NON-EMERGENCY MEDICAL TRANSPORTATION PROGRAM ...

LogistiCare – Virginia NEMT Transportation Provider Manual – October 2011

(9) “State Medicaid Plan” the State’s plan for medical assistance developed in accordance with Section 1902 of
the Act and approved by CMS.

(10) “Medicare beneficiary” means those designated individuals eligible for traditional Medicare under Title XVIII
of the Social Security Act and CMS rules and regulations and enrolled with Health Plan.

II. Additional MA Program Obligations and Requirements. Provider agrees to the following terms and
conditions to the extent applicable to NET services rendered to Medicare beneficiaries.

A. Audits; Access to and Record Retention. Provider shall permit audit, evaluation and inspection directly by
Health Plan, the Department of Health and Human Services (HHS), the Comptroller General, the Office of the
Inspector General, the General Accounting Office, CMS and/or their designees, and as the Secretary of the HHS
may deem necessary to enforce the Medicare Contract, physical facilities and equipment and any pertinent
information including books, contracts (including any agreements between Provider and its employees,
contractors and/or subcontractors providing services related to services provided to Medicare beneficiaries),
documents, papers, medical records, patient care documentation and other records and information involving or
relating to the provision of services under the Agreement, and any additional relevant information that CMS may
require (collectively, “Books and Records”). All Books and Records shall be maintained in an accurate and timely
manner and shall be made available for such inspection, evaluation or audit for a time period of not less than ten
(10) years, or such longer period of time as may be required by law, from the end of the calendar year in which
expiration or termination of the agreement under which Provider renders services to Medicare beneficiaries
occurs or from completion of any audit or investigation, whichever is greater, unless CMS, an authorized federal
agency, or such agency’s designee, determines there is a special need to retain records for a longer period of time,
which may include but not be limited to: (i) up to an additional six (6) years from the date of final resolution of a
dispute, allegation of fraud or similar fault; (ii) completion of any audit should that date be later than the time
frame(s) indicated above; (iii) if CMS determines that there is a reasonable possibility of fraud or similar fault, in
which case CMS may inspect, evaluate, and audit Books and Records at any time; or (iv) such greater period of
time as provided for by law. Provider shall cooperate and assist with and provide such Books and Records to
Health Plan and/or CMS or its designee for purposes of the above inspections, evaluations, and/or audits, as
requested by CMS or its designee and shall also ensure accuracy and timely access for Medicare beneficiaries to
their medical, health and enrollment information and records. Provider agrees and shall require its employees,
contractors and/or subcontractors and those individuals or entities performing administrative services for or on
behalf of Provider and/or any of the above referenced individuals or entities: (i) to provide Health Plan and/or CMS
with timely access to records, information and data necessary for: (1) Health Plan to meet its obligations under its
Medicare Contract(s); and/or (2) CMS to administer and evaluate the MA program; and (ii) to submit all reports
and clinical information required by Health Plan under the Medicare Contract. [42 C.F.R. §§ 422.504(e)(4), 422.504
(h), 422.504(i)(2)(i), 422.504(i)(2)(ii) and 422.504(i)(4)(v)]

B. Privacy and Accuracy of Records. In accordance with the CMS Managed Care Manual and the regulations cited
below, Provider agrees to comply with all state and federal laws, rules and regulations, Medicare program
requirements, and/or Medicare Contract requirements regarding privacy, security, confidentiality, accuracy and/or
disclosure of records (including, but not limited to, medical records), personally identifiable information and/or
protected health information and enrollment information including, without limitation: (i) HIPAA and the rules and
regulations promulgated thereunder; (ii) 42 C.F.R. § 422.504(a)(13); and (iii) 42 C.F.R. § 422.118; (d) 42 C.F.R.
§ 422.516 and 42 C.F.R. § 422.310 regarding certain reporting obligations to CMS. Provider also agrees to release
such information only in accordance with applicable state and/or federal law, including pursuant to valid court
orders or subpoenas.

