Medical Transportation

Overview

Medical transportation supplements are provided to specific recipients of income assistance and disability assistance who are eligible for general health supplements or are facing a life-threatening health need. They are intended to meet extraordinary transportation costs associated with essential medical treatment.

Medical transportation supplements are available under the Employment and Assistance Regulation and Employment and Assistance for Persons with Disabilities Regulation.

Policy

Effective: April 1, 2010

Medical transportation supplements are provided only to: 

  • recipients of income assistance or disability assistance who are eligible for general health supplements;
  • Medical Services Only recipients; or
  • Persons approved under life-threatening health need if they have a direct and immediate life-threatening need for medical transportation. 

[see Related Links – Life-Threatening Health Needs]. 

The medical transportation supplement provides the least expensive appropriate mode of transportation when:

  •  essential medical treatment is required
  • there are extraordinary transportation costs, which are needs significantly in excess of those that can be reasonably incorporated into normal daily living. (For example, a routine or follow-up visit with a medical practitioner or nurse practitioner is not extraordinary, but the costs associated with daily medical tests or treatments with a medical practitioner or nurse practitioner over an extended period of time are extraordinary.)

Note: Expenses for routine medical visits must be met through monthly support assistance.

  • the recipient provides a list of the expected medical transportation costs
  • all options and resources have been explored by the client and Employment and Assistance Worker (EAW) prior to consideration of assistance with extraordinary medical transportation costs by the ministry  Other resources include (but are not limited to):
    • family, friends, volunteer agencies and service clubs
    • the Travel Assistance Program (TAP) which is coordinated by the Ministry of Health (MoH).  Transportation partners agree to waive or discount their regular fees.  Note: The ministry may provide assistance for funding not covered by MoH TAP.  For example, if the BC Ferries fare is covered by TAP, the ministry may provide bus transportation.  Recipients must request the TAP form from their medical practitioner or nurse practitioner.
    • Health Connections Program, a regional travel assistance program that offers subsidized transportation options to help defray costs for rural residents who must travel to obtain non-emergency medical care outside their home communities.  [see Contacts – Health Connections Program]
    • Medical Travel Accommodation, which provides hotel accommodation at discounted rates to patients and their families who are required to travel to out- of- town locations to access non-emergency care.  [see Contacts – Medical Travel Accommodation]

Taxi fares are not to be routinely provided and should only be considered when the medical travel need has been documented and no other options are available, including family and friends.  Alternatives to consider, where appropriate, include issuing funds for a day/week/month local transit pass and checking to see if the client has a subsidized bus pass. [see Related Links – BC Bus Pass Program]

Ongoing medical transportation for extraordinary and predictable appointments that have been confirmed in writing by a medical practitioner or nurse practitioner (for example, daily blood tests over an extended period or ongoing chemotherapy or kidney dialysis) may be authorized to a maximum of 12 months.  If an extension is required, a review will be performed prior to the discontinuance of an ongoing medical transportation supplement in order to confirm the continuing need.  Updated medical information will be requested where necessary. 

Supplementary assistance for non-local, non-emergency medical transportation is only considered when:

  • the required essential medical treatment is not available in the local community; and
  • the recipient has received a referral for the required medical treatment from a medical practitioner or nurse practitioner.

Medical practitioners outside of the local area must be recognized as a specialist in a field of medicine or surgery in accordance with the bylaws made by the board for the College of Physicians and Surgeons.

A medical transportation supplement may be considered for a recipient who resides in an area where planned birthing and maternity services are not available and who must leave their community to give birth. 

Recipients living in areas bordering Alberta may obtain routine medical treatment there when it is more reasonably available. In these cases, it is important to follow the specific procedures outlined in the regional medical transportation plan.  The Service Delivery Director develops this plan in each region.

[For information on contacting the Ministry of Health and Travel Assistance Program (TAP), see Contacts.]

