PPEC transportation: driving medically fragile children to pediatric extended care centers

PPEC stands for prescribed pediatric extended care center: a licensed daytime center where children who need skilled nursing spend the day, with the center, a Medicaid ride vendor, or a contractor handling the trips to and from home. The rides run on a school-bus pattern. The same children ride at the same times every weekday, with a staff member from the center aboard. Who drives, who rides along, and who pays differ by state. This page covers Texas and Florida in detail and shows how the rides are paid in two more states. For the general rules on children in a van, see children on NEMT rides.

What a PPEC is

A PPEC is a nonresidential center for children who depend on medical care during the day. Florida’s statute defines it as a place that provides basic nonresidential services to three or more medically dependent or technologically dependent children, on a physician’s prescription and with a parent’s or guardian’s consent. The same chapter says no child may attend for more than 12 hours in a 24-hour period. A child counts as medically or technologically dependent when the medical condition calls for continuous therapeutic interventions or skilled nursing supervision.

Texas uses the name PPECC and describes the same service in its Medicaid state plan: physician-prescribed services for a child under 21 who is medically or technologically dependent, under a registered nurse’s supervision, with prior authorization. Texas, Florida, Mississippi, and Pennsylvania all pay for PPEC care through Medicaid. The detailed vehicle and staffing rules below come from Texas and Florida.

Who rides with the child in Texas

In Texas, a nurse or a direct care staff member from the center rides with each child, as the child’s physician orders. The state plan amendment CMS approved on May 14, 2024, effective September 1, 2024, says the PPECC must provide the transportation, itself or through a contractor, when the physician finds the child stable and the parent or guardian wants the ride. It adds that the child must be accompanied by a PPECC nurse or direct care staff member, as identified by the physician in the plan of care.

The licensing rule, 26 TAC 550.1101, was amended effective October 16, 2024 and says the same thing with more detail:

• The crew. A center must adopt written rules on the staff and equipment that go with a child. The staff must include a driver and a direct care staff member, or a nurse if necessary, depending on the children’s acuity and as decided with the prescribing physician.
• The ratio. Under 26 TAC 550.1102, at least one direct care staff member rides for every seven children, and more when the children’s acuity calls for it.
• The parent. A parent does not have to ride along when the center transports the child, and may decline the center’s transportation altogether.
• The vehicle. The center must make sure the vehicle is accessible for a child with disabilities and equipped for the child’s needs on the road.

What the van and driver must meet in Texas

A Texas center must be able to show a long list of items for the people and vans that carry its children. The rules ask for:

• A valid and appropriate Texas driver’s license, with a copy on file at the center.
• A current Texas safety inspection sticker and registration decal on the vehicle.
• Commercial insurance that covers minors and staff in the vehicle in an accident or injury, with the insurance documentation kept on file, including the insurer’s name, the policy number, the period, and an explanation of coverage.
• A first aid kit with unexpired supplies, including oxygen, a pulse oximeter, and suction equipment, in each center vehicle.
• A master transportation list with each child’s name, pickup and drop-off locations, and the people authorized to take the child, held by the driver and the staff aboard and on file at the center.
• A daily attendance record for every trip with the driver’s name, the date, the names of everyone aboard, the name of the person who received each child, and the time of release.
• Curbside boarding, with the child accompanied safely to the destination, and no child left alone in the vehicle at any time.
• An end-of-trip check of the vehicle to make sure no child remains, signed with the time of the inspection.
• No hand-held phone while driving, and no more passengers than the manufacturer’s recommended capacity.
• A notice near the emergency exit naming the administrator, the center, and its phone number and address.
• A written emergency policy for mechanical breakdowns, vehicle accidents, and a child’s emergency.
• Restraint or securement of each child under the federal motor vehicle safety standards, state law, and the center’s rules.

The center holds the license, so it answers for these rules. A ride company that drives for a center should expect to be asked for proof of each item before the first run.

How Florida runs the same rides

In Florida, a PPEC child who is not enrolled in a Managed Medical Assistance plan gets rides from one of AHCA’s two ride vendors, and the PPEC sends an escort. Florida’s PPEC licensing chapter, rule 59A-13, has no routine transportation rule. Its one transport requirement is in 59A-13.022: emergency transportation must be performed by a licensed EMS provider, with a PPEC staff member accompanying each child. The ride rules are in two coverage policies.