C. Hold Harmless of Medicare Beneficiaries. Provider hereby agrees: (i) that in no event including, but not limited
to, non-payment by Health Plan or First Tier Entity, Health Plan’s determination that services were not Medically

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Necessary, Health Plan’s or First Tier Entity’s insolvency, or breach of the agreement between Provider and First
Tier Entity that is the subject hereof or the agreement between First Tier Entity and Health Plan, shall Provider bill,
charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse
against a Medicare beneficiary for amounts that are the legal obligation of Health Plan and/or First Tier Entity; and
(ii) that Medicare beneficiaries shall be held harmless from and shall not be liable for payment of any such
amounts. Provider further agrees that this provision (a) shall be construed for the benefit of Medicare
beneficiaries; (b) shall survive the termination of the agreements between Provider and First Tier Entity and First
Tier Entity and Health Plan regardless of the cause giving rise to such termination; and (c) supersedes any oral or
written contrary agreement now existing or hereafter entered into between Provider and Medicare beneficiaries,
or persons acting on behalf of a Medicare beneficiary. [42 C.F.R. § 422.504(g)(1)(i) and (i)(3)(i)]

D. Hold Harmless of Dual Eligible Members. With respect to those Medicare beneficiaries who are designated as
Dual Eligible Members for whom the State Medicaid agency is otherwise required by law, and/or voluntarily has
assumed responsibility in the State Medicaid Plan to cover those Medicare Part A and B Member Expenses
identified and at the amounts provided for in the State Medicaid Plan, Provider acknowledges and agrees that it
shall not bill Medicare beneficiaries the balance of (“balance-bill”), and that such Medicare beneficiaries are not
liable for, such Medicare Part A and B Member Expenses, regardless of whether the amount Provider receives is
less than the allowed Medicare amount or Provider charges due to limitations on additional reimbursement
provided in the State Medicaid Plan. Provider agrees that it will accept First Tier Entity’s payment as payment in
full or will bill the appropriate State source if Health Plan has not assumed the State’s financial responsibility under
an agreement between Health Plan and the State. [42 C.F.R. § 422.504(g)(1)(iii).]

E. Accordance with Health Plan’s Contractual Obligations. Provider agrees that any services provided to
Medicare beneficiaries shall be consistent with and comply with the requirements of the Medicare Contract. [42
C.F.R. § 422.504(i)(3)(iii).]

F. Prompt Payment of Claims. First Tier Entity will process and pay or deny claims for Covered Services within
the timeframe set forth in the agreement between Provider and First Tier Entity . [42 C.F.R. § 422.520(b).]

G. Delegation of Provider Selection. As applicable, Provider understands that if selection of providers who render
services to Medicare beneficiaries has been delegated to First Tier Entity by Health Plan, either expressly or
impliedly, then Health Plan retains the right to approve, suspend or terminate such downstream or subcontracted
arrangements to the extent applicable to Medicare beneficiaries enrolled with Health Plan. [42 C.F.R.
§ 422.504(i)(5).]

H. Compliance with Health Plan’s Policies and Procedures. Provider shall comply with all policies and procedures
of Health Plan to the extent applicable to the services rendered by Provider. Such policies may include written
standards for the following: (a) timeliness of access to care and member services; (b) policies and procedures that
allow for individual medical necessity determinations (e.g., coverage rules, practice guidelines, payment policies);
and (c) Health Plan’s compliance program which encourages effective communication between Provider and
Health Plan’s Compliance Officer and participation by Provider in education and training programs regarding the
prevention, correction and detection of fraud, waste and abuse and other initiatives identified by CMS. [42 C.F.R.
§ 422.112; 42 C.F.R. § 422.504(i)(4)(v); 42 C.F.R. § 422.202(b); 42 C.F.R. § 422.504(a)(5); 42 C.F.R.
§ 422.503(b)(4)(vi)(C) & (D) & (G)(3).]