Effective: July 17, 2008

Rates for travel by private vehicle may be authorized over the allowable 20 cents per kilometre only in exceptional circumstances as follows:

Agency / Escort Driver

  • The client has no private vehicle and all other sources of private transportation through family and friends have been exhausted; and
  • The only transportation available to the client is a driver, provided through an agency, who requires more than the allowable rate to cover extra costs such as additional insurance.  ICBC requires a vehicle to be insured for “business” rather than “pleasure” whenever a person receives compensation for transporting others; or
  • The client is unable to get to an appointment on their own and requires an escort who is driving the client in the escort’s vehicle and requires more than the allowable rate; or
  • The client is able to get to an appointment on their own but requires post-treatment travel, which is provided by an agency driver or escort that requires more than the allowable rate
  • If volunteer agencies or escorts are not available, other means of travel may be required, e.g., ambulance, taxi (this should only be considered for local transportation), etc...

Older Vehicle

  • The client has an older or less economical or reliable vehicle that is more costly to run (e.g., an older van or truck)

Significant Gas Price Increase

  • In the event of a significant automotive gas price increase, regions will determine what is an appropriate temporary increase in kilometre allowance

In all of the above circumstances, any rate above 20 cents per kilometre will only be authorized if:

  • All other less expensive modes of transportation have been canvassed and found unavailable or unsuitable; and
  • The specific private vehicle is the least expensive of the appropriate modes of transportation available.
  • There is a separate product for Medical Transportation issued under exceptional circumstances.

Effective: April 1, 2010

Medical transportation supplements should only be issued when the recipient is receiving essential medical treatment provided under Medical Services Plan (MSP) or the Hospital Insurance Act.

The following must be considered when determining eligibility for medical transportation:  

Transportation Costs

  • In cases where air, rail, bus or ferry are transportation options, the discounts offered by TAP may make these forms of travel the most economical.  TAP does not provide assistance with fuel costs.  The ministry may provide assistance for funding not covered by MoH TAP.  Through TAP, BC Ferries offers a full discount for the patient, escort (if approved by medical practitioner or nurse practitioner) and regular passenger car fare (those traveling in over height and extra length vehicles, including recreational vehicles and trailers, are required to pay the difference between regular and assessed fare for their vehicle).

Note:  The TAP program depends on the participation of transportation partners who provide fare discounts to patients presenting an approved TAP confirmation form.  The cost for a ferry reservation is not covered by the ministry nor the TAP program.  The TAP form does not guarantee space on the ferry nor priority loading.

Food or Support Costs

  • if treatment is provided on an out-patient basis

Accommodation Costs

  • Before providing assistance with accommodation costs, all resources must be explored, which may include (but are not limited to):  family and friends, government programs and agencies (such as Medical Travel Accommodation Listing provided by Corporate Supplies), BC Cancer Agency lodges, and non-profit/volunteer agencies (such as Easter Seals, BC Kidney Foundation Kidney Suites, Aboriginal Patient’s Lodge, Heart House).  If a hotel, motel, or bed and breakfast is the least costly appropriate form of accommodation, ensure applicants have pursued all possible discounts, such as those available through Internet booking services

Escort Costs, if applicable

  • An escort may be considered eligible for medical transportation only when accompanying a patient who is:

    • 18 years of age and under; or
    • incapable of travelling independently due to medical reasons.
    • The medical practitioner or nurse practitioner must indicate that an escort is required when medical reasons are indicated.

Effective: December 1, 2003

Under no circumstances is the medical transportation to be issued to purchase, maintain, repair, or insure a vehicle.

Under no circumstances are Emergency Health Services Commission ambulance bills to be paid directly by the ministry.  Out-of-province ambulance bills are not paid by the Ministry of Health and are not eligible for payment by the ministry.  Ambulance bills incurred while not in receipt of assistance are not covered.

