Issue #24-04

The purpose of this Alert is to inform SSHSP providers of updated Medicaid requirements for reimbursement of special transportation under the Preschool/School Supportive Health Services Program in accordance with the updated comprehensive guidelines issued by The Centers for Medicare and Medicaid Services. The updated requirements will become effective on July 1, 2024, for the Preschool/School Supportive Health Services Program. The information in this Medicaid Alert supersedes that in Medicaid Alert #13-10.

With some exceptions, Medicaid reimbursable special transportation is limited to those situations where the student receives transportation in a vehicle modified to accommodate the student’s disability to obtain a Medicaid-covered service (other than transportation) or returns from a Medicaid-covered service. A specially modified vehicle is one where the vehicle has a physical feature to accommodate a specific student with a disability. The updated comprehensive guidelines issued by The Centers for Medicare and Medicaid Services were updated to include the following examples that do qualify a vehicle as a specially modified vehicle for purposes of Medicaid reimbursement:

• a wheelchair lift or ramp
• special harnesses
• air conditioning
• specialized suspension systems

Examples that do not qualify a vehicle as a specially modified vehicle for purposes of Medicaid reimbursement include the following:

• seat belts
• presence of a nurse or an aide

For dates of service on or after July 1, 2024, in order for transportation to be Medicaid reimbursable, the following criteria must be met:

• The specific medical need for special transportation to accommodate the student’s disability must be documented in the student’s Individualized Education Program (IEP); and
• An explanation as to how the transporting vehicle has been specially modified to serve the needs of that student with a disability must be documented in the IEP; and
• The student must be traveling to or from a Medicaid reimbursable service other than special transportation.

Reminder: All Medicaid documentation, including bus/transportation logs (attendance), must be maintained for each one-way trip.

Special circumstances where transportation is Medicaid reimbursable, regardless of the type of vehicle used, are when:

• A student resides in an area that does not have school bus transportation (such as those areas in close proximity to a school) but has a medical need for transportation that is noted in the IEP and the student is traveling to or from a Medicaid reimbursable service; and
• A student is transported from school or home directly to and/or from a provider in the community for the exclusive purpose of accessing an SSHSP service, (e.g., BOCES or other contracted provider), and transportation is noted in the IEP. If the student is transported to a provider located in the community and is then transported directly back to school or directly home, both one-way trips are Medicaid reimbursable.

Other than these two exceptions, transportation on a regular (unmodified) bus or other vehicle to/from school must not be billed to Medicaid.

Note: The New York State Education Department (NYSED) field memorandum, dated March 2005, titled Special Transportation for Students with Disabilities, is NYSED’s guidance to be used when determining the need for special transportation services when developing an IEP. This memo reflects special education policy only and cannot be used to determine if or when special transportation is Medicaid reimbursable. To determine if Medicaid reimbursement is available for a special transportation service, that service must meet the criteria established by CMS and outlined in this Medicaid Alert. This guidance replaces guidance previously issued to SSHSP providers for Medicaid reimbursement of special transportation services.

In all cases, the medical need for the physical or environmental adaptations during transport must be identified in the IEP. Medicaid cannot be billed for the transportation of a student in a physically adapted bus or other vehicle if there is not a medical reason documented in an IEP for use of an adapted vehicle.

If you have any questions or comments regarding this Alert, please contact the NYS Department of Health at (518) 473-2160 or at SSHSP@health.ny.gov, the NYS Education Department, Medicaid Unit at medined@nysed.gov.