I. Delegation (Accountability) Provisions. Provider agrees that to the extent Health Plan, in Health Plan’s sole
discretion, elects to delegate any administrative activities or functions to First Tier Entity, the following shall apply:

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(1) Reporting Responsibilities. The Health Plan and First Tier Entity will agree in writing to a clear statement
of such delegated activities and reporting responsibilities relative thereto. [42 C.F.R. § 422.504(i)(3)(ii) and 42
C.F.R. § 422.504(i)(4)(i)]

(2) Revocation. In the event CMS or Health Plan determines that First Tier Entity does not satisfactorily
perform the delegated activities and any plan of correction, any and all of the delegated activities may be
revoked upon notice by the Health Plan to First Tier Entity. [42 C.F.R. § 422.504(i)(3)(ii) and 42 C.F.R.
§ 422.504(i)(4)(ii)]

(3) Monitoring. Any delegated activities will be monitored by the Health Plan on an ongoing basis and
formally reviewed by the Health Plan at least annually. [42 C.F.R. § 422.504(i)(3)(ii) and 42 C.F.R.
§ 422.504(i)(4)(iii)]

(4) Credentialing. The credentials of medical professionals, if any, affiliated with Provider and/or First Tier
Entity will either be reviewed by Health Plan or, in the event Health Plan has delegated credentialing to First
Tier Entity, First Tier Entity’s credentialing process will be reviewed and approved by Health Plan, monitored
on an ongoing basis and audited at least annually. [42 C.F.R. § 422.504(i)(3)(ii) and 42 C.F.R. § 422.504(i)(4)(iv)]

(5) No Assignment of Responsibility. Provider understands that Provider and/or First Tier Entity may not
delegate, transfer or assign any of Provider’s or First Tier Entity’s obligations with respect to Medicare
beneficiaries or any delegation agreement between Health Plan and Provider and/or First Tier Entity without
Health Plan’s prior written consent.

J. Compliance with Laws and Regulations. Provider agrees to comply with all applicable Medicare laws, rules
and regulations, reporting requirements, CMS instructions, and with all other applicable state and federal laws,
rules and regulations, as may be amended from time to time including, without limitation: (a) laws, rules and
regulations designed to prevent or ameliorate fraud, waste and abuse including, but not limited to, applicable
provisions of Federal criminal law, the False Claims Act (31 U.S.C. 3729 et. seq.), and/or the anti-kickback statute
(section 1128B(b) of the Act); (b) applicable state laws regarding patients’ advance directives as defined in the
Patient Self Determination Act (P.L. 101-58), as may be amended from time to time; (c) Federal Health Insurance
Portability and Accountability Act of 1996 (HIPAA) administrative simplification rules found at 45 C.F.R. parts 160,
162, and 164; and (d) laws, rules and regulations and CMS instructions and guidelines regarding marketing.
Additionally, and to the extent applicable, Provider agrees to maintain full participation status in the federal
Medicare program and shall ensure that none of its employees, contractors, or subcontractors is excluded from
providing services to Medicare beneficiaries under the Medicare program. [42 C.F.R. § 422.204(b)(4) and 42 C.F.R.
§ 422.752(a)(8)]

K. Accountability. Provider hereby acknowledges and agrees that Health Plan oversees the provision of services
by Provider to Medicare beneficiaries and that Health Plan shall be accountable under the Medicare Contract for
such services regardless of any delegation of administrative activities or functions to Provider or First Tier Entity.
[42 C.F.R. § 422.504(i)(1); (i)(4)(iii); and (i)(3)(ii)]

L. Benefit Continuation. Upon termination of Provider’s status as a participating provider with Health Plan
(unless such termination was related to safety or other concerns), Provider will continue to provide health care
benefits/services to Medicare beneficiaries in a manner that ensures medically appropriate continuity of care and
for the time period required by applicable law. Specifically, for Medicare beneficiaries who are hospitalized on the
date of such termination, services will be provided through the applicable Medicare beneficiary’s date of
discharge. [42 C.F.R. § 422.504(g)(2)]. The parties acknowledge the provisions set for in this paragraph K are not
applicable to NET services.