Services that are not considered essential medical treatment and therefore not eligible for medical transportation include (but are not limited to):

  • self-help groups
  • methadone programs or treatment
  • Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or Gambler’s Anonymous (GA) meetings
  • psychological counselling
  • recreation or health clubs
  • esthetician for electrolysis
  • pharmacies
  • medical equipment stores
  • medical supply stores
  • orthotic appliance suppliers
  • routine dental treatment
  • water therapies (for example, swimming pools)

Procedures

Effective: April 1, 2010

To apply for a local medical transportation supplement, recipients are to provide:

  • written verification from a medical practitioner or nurse practitioner

To apply for a non-local medical transportation supplement, recipients are to provide:

  • a Request for Non-Local Medical Transportation Assistance form (HR3320); and
  • written verification from a medical practitioner or nurse practitioner or a TAP form with confirmation number.

The EAW must provide the recipient with the request form (HR3320) and a Medical Transportation Information Checklist – For Clients [see Additional Resources], which lists the information required when requesting a medical transportation supplement.

Effective: February 7, 2005

Any medical transportation supplement related to vehicle transportation is strictly limited to the maximum shown in Rate Table: Health Supplements and Programs – Medical Transportation Supplement [see Policy – Exceptional Circumstances].  The EAW must ensure that only the least expensive appropriate mode of transportation is issued. 

Note:  Greyhound Canada offers significant advance purchase fare discounts that may cost less than issuing for vehicle transportation. [see Contacts]

Normally, meal allowances are not to be provided. Money for food is provided to income assistance recipients through the monthly support supplement.  For those exceptional cases where circumstances warrant a meal allowance, it should not exceed the amount shown in Rate Table: Health Supplements and Programs – Medical Transportation Supplement.

Effective: December 1, 2003

Recipients provide their Personal Health Number (PHN) at the time of service as is provided through Medical Services Plan premium assistance. [see Related Links – Medical Services Plan and Medical Coverage]

If a recipient submits a bill for ambulance services rendered while in receipt of assistance, ministry staff write the PHN on the bill and forward the bill to the Ministry of Health.

If a recipient submits a bill for ambulance services rendered while not in receipt of assistance, the recipient must be advised that it is a matter between the recipient and the Emergency Health Services Commission.

Effective: May 20, 2010

The EAW must use the following procedures when issuing medical transportation over 20 cents per kilometre:

  1. Document on the case that all sources of private transportation have been exhausted (client’s, friend’s or relative’s vehicle).
  2. If using an agency, the reason for the higher rate must be confirmed and documented on the case with a confirmation from the agency where possible.  It should include what travel expenses the agency’s rate covers (i.e., gas, insurance, vehicle maintenance).
  3. The Supervisor must approve rates higher than the 20 cents per kilometre. The approval is to be entered on the case.
  4. When issuing rates higher than 20 cents per kilometre, the appropriate benefit plan must be used and the rate per km entered.
  5. When considering a higher kilometre rate for older or less economical vehicles, [see Additional Resources – Natural Resources Canada] for information on vehicle types, gas consumption and average kilometre costs.

Effective: April 1, 2010

For persons who face a life-threatening health need and who are otherwise not eligible for a medical transportation supplement ensure that written verification from a medical practitioner or nurse practitioner is on the case confirming that a life-threatening health need exists and that travel is required to receive treatment for that need.

A recipient who must leave their community to receive essential medical services and treatments that are not available locally may be eligible for a medical transportation supplement if the need for out-of-community travel is confirmed by a medical practitioner or nurse practitioner.  This would include a recipient who resides in an area where planned birthing and maternity services are not available and who must leave their community to give birth.

  1. Determine if the applicant is eligible for a supplement to meet the life-threatening health need by running the Assisted Eligibility tool. [see policy and procedures in Related Links – Life-Threatening Health Needs]
  2. If the applicant is eligible for this supplement, follow the steps outlined below for either local or non-local medical transportation.

