Information Bulletin 99-6
Questions And Answers Re: ICF/MRS Responsibility In Payment For Transportation For ICF/MR Residents
The following questions and answers were clarified by the HCFA Chicago Regional Office and are being sent to you for your information and guidance.
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 skill" 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 person's individual 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 the transportation to and from that activity is paid for by the client with his/her personal funds.
Can a provider 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.
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 vocation 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.
If you have any questions regarding this information bulletin, please contact:
Minnesota Department of Health
Compliance Monitoring Division
Licensing and Certification Program
85 East Seventh Place, Suite 300
PO Box 64900
St. Paul, MN 55164-0900.