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ATTACHMENT 14

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Before transporting clients for LogistiCare, all drivers must complete the following:

1. LGTC Orientation
2. Driver Requirements and Responsibilities
3. Passenger Assistance, Service and Safety (PASS)
4. Dealing with Emergencies [Accidents, Incidents and Breakdowns]
5. Basic First-Aid
6. Blood borne Pathogens
7. Defensive Driving
8. HIPAA Requirements
9. Lifts, Ramps and Wheelchair Securement

LGTC Orientation

Who are we?

LogistiCare is the Non-Emergency Transportation (NET) Broker for the Virginia Department of
Medical Assistance Services (DMAS)
Began Virginia Medicaid NET in 2001 with partial state coverage – expanded to cover the entire
state in 2003
LogistiCare headquarters are in Atlanta, GA and currently operates in 33 states plus Washington,
D.C.
LogistiCare operates 24/7/365
Transportation is arranged for Medicaid recipients or members of Managed Care Organizations
(MCO) who have no other means of transportation, and who need to see a physician or a health
care facility for an authorized covered service.
Covered Services under Medicaid include:

o Hospital Discharges
o Doctors Visits, Physical Therapy, X-Rays, Dialysis, and other Medical appointments
o Adult Day Care, Day Support, and Supported Employment Services

Where are we?

LogistiCare operates six regional offices throughout the state (Forest, Charlottesville / Augusta

County, Herndon, Norfolk, Norton, and Richmond) and a network operations center/call center

in Norton.

Drivers are to utilize the following phone numbers to contact LogistiCare, depending on which

region they operate in:

o Region 1 (Norton): 866-608-8791 Provider

o Region 2 (Forest): 866-254-5410 Provider

o Region 3 (Richmond): 866-810-8302 Provider

o Region 4 (Norfolk): 866-886-4009 Provider

o Region 5 & 6 (Charlottesville): 866-342-1584 Provider

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o Region 7 (Herndon): 866-216-7834 Provider

Below is a map showing each Region, along with the Toll Free numbers that the Members use to contact

LogistiCare. These numbers are not to be used by Transportation Providers or their drivers.

Transportation Providers and their drivers are to use the numbers listed on the previous page.

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Driver Requirements

a. Are at least 18 years of age and have had a valid driver’s license for at least one year.
b. Have a current valid driver’s license to operate the transportation vehicle to which they are

assigned.
c. Drivers shall have no more than two chargeable accidents or moving violations in the last three

years.
d. Drivers shall not have had their driver’s license suspended or revoked for moving traffic violations in

the previous five years.
e. Drivers shall not have been convicted of any crime as defined in Va. Code §37.2-314(B). The

Contractor must require that the transportation provider secure, maintain, and provide criminal
background checks to DMAS from Virginia State Police and the national FBI fingerprint database on
each driver before the driver transports members under this contract.
f. All drivers and attendants shall be courteous, patient, and helpful to all members and be neat and
clean in appearance.
g. No driver or attendant shall use prescription medications that impact the ability to perform while on
duty, alcohol, narcotics, or illegal drugs and no driver shall abuse alcohol or drugs at any time. The
transportation provider shall not use drivers who are known abusers of alcohol or prescription drugs
or known consumers of illegal narcotics or drugs.
h. All drivers and attendants shall wear a visible nametag that is easily read and identifies the
employee, the employer, and the Contractor. The driver shall show the nametag to the member,
facility, or other service provider employee upon arrival for picking up the member.
i. Vehicles always shall be smoke free. Drivers and attendants shall not smoke while in the vehicle,
while assisting a member, or in the presence of any member.
j. Drivers shall not use mobile telephones (including texting) or headphones while the vehicle is in
motion.
k. Drivers or attendants must exit the vehicle to open and close vehicle doors when members enter or
exit the vehicle. Drivers or attendants must provide an appropriate level of assistance to members
when requested or when necessitated by the member’s mobility status and personal condition. This
includes curb-to-curb, door-to-door, and hand-to-hand assistance, as shown in the manifest.
l. If a curbside pick-up is not being made, drivers and attendants shall identify themselves, show their
identification and announce their presence at the entrance of the facility or residence at the
specified pick-up location or to attending facility staff.
m. Prior to moving the vehicle, drivers and attendants shall assist members as needed to be seated and
confirm that all seat belts are fastened properly.
n. Prior to starting the vehicle, drivers and attendants shall properly secure all wheelchairs and
wheelchair passengers.
o. Drivers and attendants shall provide necessary assistance, support, and oral directions to members,
including assistance to members with limited mobility, and with the loading, securing and storing of
mobility aids and wheelchairs.
p. Before departing the drop-off point, drivers shall confirm that the delivered members are safely
inside their destination.

