is manufactured to transport.
    3. (3) Each commercial insurance policy must name the Department of Human Services as an additional insured and loss payee under the policy.
    4. (4) All commercial insurance coverage must be with companies licensed and approved to do business with the State of Arkansas.
    5. (5) An EIDT must maintain documentation evidencing that the required commercial insurance is in place for each vehicle that is used to transport a client.

34. (s) Each vehicle used to transport a client must have the following safety equipment on board:

    1. (1) Fire extinguisher;
    2. (2) First-aid kit;
    3. (3) Reflective triangles;
    4. (4) Flashlight; and
    5. (5) Reflective safety vest.

35. (t) Each vehicle used to transport a client must be maintained in a sanitary and safe condition, which includes without limitation:

    1. (1) A heating and air conditioning system that is in good working condition;

    2. (2)

       1. (A) Each client must have their own seating space with a functioning seat belt or other appropriate safety restraint in accordance with federal and state law and manufacturer’s guidelines.
       2. (B) Each client under six (6) years of age or weighing less than sixty (60) pounds must be restrained in a child passenger seat secured in accordance with the manufacturer’s guidelines;

    3. (3) Vehicle interiors must be free of:

       1. (A) Dirt;
       2. (B) Oil;
       3. (C) Grease;
       4. (D) Litter;
       5. (E) Torn upholstery;
       6. (F) Torn ceiling coverings;
       7. (G) Damaged seats;
       8. (H) Protruding sharp edges;
       9. (I) Hazardous debris; and
       10. (J) Unsecured items;

    4. (4)

       1. (A) Vehicles with an entry step-up of greater than twelve inches (12”) must include a retractable step or step stool to aid in client boarding.
       2. (B) A step stool must have four (4) legs with anti-skid tips on each leg;

    5. (5) Vehicle exteriors must be clean and free of:

       1. (A) Broken:

          1. (i) Windshields;
          2. (ii) Mirrors; and
          3. (iii) Windows; and

       2. (B) Excessive:

          1. (i) Grime;
          2. (ii) Dirt;
          3. (iii) Dents; and
          4. (iv) Damage;

    6. (6)

       1. (A) The floor of each vehicle must be covered with commercial anti-skid ribbed flooring or carpeting.
       2. (B) Any ribbed flooring must not interfere with wheelchair movement;

    7. (7)

       1. (A) Any vehicle with a maximum capacity of seven (7) or more passengers and one (1) driver that is used by an EIDT to transport clients must have a safety alarm device.

       2. (B) The safety alarm device must:

          1. (i) Always be in working order and properly maintained;
          2. (ii) Be installed so that the driver is required to walk to the very back of the vehicle to reach the switch that deactivates the alarm;
          3. (iii) Be installed in accordance with the device manufacturer’s recommendations; and
          4. (iv) Sound the alarm for at least one (1) minute after the activation of the safety alarm device;

    8. (8)

       1. (A) Any vehicle used by an EIDT to transport clients must have a camera system installed.

       2. (B) The camera system must:

          1. (i) Be in working order at all times that a vehicle is used to transport clients;
          2. (ii) Be properly maintained;
          3. (iii) Have at least seven hundred twenty pixels (720p) resolution camera or cameras;
          4. (iv) Maintain daily footage for a minimum of forty-five (45) days;
          5. (v) Include GPS tracking; and
          6. (vi) Have camera or cameras positioned so that all passenger activity on each vehicle is recorded; and

    9. (9) Each vehicle used to transport a client must prominently display:

       1. (A) Provider name; and
       2. (B) Provider contact information.

Codification Notes: “GPS” means Global Positioning System.