Can one aide bill both a care visit and a ride for the same hour?

It depends on the waiver and the rate. Ohio's rule for its developmental disability waivers bars billing homemaker or personal care by the driver during a per-trip ride and allows it during a per-mile ride. Utah's New Choices Waiver bars billing Attendant Care in transit unless a second employee, assessed as needed, gives active care while the first drives. The waiver service definition in your own state sets the rule that applies to you.

What does a waiver trip record usually have to include?

The rider, the date, when the trip started and stopped, where it began and ended, and who drove, with a signature. The details differ by state. Ohio also wants the vehicle's license plate and the names of everyone aboard, and Utah wants the rider's signature or a note on why there is none. Read the rule for the waiver you serve before you design the form.

Can a waiver ride take a client to a doctor's appointment?

In Utah, no. The New Choices Waiver provider agreement says non-medical transportation is not equivalent to medical transportation and bars billing Medicaid to take a waiver client to a medical appointment. It also bars driving to a nearby non-medical stop as a way around that rule. Rides to medical care are paid through a different benefit, explained in the guide to adding rides to a home care agency.

How long does a waiver service authorization for rides last?

In Utah, at most one year, even when the end date on the form is blank. The authorization lists the billing code, number of units, frequency, and duration. The state recovers payment for dates outside the span, for units over the amount authorized, and for codes that were not authorized. Standing rides should stop where the authorization stops.

Can a waiver client be billed for a missed ride?

In Utah, only if the client or the client's legal representative signed a written cancellation policy that expressly allows it. Without that signed policy, the provider cannot charge the client for a missed or canceled appointment. For private-pay rides, the cancellation terms in your own agreement apply.

Home Care Agency Transportation Software

Q: What happens to standing rides when a client goes into the hospital?

In Utah, the service authorization is suspended while the client is admitted to a hospital or skilled nursing facility. After discharge, the provider checks with the case management agency for approval to resume if units remain, or asks for a new authorization if the old one has expired. Pause the series for the stay and restart it only after approval.

Why do rides need their own record, apart from care visits?

A care visit and a ride can overlap in time, and some waivers say which of the two may be billed, so the two have to be separable on paper. Utah’s New Choices Waiver is a clear example. A provider that is also enrolled as an Attendant Care provider cannot bill Attendant Care during time spent in transit. The one exception is a client whom the case management agency assessed as needing active care during the ride, from a second employee while the first drives. Utah also asks the provider for separate, distinct log notes for each service it provides.

Ohio draws the line by rate. Its rule for developmental disability waivers (OAC 5123-9-18, effective January 2, 2025) bars billing homemaker or personal care by the driver during a per-trip ride, and allows it during a per-mile ride. The guide to IDD transportation services walks through both rates.

An agency whose aides also drive therefore needs two records for the same afternoon, a visit and a ride, each with its own start and end times. The care visit stays in the system that tracks visits. The ride record shows, trip by trip, when the vehicle was moving with the client aboard. Which program pays for which ride is covered in adding rides to a home care agency.

What does a waiver ride record have to show?

It has to show who rode, when, where, and who drove, and the exact list depends on the state. Utah’s agreement asks for these items in every service record:

The rider. First and last name.
The service. The date, the service by title (for example, “Non-Medical Transportation, T2003”), and the start and end times of each service encounter.
The places. The pickup address, general stopping points, and the final drop-off address.
The people. The driver’s name, and the name of the second employee when one gives active care during the ride.
The signatures. One from whoever performed or can attest to the service, and one from the member who received it, or a note on why none was obtained.

Utah requires the provider to hand these records to the waiver program office or another state designee on request. Ohio’s list differs. It adds the Medicaid ID number, the vehicle’s license plate, and the name of everyone in the vehicle, and for per-mile service it asks for the mileage of every separate commute, by odometer readings or by GPS tracking or mapping. The non-medical transportation software page compares Ohio’s three rules side by side.

Most of these items are things a trip record captures as the ride happens: the rider, the times, the addresses, the driver, and the signature. What is left is each state’s own extras, such as Ohio’s list of everyone aboard or Utah’s second employee.

Is visit verification a separate system from the ride record?

Yes. Electronic visit verification (EVV) is a federal requirement for personal care and home health visits made at a person’s home, and CMS’s questions and answers on section 12006 of the Cures Act do not mention transportation. The visit goes in the system your state requires for visits, and the ride goes in the record described above.

States can set their own rules for other services, so ask your state Medicaid agency or the waiver program whether a ride service needs anything beyond a trip record. EVV requirements for NEMT covers what the federal mandate requires and what states have added for rides.

How do standing rides fit a service authorization?

A standing ride has to end where its authorization ends. Utah’s agreement says the authorization lists the billing code, number of units, frequency, and duration, and that no service may begin until the authorization has been signed by the case management agency and the provider. An authorization lasts at most one year even when its end date is left blank. The state recovers payment for dates of service outside the span, for units beyond the number authorized, and for codes that were never authorized. Units authorized for one client cannot be moved to another.

Hospital stays change the picture too. Under the same agreement, an authorization is suspended while the client is admitted to a hospital or skilled nursing facility. After discharge, the provider checks with the case management agency for approval to resume if units remain, or asks for a new authorization if the old one has expired. In practice that means three things from the schedule:

An end date that matches the authorization, so a weekly ride does not run past it.
A pause for an admission, so no new rides are built while the client is in a hospital.
A restart only after approval, so a series is not switched back on by habit.

Who pays when a client’s ride is not a waiver ride?

A ride the care plan lists goes to the waiver, a ride to a medical visit goes to the state’s medical transportation benefit, and anything else is paid by the client, a family member, or another payer. So each trip needs its own payer, because one client can have rides billed to different places in the same week. Utah’s agreement says non-medical transportation follows the client’s care plan and does not deviate from it. It also bars billing Medicaid to take a waiver client to a medical appointment, or driving to a nearby non-medical stop as a way around that rule. Adding rides to a home care agency sorts out which program pays for which ride.

The payer also decides what can be charged for a missed ride. Utah lets a provider bill a waiver client for a missed or canceled appointment only if the client or the client’s legal representative signed a written cancellation policy that allows it. The same agreement requires the provider to accept the waiver rate as payment in full, and bars charging Medicaid for waiting at stopping points or for events such as crossing a county line. So the signed policy belongs in the client’s file before the first ride, and a no-show record should show when the driver arrived and how long the driver waited.

Running rides next to care visits in HealthRide

HealthRide runs the ride side, next to whatever system tracks your care visits. Recurring trips repeat about six weeks ahead, a series can be paused during a hospital stay and ended when care changes, and changing one day leaves the series alone. Drivers run each trip in the driver app, which records the times, the GPS-recorded miles, the rider’s signature, and the recorded wait when a client is not there, for a trip log that exports as a CSV or PDF. Private-pay clients pay by card through a pay link or a saved card, and an agency that pays for its clients’ rides gets an invoice on that payer’s own terms, with checks recorded in the same ledger through payments.

Transportation software for home care agencies adding rides