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q. Drivers and attendants shall not touch any member except as appropriate and necessary to assist
the member into or out of the vehicle, into a seat, to secure the seat belt, or to render first aid or
assistance for which the driver has been trained.

r. Drivers and attendants shall not solicit or accept money, goods or additional business from
members.

s. Drivers must be familiar with and knowledgeable of the streets and highways of the areas in which
they are transporting.

t. Drivers and attendants must comply with HIPAA, by keeping all members’ health care identifying
information confidential, and not visible to other passengers, and by not discussing health care
identifying information with anyone who is not involved with the member’s treatment or other
health care services.

Services include: Curb-to-Curb; Door-to-Door; Hand-to-Hand
Curb-to-Curb

Assist passengers in opening the vehicle door, assist in the process of being seated; confirm all
seat belts are fastened properly and that the door of the vehicle is secured before moving the
vehicle.
Assist by folding and storing the passenger’s wheelchair or other mobility device as necessary.
Assist passengers in the process of exiting the vehicle.
Before departing drop-off point, shall confirm that the delivered passengers are safely inside
their destination.
Shall not transport passenger to any destination other than what is assigned and authorized by
LogistiCare.
Most transports are “curb-to- curb” unless otherwise noted on the trip manifest.
Door-to-Door:

Transportation provided to Members who need assistance to safely move between the door of
the vehicle and the door of the Member’s pick-up point or destination.
The driver exits the vehicle and assists the Member from the door of the pick-up point (e.g.,
residence), escorts the Member to the door of the vehicle and assists the Member in entering
the vehicle.
The driver is responsible for assisting the Member throughout the trip and to the door of the
destination.
Drivers, except for ambulance or stretcher van personnel, should not enter a residence.
Hand-to-Hand

Transporting the Member from a person at the pick-up point into the hands of a facility staff
member, family member or other responsible party at the destination.
Some Members with dementia or developmental disabilities, for example, may need to be
transported hand-to-hand.

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Upon Arriving at a Location:
Always Identify yourself
All drivers shall wear and have clearly visible an easily readable name/identification tag
Drivers shall show their name/identification tag to the passenger and/or facility staff.
Passengers are not required to be transported before their scheduled pick up time

WHAT IS CONSIDERED LATE?
A-Leg – more than 15 minutes past the scheduled pick up time
B Leg (Scheduled) – more than zero (0) minutes past the scheduled pick up time
“Will Call” – more than forty-five (45) minutes after initial notification that passenger is ready
for pick-up

Escorts
One escort that has been arranged with LogistiCare prior to transport may attend each
passenger. .
Minors (children) 17 and under can be transported without an escort only after a “Minor
Consent Form” has been completed and approved by LGTC prior to transport.

Pick up and Drop off Locations
Drivers must pick up and deliver passenger(s) to designated locations as listed on the manifest.
It is strictly against LogistiCare policy to do otherwise!

Appropriate Assistance
Drivers shall not touch any passengers except as appropriate and necessary to assist passenger
into or out of the vehicle, into a seat, to secure the seat belt, to secure wheelchair, or to render
first aid or assistance for which driver has been trained. Use your discretion and BE CAREFUL
and AWARE!

Solicitation
Drivers shall not solicit or accept money, goods or additional business from passengers at any
time.

No Eating or Drinking is allowed during transport of passengers.

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Drivers shall not smoke while in the vehicle, while assisting a passenger or in the presence of
any passenger or facility staff representative.
Use of headphones at any time is strictly prohibited with the exception of hands-free headsets
for mobile telephones. Drivers shall not use mobile phones while vehicles are in motion (while
driving).
Drivers must be familiar with the streets and highways of the areas in which they are
transporting. Use maps, driving directions, GPS navigation systems, etc. “Getting lost is not an
option!”

