1. A. Transportation-community access services are provided to assist the beneficiary in becoming involved in his or her community. The service encourages and fosters the development of meaningful relationships in the community, which reflects the beneficiary’s choice and values. This service provides the beneficiary with a means of access to community activities and resources. The goal is to increase the beneficiary’s independence, productivity, and community inclusion and to support self-directed employee benefits as outlined in the beneficiary’s POC.

   1. 1. Transportation-community access services are to be included in the beneficiary’s plan of care.
   2. 2. The beneficiary must be present for the service to be billed.
   3. 3. Prior to accessing transportation-community access services, the beneficiary is to utilize free transportation provided by family, friends, and community agencies.
   4. 4. When appropriate, the beneficiary should access public transportation or the most cost-effective method of transportation prior to accessing transportation-community access services.

2. B. Service Limits

   1. 1. Community access trips are limited to no more than three round trips per day and must be arranged for geographic efficiency.
   2. 2. Greater than three trips per day require approval from the department or its designee.

3. C. Service Exclusions

   1. 1. Transportation-community access services shall not replace the following services:

      1. a. transportation services to medically necessary services under the Medicaid State Plan;
      2. b. transportation services provided as a means to get to and from school; or
      3. c. transportation services to or from day habilitation, prevocational services, or supported employment services.

   2. 2. Transportation-community access services are not available to beneficiaries receiving the following services:

      1. a. shared living;
      2. b. host home; or
      3. c. companion care.
   3. 3. Transportation-community access will not be used to transport beneficiaries to day habilitation, pre-vocational, or supported employment services.
   4. 4. Transportation-community access services may not be billed for the same day at the same time as community living supports.

4. D. Provider Qualifications. Friends and family members who furnish transportation/community access services to waiver beneficiaries, must be enrolled as a Medicaid non-emergency medical transportation (NEMT) family and friends provider with the Louisiana Department of Health, Bureau of Health Services Financing.

   1. 1. In order to receive reimbursement for transporting Medicaid beneficiaries to waiver services, family and friends must maintain compliance with the following:

      1. a. state minimum automobile liability insurance coverage;
      2. b. possess a current state inspection sticker; and
      3. c. possess a current valid driver’s license.
   2. 2. No special inspection by the Medicaid agency will be conducted.

   3. 3. Documentation of compliance with the three listed requirements for this class of provider must be submitted when enrollment with the Medicaid agency is sought. Acceptable documentation shall be the signed statement of the individual enrolling for payment that all three requirements are met.

      1. a. The statement must also have the signature of two witnesses.
   4. 4. NEMT (family and friends transportation) providers may provide for up to three identified waiver beneficiaries.
5. E. Vehicle Requirements. All vehicles utilized by for profit and non-profit transportation services providers for transporting waiver beneficiaries must comply with all of the applicable state laws and regulations and are subject to inspection by the department or its designee.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office for Citizens with Developmental Disabilities, LR 33:2454 (November 2007), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 41:2166 (October 2015), amended by the Department of Health, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 45:1768 (December 2019), LR 47:1523 (October 2021), LR 48:1570 (June 2022), LR 50:1835 (December 2024).