Effective: September 1, 2016

To issue a supplement for local, non-emergency medical transportation, run the Assisted Eligibility tool, which will include the following:

  1. Ensure the recipient has provided written verification of the medical need for the requested transportation from a medical practitioner or nurse practitioner. The written verification should provide the following information:
  • Confirmation that the medical treatment is covered by MSP or the Hospital Insurance Act
  • Number of appointments per week necessary for the treatment, if applicable
  • Expected duration of the treatment, if applicable
  • Whether an escort is medically required or not required
  • Specific reason why the recipient is unable to use public transportation if the person requires a taxi on an ongoing basis.
  1. Confirm that the medical travel is to a medical practitioner’s office or a specialty clinic for essential medical treatment (e.g., laboratory clinic, radiology clinic, hospital, etc.)
  2. Determine all of the following:
  • Does the client have a bus pass that will meet their need?
  • Will providing a day / week / month local transit pass meet the need and be the least expensive?
  • Is the recipient able to contribute or have access to alternative resources through a financial assessment?  
  1. Scan and profile the written verification from the medical practitioner or nurse practitioner into the case and document detail information of approved supplement.

Effective: April 28, 2015

Recipients should receive approval for non-local, non-emergency medical transportation funding through the Provincial Transportation Program prior to travel or leaving their home community. However, in emergency circumstances where the recipient could not receive medical transportation funding prior to travel or where the recipient incurs additional costs associated with the medical treatment/travel, the recipient may request medical transportation funding from the Provincial Transportation Program from the medical treatment location. In these cases the recipients’ circumstances will be noted on the case.

A recipient who must leave their community to receive essential medical services and treatments that are not available locally may be eligible for a medical transportation supplement if the need for out-of-community travel is confirmed by a medical practitioner or nurse practitioner.  This would include a recipient who resides in an area where planned birthing and maternity services are not available and who must leave their community to give birth. 

To issue a supplement for non-local, non-emergency medical transportation, run the Assisted Eligibility tool, which will include the following:

  1. Ensure the recipient has either provided written confirmation from their medical practitioner or nurse practitioner, that the essential medical treatment or service is not available locally or a copy of the TAP form with confirmation number:
  • If the medical transportation supplement is only to cover the expense of mileage or expenses of a volunteer driver, request that the recipient provide written verification from their medical practitioner or nurse practitioner.  The written verification should provide the following information:

    • Confirmation that the treatment is covered by MSP or the Hospital Insurance Act
    • Confirmation that the treatment is not available locally
    • Date and time of the appointment
    • For ongoing appointments, schedule and duration of appointments, (for example 1 visit per month for 3 months) [For more information, see Procedures - Issuing a Supplement for Ongoing Medical Transportation]
    • Number of appointments per week necessary for the treatment and expected duration of the treatment, if applicable.
    • If an escort is requested, confirmation that an escort is medically required 
  • If the recipient requires air, rail, or ferry as a mode of transportation, request that the recipient provide a copy of the TAP form with confirmation number.

Case Examples:

Scenario 1 – client lives in Chilliwack and requires a chemotherapy treatment at the Vancouver General Hospital in downtown Vancouver.  This treatment is a day trip and client does not require accommodation.  The only expense that is being claimed is mileage.  In this situation, the client should provide written verification from their medical practitioner or nurse practitioner.

Scenario 2 – client lives in Port Alberni and is referred for various laboratory tests at the Vancouver General Hospital.  The duration for these tests will be 3 days.  Client will require a ferry, mileage, accommodation, and meals while visiting the laboratory clinics at the hospital.  In this situation, the client should provide a copy of the TAP form with confirmation number. 

  1. Ensure the recipient has submitted a Request for Non-Local Medical Transportation Assistance form (HR3320).

  2. Confirm that the medical travel is to a medical practitioner that is recognized as a specialist in a field of medicine or surgery in accordance with the bylaws made by the board for the College of Physicians and Surgeons of British Columbia.  [For information on how to verify a specialist, see Contacts.]

  3. Determine if the recipient is able to contribute or have access to alternative resources through a financial assessment.