When You Know That Transportation is going to be late . . .
Promptly Notify LogistiCare Provider Line
Notify the awaiting customer and/or facility at the pick-up point.

No Shows
If a driver arrives to pick up a passenger and the passenger is not at the pick up address, or if the
passenger informs you that they are not going to the scheduled appointment, the driver (YOU)
or the provider company MUST notify the Regional Office Provider Line as soon as possible.
To eliminate or lessen the chance of a rider “NO SHOW”, one good and recommended practice
is to contact the passenger the night before or the morning of the scheduled appointment to
verify that the member will still be attending their appointment.

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HIPAA- Health Insurance Portability and Administration Act of 1996
The law requires that all information that may individually identify a patient be used with utmost care
and only in connection with the treatment of that patient.

All information about passengers, including their names,
Medicaid number, doctor’s name, and address, must be kept in strict confidence.

Trip information is provided on a faxed or downloaded document known as the Trip Manifest.
The Manifest lists:

1. Trip Number – Identifies trip by an assigned number issued by LGTC
2. Pick up and drop off time and address
3. Dir Comment – (Directions/Comments) Notifies driver of any special needs or directions
4. Patient identification- Name and contact information

The Trip Log:
1. Drivers must submit original trip logs with all proper signatures
2. Drivers must fill out trip logs in their entirety
3. Drivers must utilize their full name as it appears on their driver’s license
4. Trip logs with incorrect information will result in a denial of payment.
5. Complete and accurate information is the responsibility of the DRIVER.
6. If member is unable to sign, you must have a caretaker at the point of pick-up and point of drop
off sign for the member.

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7. Drivers may NEVER sign for the member
Examples of these documents are on the following pages.
Important Terms

A-Leg - First part of trip at the pick-up point, can be a residence or a facility
B-Leg - Second part of a trip, the return from a facility to a residence for example
Will Call - Usually the return part of a trip when the return time is not known or scheduled (for
instance, a doctor’s appointment).
Drivers must arrive within 45 minutes of notification that the member is ready for pick-up.
Vehicle Inspection
LogistiCare has Field Monitors that conduct routine inspections of all Transportation Provider vehicles.
Vehicles must abide by regulations set forth by local and state regulations, the ADA, DMAS, and
LogistiCare. The following page shows a sample Vehicle Inspection Report that your vehicle, depending
on the applicable level of service, must be able to pass at all times.

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CLIENT JOE 434 123-4567
DAY, AGOOD

2009 BEE ST
123 HAPPY AVE

Driver, Mike

FOR TRAINING PURPOSES ONLY

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Customer Service

The driver is the most important asset of any
Transportation Provider. YOU are making the first
and most lasting impression. However, the most
important person during transportation is the rider!
When providing assistance, it is very important to
remember you are dealing with a person.
ASK before taking direct action!
If the passenger refuses your offer of assistance, you
must be close by and watch for signs of trouble.
Immediately call your dispatcher in the event of any
accident or incident, no matter how minor!

Safety

Make sure all passengers have their seatbelts buckled before you move the vehicle
You MUST ensure that all wheelchair members are properly fastened in the vehicle,
including shoulder and lap belts.
NEVER drive over the speed limit.
Slow down when it is raining and use your wipers and lights.
Keep a safe following distance. It takes over 500 feet to stop at 60 mph!
Hands free mobile devices only!
Never text while driving!
Avoid “Road Rage”…when in doubt, back off.
Remember, “eyes on the road, hands on the wheel.”

