Contact guard, min, mod, and max assist: what a rider's assistance level means for the ride

What does contact guard assist mean?

Contact guard assist means a helper keeps hands on the rider to steady them while the rider does the work. CMS’s nursing home manual files it under code 04, “Supervision or touching assistance,” and describes the help as touching, steadying, or contact guard. Standby assist is the hands-off version. CMS’s older rehabilitation manual defines it as no more help than standing by, cuing, or coaxing, without physical contact.

This is the clinical scale on a ride request. The curb-to-curb, door-to-door, and hand-to-hand levels a broker assigns are a different list, covered under level of service.

What separates contact guard from the next level is weight. In Section GG’s examples, a certified nursing assistant who steadies a resident moving from lying to sitting is coded 04. A therapy assistant who steadies a walker and supports part of the resident’s weight for the last 2 of 10 feet is coded 03, partial or moderate assistance. For a driver, the practical test is simple: if the rider’s weight shifts onto you, it is no longer contact guard.

How do minimal, moderate, and maximal assist differ?

They measure how much of the effort the helper supplies. CMS’s manuals show two scales, and they line up roughly, not exactly.

The two do not match at the bottom. In the older scale, total assistance still leaves the rider with under 25 percent of the effort. In Section GG, dependent means the helper does all of it, or the rider needs two helpers, even if the second only stands by.

What does each level mean for the ride?

A rider at contact guard or easier needs steadying, not lifting, and a driver can usually give that. A rider who needs a helper to lift or support them needs a plan that a single driver does not carry out alone. Safe passenger transfers compares what each program lets a driver do.

• Independent, standby, or contact guard. An independent rider fits curb-to-curb service. A rider who needs cues or steadying can be served door-to-door, where MTM Health’s Virginia handbook has the driver escort the member between the door and the vehicle and limits physical contact to what is necessary for safe assistance.
• Minimal or moderate. Whenever the helper lifts or supports the rider, the work leaves the standard driver role. The Virginia handbook says curb-to-curb and door-to-door assistance do not include lifting any member, and CareOregon’s manual tells drivers never to move a member between a wheelchair or bed and another surface, or to take a walking member’s full weight, unless the brokerage has authorized a licensed, trained driver.
• Maximal or dependent. Plan for the rider to stay in the wheelchair on a lift or ramp, or to travel by stretcher. Section GG scores a rider who needs two helpers as dependent. On a ride, that is the situation a two-person assist covers.

Read each program’s own wording against its own definition. Louisiana’s Medicaid manual says the provider touches no passenger unless the passenger asks for “moderate assistance” into and out of the vehicle and to the entrance, so do not read that phrase against the therapy table.

Which activity does the level describe?

Section GG scores each activity on its own, so one rider can hold several levels. The ones that matter for a ride are chair or bed-to-chair transfer (GG0170E), car transfer (GG0170G), walking 10 feet (GG0170I), and wheeling 50 and 150 feet (GG0170R and S). Ask for the car transfer level, because it describes getting into a vehicle seat.

Two Section GG rules help when a request is vague. A resident who stays in a wheelchair and never moves into a car or van seat is not scored on the car transfer, so a chair-bound rider will show a not-attempted code instead of a level. And code 10, not attempted due to environmental limitations, covers cases such as no car being available during the assessment. It means nobody tried the transfer, not that the rider cannot do it.

What should you ask when a request says “min assist”?

Ask four questions before the trip is accepted:

1. Which scale does the word come from, nursing home Section GG or the older rehabilitation scale?
2. Does the helper take any of the rider’s weight, or only touch and steady?
3. How many helpers does the rider need?
4. Does the rider transfer to a vehicle seat, or stay in the chair?

The answers decide the service level. If the booked level does not match, the guide on trips booked at the wrong level of service covers what to do, and safe passenger transfers covers the methods a trained driver may use.

Matching the level to the vehicle in HealthRide

Wheelchair, stretcher, and oxygen needs are matched on HealthRide’s dispatch board, so the vehicle you send fits the service level the trip was booked at.