Safe Travel for All: Establishing a Statewide Program for Adaptive Needs Transportation

Ben Hoffman, M.D., CPST-I, FAAP
Adrienne Gallardo, MA, CPST-I
Larisa Nefedov, MA, CPST-I
Michelle Nichols, CPST-I, STAC-I

Children and youth with special health care needs may require specialized accommodations to be safely transported in motor vehicles. Certified Child Passenger Safety Technicians (CPST) with additional training in adaptive needs transportation are best qualified to perform these assessments, in collaboration with families and medical professionals. Access to high-quality assessment to ensure safe transportation for children and youth with special health needs is limited by a number of factors: 1. Geography: Most Oregon communities lack access CPSTs with adaptive needs training. While there are statewide systems-level solutions for referral to pediatric specialty care, Oregon lacks a centralized approach for adaptive transportation assessment. 2. DME Regulation: Adaptive needs seats/vests are regulated by NHTSA, not the FDA. In practice, adaptive needs car seats fall into a gray zone between DME and “adaptive equipment,” and coverage depends on whether a given payer’s written policy chooses to include them under DME benefits. 3. Conflict of Interest: Adaptive needs seats/vests are sold/distributed by for-profit DME companies, raising concerns of bias from Medicaid payers. 4. Billing: CPSTs with adaptive needs training have not heretofore been able to bill Medicaid for assessment. This precludes a path to revenue generation and sustainability.

The Doernbecher Injury Prevention Program in Portland, OR, conducted a landscape analysis to identify access barriers to high-quality adaptive-need transportation services (Figure 1). Based on the findings, we identified structural and policy solutions, with a focus on state administrative rules, using the AAP CPTI Project Planning Tool. We then began building relationships with state governmental leaders and key staff to collaboratively address regulatory change.

Through collaboration with the Oregon Department of Transportation, we established a statewide referral system for adaptive needs transportation, including hiring a full-time CPST to perform the assessments.

We then worked with staff from Oregon Medicaid to revise state regulations to address the following: 1. Classification of NHTSA-certified adaptive needs seats/vests as DME 2. Establishing CPSTs with supplemental training in Adaptive Needs Transportation as Medicaid billing providers a. Established acceptable billing codes b. Established standards for CPST billing under a licensed independent provider who is also a CPST-I

The relevant regulations are shown in Figure 2.

Through collaboration with state Medicaid leaders and staff, Oregon became the first state to : 1. Explicitly identify adaptive needs car seats/vests as DME. 2. Establish CPSTs with adaptive needs expertise as Medicaid billing providers.

1. Discuss barriers to high-quality adaptive needs transportation assessment and resources.
2. Describe regulatory approaches to improving access to adaptive needs transportation services and supports.
3. Explain how CPSTs with adaptive needs training can bill Medicaid for services provided.