Communication

There are three steps for better communication – We call them the ABCs

Adjust how you communicate if necessary
o Use simpler words
o Show how to do the things you’re telling them to do
o Write it down or draw a simple picture
o You may need to give the information more than once before the passenger
understands

Be alert to the person – be an active listener
Check for comprehension – ask the passenger what they are going to do now

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Sexual Harassment

Defined as: Unwelcome sexual advances, requests for sexual favors and other verbal and
physical conduct based on gender when:
Such conduct has the purpose or effect of unreasonably interfering with the individual’s work
performance or creating an intimidating, hostile or offensive working environment including,
but not limited to:

o Gender harassment: Generalized gender-based remarks and behavior.
o Seductive behavior: Inappropriate unwanted, offensive physical or verbal sexual

advances.
o Sexual bribery: Solicitation of sexual activity or other sex-linked behavior by promise of

reward.
o Sexual coercion: Coercion of sexual activity by threat of punishment.
o Sexual assault: Gross sexual imposition like touching, fondling, grabbing or assault.
o Sexual harassment can occur in a variety of circumstances including, but not limited to:
o The victim or harasser can be man or woman.
o Victim does not have to be a person of the opposite sex,
o The victim does not have to be the person harassed, but could be anyone affected by

the offensive conduct.
o The harasser’s conduct must be unwelcome.

Americans with Disabilities Act –ADA

The ADA is an extensive civil rights law designed to remove barriers
that prevent individuals with disabilities from enjoying the same
opportunities that are available to persons without disabilities.
In general, for transportation providers, the law prohibits
transportation providers from denying individuals with disabilities
the opportunity to use transportation services, if the individuals are
capable of using the system.
The ADA requires operators to assist and be courteous to passengers with disabilities.
Permit all canine service animals to accompany passengers.
Permit all passengers, including standees, to use the lift.—that can be properly secured.
Allow passengers with disabilities to board the lift either forward or backwards.
Transport any mobility device that fits on the lift and can be properly secured.
ADA gives specific guidelines for either forward OR Rear-facing securement.
If device cannot be safely secured it is contract policy that you may not transport.
Under the law, you cannot require passengers with disabilities to:

–Transfer from a mobility device to a regular seat. You MAY recommend they do so.

–Use designated seats if the person does not want to.

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–Have a personal care assistant.
NOTE: Remember – passengers using assistive devices, such as crutches, canes or walkers and
passengers who have difficulty using stairs are permitted to use the lift. Always instruct the passenger to
hold the railing for additional safety.

Assisting Persons with Service Animals
Included in the ADA regulations is the right of a person traveling with a service animal to have equal
access to public transportation and accommodations – shall permit service animals to accompany
individuals with disabilities in vehicles and facilities. 49CFR 37,167(d)
The ADA defines “service animal” in the following way: Service animal means any dog that is
individually trained to do work or perform tasks for the benefit of an individual with a disability,
including a physical, sensory, psychiatric, intellectual, or other mental disability. Other species of
animals, whether wild or domestic, trained or untrained, are not service animals for the purposes of
this definition. [Enacted 3-15-2011]
It is illegal to require a person with a service animal to provide proof that the animal is a service animal.

—Two questions that may be asked regarding service animals:

1) “Is this a service animal?” If the passenger answers “yes” and the animal is under control, welcome
them aboard as a team. [Variation: Is that a pet? - - Do not transport pets.]

2) “What service does the animal provide?” If the passenger can describe a service, welcome them
aboard as a team.

The member accompanied by a service animal is responsible for the conduct of the service animal
Assisting the Visually Impaired

Speak in a normal tone.
Address the person directly to help them locate you.
Speak directly to the person. If your gaze wanders, your voice follows.
A person who is blind may great you with, “It’s good to see you again.” Therefore, use normal
terms.
If you will be guiding a person who is blind, ASK how you may assist them. Permit the passenger
to grab your arm.

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Walk at a normal pace – one comfortable for you and the person you are guiding.
Alert to changes in walking surface and surrounding obstructions.
Hesitate before going up or down steps or curbs and verbally announce “step up” or “step
down”.
Use the word “STOP”. It has only one meaning – cease what you are doing.
To guide to a seat, place the person’s hand on the back of the seat. Do not push the person into
the seat.
The person will use their sense of touch to gauge the type, height and width of the seat.

