Form 3598, Individual Transportation Plan

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Documents

Effective Date: 4/2017

Instructions

Updated: 2/2022

Purpose

To justify the use of Community Living Assistance and Support Services (CLASS) and Deaf Blind with Multiple Disabilities (DBMD) funded transportation.

Procedure

CLASS/DBMD funded transportation is available through habilitation and residential habilitation if needed to support an individual's desired goals and objectives for transportation identified on the CLASS or DBMD Individual Program Plan (IPP) or when transportation services are added as an adaptive aid.

The Service Planning Team (SPT) or program provider is responsible for developing an individual transportation plan (ITP) if transportation as a habilitation, residential habilitation, supported home living (SHL) or community support (CS) activity is identified as a need on the individual's IPP.

The ITP is meant to be used as a planning instrument for the individual's anticipated transportation needs during the year. The level of specificity included in the plan will depend on the individual's specific transportation needs. The Texas Health and Human Services Commission (HHSC) recognizes that instances may occur throughout the year that could result in the need for reasonable minor adjustments to the plan. However, instances that occur which will result in a major change to the plan must include a revised ITP. 

The goal or trip purpose for transportation should be specifically described, based on the individual's needs necessary to enable the individual's independence and integration into the community.

Destinations must be described; for example, grocery shopping, banking, to and from work, etc., as described in the IPP.

Mode of transportation must be designated to assure the most cost effective means of transportation (for example, habilitation attendant, taxi vouchers, bus passes, etc).

Frequency and calculation of units must include the number of times each transportation activity is performed on a daily, weekly or monthly basis. To calculate the units, multiply the amount of time by the number of days, weeks or months within the start date to the completion date.

Estimated total units and a total cost for the start date to completion date must be documented on the form.

Indicate by checking the appropriate box if non-waiver resources were attempted for the transportation activity.

Note: The case manager or service coordinator is responsible for identifying and exhausting non-Medicaid waiver services, when possible, for transportation needs prior to adding  transportation as a waiver service.

If the individual works or attends school and transportation is needed, provide the individual's schedule in the space provided.

In addition to the IPP, mark the appropriate box(es) to indicate the method used to develop the ITP to assist the individual in accomplishing the outcome(s)/purpose(s).

Signatures

Members of the SPT must sign and date Form 3598 in the designated spaces.