The Medicaid PPEC coverage policy lists, among the services a PPEC must provide, “an appropriate escort for travel to and from the PPEC when Florida Medicaid non-emergency transportation is provided.” It also says that:

• The PPEC day starts at pickup. It begins when the child arrives at the PPEC or is picked up for escorted transportation, and ends when the child leaves the center or is returned home by escorted transportation.
• The center keeps a daily log signed by the parent or guardian, with the arrival and departure times and, if the child was escorted, the pickup and return times.
• Transportation is not part of the PPEC benefit. The policy lists it as not covered under the PPEC service, and the ride benefit covers it separately.

The ride program’s coverage policy sets the order of the run. When an escort is medically necessary to protect the child, the ride company must pick up the escort at the PPEC, or a spot the two agree on, before it picks up the child. It must return the child to the starting point before it takes the escort back to the PPEC. The escort cannot be the driver or a ride company employee. For the vendors, rates, and policy rules around these trips, see Florida Medicaid NEMT rates.

One timing issue shows up in the state’s own paperwork. In its 2025 waiver renewal, AHCA reports that one of its two ride vendors missed two on-time standards in several months of 2024, and that most of the late trips were PPEC trips. As AHCA records the vendor’s explanation, most PPECs list the time their escort leaves to collect the child as the appointment time, rather than when the child must arrive. The trips repeat at the same time each day, the centers work on a reservation basis with no fixed arrival times, and they do not update the schedule for daily changes. AHCA also reports that it had received no complaints about PPEC children arriving late. For a ride company, the lesson is to agree with each center on which time counts and how a change reaches dispatch.

Pennsylvania and Mississippi: two more ways the ride is paid

Other states pay for PPEC rides in their own way, so the first call is always to the payer. Two examples:

• Pennsylvania. AmeriHealth Caritas Pennsylvania’s July 2026 provider manual sets guidelines for ambulance transportation to and from a PPECC or medical daycare: the member is under 21, is approved for the center, needs oxygen, ventilator support, critical monitoring, or critical medication during transport that calls for ambulance-level care, and has no caregiver able to transport. The ambulance is prior authorized along with the PPECC request, and the plan’s rapid response transportation department is told about each approval. A child who needs ambulance-level care en route is not a wheelchair van trip.
• Mississippi. The state plan amendment effective May 1, 2025 says the Division of Medicaid reimburses transportation provided by PPECs at the lesser of the provider’s usual and customary charge or the state fee schedule.

Car seats, wheelchairs, and airway equipment

Texas requires a center to restrain or secure each child under the federal motor vehicle safety standards and state law, and the right seat or chair depends on the child. The details are in other guides: children on NEMT rides for seat laws and who supplies the seat, adaptive strollers and pediatric wheelchairs for securing a child in the chair, and trach and ventilator transport for airway riders. Drivers are not clinicians, so the staff member aboard answers for the child’s medical needs.

How a ride company gets PPEC routes

In Texas, a ride company gets PPEC work by contracting with the center, and in Florida by joining a ride vendor’s provider network. The Texas state plan amendment spells out the Texas side:

• The center is the customer. Transportation is provided by the PPECC or a contractor of the PPECC. The plan says PPECC transportation is not provided by the transportation broker.
• The center is paid per case. Texas reimburses transportation to and from the PPECC per case, only when it is used. A contract should settle no-shows, absences, and late cancellations in writing.
• Families choose the center. The recipients choose their PPECC provider, and that provider renders the transportation.

In Florida, each of the two AHCA ride vendors builds its own provider network for its regions, so the route starts with the vendor. Before a first run in either state, a ride company should ask the center for:

1. The route sheet: the children, the pickup locations, and the times.
2. The staff aboard for each route and how the center decides when a nurse is needed.
3. Each child’s emergency plan, and the center’s rule on calling 911.
4. The authorized-release list and how changes reach the driver.
5. Who supplies the child’s seat and the first aid kit.
6. How the center tells you the same morning that a child will not attend.

Planning daily PPEC trips in HealthRide

A PPEC route repeats every weekday, which suits recurring trips: set each child’s morning and afternoon trip up once and HealthRide keeps it going. Wheelchair, stretcher, and oxygen needs are matched to the vehicle, and escorts are part of the trip. See recurring trips and fleet.