Hidden Disabilities
Any one or combination of impairments, such as epilepsy; heart or lung problems; diabetes;
cancer; kidney failure; etc., which might affect the function and or endurance of an individual.
Make every attempt to keep the air in the vehicle as clean as possible. Closing windows and
using air-conditioning helps.

Cardiovascular Disease
Keep in mind that passengers with cardiovascular disease require extra patience on your part
and may be fearful of any physical activity.

Respiratory Disorder

Emphysema, bronchial asthma, and some allergies are examples of respiratory disorders.

Hearing Impairments
The major barrier facing a person with a hearing impairment is one of communication. Unable
to benefit from voice communication, persons with severe hearing impairment rely upon their
eyes for signals to aid understanding.
When communicating with anyone always speak normally as with anyone else unless the
member indicates verbally or non-verbally that they have a communication challenge.

Speech Disorders
Be patient, and be careful not to make fun of a passenger with a speech disorder.
If you are not sure of what the passenger said, ask him/her to repeat their statement. Repeat
what you think you heard. Or - Ask your passenger to start again where you end.

Cognitive Disabilities
Some passengers may have disabilities that affect their ability to know, think, remember, and
learn (cognition).

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Alzheimer’s disease

Alzheimer’s Disease affects memory, speech, and other intellectual skills. People with this
disease experience changes in their mood, personality and behavior. It is often necessary to
repeat information.
Stroke

An interruption in the blood supply to the brain which may cause paralysis and a loss of feeling
of one side of the body; may cause memory loss and confusion; and difficulty speaking and
understanding.

Cerebral Palsy

A group of conditions, not a disease caused by damage to the brain before, during or just after
birth.
Referred to as a developmental disability which can affect posture, muscle control, and in some
cases senses.
Individual may have a balance problem, difficulty walking, difficulty using his/her arms and
hands.
Individual may have great difficulty speaking clearly therefore, ask yes or no questions.

Tips on assisting

Speak as you would to any passenger.
Speak directly to the individual not a friend or companion.
Be patient; allow time for the individual to speak.
Don’t pretend you understood something that was said if you did not.

Learning Disabilities

A disorder that makes it hard for a person to store, process or express information.
Individuals with a learning disability may have:

o short attention span; poor memory ;
o difficulty with reasoning
o some difficulty with social behavior, and skill problems understanding and following

verbal directions

Mental Retardation

Mental retardation is not the same as a mental illness, although some people may have both.
An individual with mental retardation has a very below average intellectual functioning (IQ below 70
to 75), and significant limitations in two or more daily living skills such as communication, self-care,
social skills, health and safety, and shows up in a person before the age of 18.

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Mental Illnesses
Mental illnesses are defined as; brain diseases, which affect an individual’s ability to think, feel
and relate to other people and the environment.
Mental illness is not the same as mental retardation and can occur at any time during life.
Mental illnesses include schizophrenia, major depression, manic-depressive disorder, phobias,
anxiety, personality disorders and stress-related illnesses and disorders.

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Autism

A lifelong disability that usually affects a person’s social interaction, learning, communication,
and behavior due to interference with the way the person’s brain collects and organizes
information.

Traumatic Brain Injury

Individuals with a traumatic brain injury may:

Have difficulty paying attention or concentrating
Have difficulty remembering, understanding complex topics or issues
Have difficulty thinking through the steps needed to do something
Not move, think, or react quickly
Have difficulty putting thoughts into words
Take a long time to respond to a question

Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that is
needed to convert sugar, starches and other food into energy needed for daily life.

Type I – results from the body’s failure to produce insulin. It is usually diagnosed in children and
young adults
Type II – the most common form – occurs in people of all ages and ethnic groups

Signs of high blood sugar
• Extreme thirst
• Dry mouth
• Warm, dry skin that does not sweat
• High fever
• Sleepiness or confusion
• Loss of vision
• Hallucinations, weakness on one side of the body
o Tips for drivers
 Try to get water for the passenger and call 911

Signs of low blood sugar
Hunger
Sweating
Sleepiness
Trouble speaking
Nervousness and shakiness
Dizzy or lightheaded, confusion

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