  4. Ensure the client has provided a detailed itinerary and a detailed list of requested assistance in Section A Part 3 of HR3320. [see Policy – Included in Medical Transportation]

  5. Determine the least expensive appropriate transportation mode.  Check the TAP provided by the Ministry of Health (MoH) which offers discounted transportation, Health Connections Program which offers subsidized transportation options, as well as charitable assistance through corporate partnership with various organizations.

  6. Complete Section B of the Request for Non-Local Medical Transportation Assistance form (HR3320) to determine eligibility and assess the medical transportation supplement.

  7. If the ministry should choose to pay for accommodation directly to the hotel on behalf of the recipient, add a note in the comment box of Section B “Ministry will pay hotel directly for client’s accommodation” and send confirmation to the hotel – Accommodation Confirmation (HR3327).

  8. Scan and profile a copy of the HR3320 and written verification from a medical practitioner or nurse practitioner or the TAP form into the case along with all other relevant documentation supporting the decision.

Effective: April 1, 2010

Patients are automatically covered for medical services obtained in other provinces, provided the service rendered is covered by MSP and the patient is registered with MSP at the time of service. [For more information, see Related Links – Medical Services Plan and Medical Coverage.]

If a medical practitioner refers a patient for medical care outside of Canada, the medical practitioner must request a prior authorization from MSP for services rendered outside the country.

To issue assistance for medical transportation outside BC or Canada, run the Assisted Eligibility tool, which will include the following:

Ministry Staff

1.

Ensure the recipient has provided written verification of the medical need for the requested transportation from a medical practitioner or nurse practitioner.  The written verification should provide the following information:

  • Confirmation that the treatment is covered by MSP or the Hospital Insurance Act
  • Confirmation that the treatment is not available locally
  • Number of appointments per week necessary for the treatment, if applicable
  • Expected duration of the treatment, if applicable
  • Whether an escort is required or not required

 

2.

Ensure the recipient has submitted the Request for Non-Local Medical Transportation Assistance form (HR3320).

 

3.

Ensure all discounts or medical rates have been pursued.

 

4.

Confirm that the medical travel is to a medical practitioner’s office or a specialty clinic for essential medical treatment (e.g., laboratory clinic, radiology clinic, hospital, etc.).

 

5.

Confirm that the medical practitioner is recognized as a specialist in a field of medicine or surgery in accordance with the bylaws made by the board for  the College of Physicians and Surgeons.

 

6.

Determine if the recipient is able to contribute or access alternative resources through a financial assessment

 

7.

Ensure the recipient has provided a detailed itinerary and detailed list of requested assistance in Section A Part 3 of HR3320. [see Policy – Included in Medical Transportation]

 

8.

Determine the least expensive transportation mode.  Check the TAP provided by the Ministry of Health (MoH) which offers discounted transportation, Health Connections Program which offers subsidized transportation options, as well as charitable assistance through corporate partnership with various organizations. [see Contacts]

 

9.

Complete Section B of the Request for Non-Local Medical Transportation Assistance form (HR3320) to determine eligibility and assess the medical transportation supplement.

 

10.

If the ministry should choose to pay for accommodation directly to the hotel on behalf of the recipient, add a note in the comment box of Section B “Ministry will pay hotel directly for client’s accommodation” and send confirmation to the hotel – Accommodation Confirmation (HR3327).

Supervisor

11.

Review all documentation for approval and complete supervisor approval activity.

 

12.

Scan and profile a copy of the HR3320 and written verification from a medical practitioner or nurse practitioner into the case along with all other relevant documentation supporting the decision.

Effective: April 1, 2010

Ongoing medical transportation for extraordinary and predictable appointments that have been confirmed in writing by a medical practitioner or nurse practitioner (for example, daily blood tests over an extended period or ongoing chemotherapy or kidney dialysis) may be authorized to a maximum of 12 months.

If an extension is required, the EAW must complete the following steps:

  1. Review the medical documentation on the case to determine if the extension can be given based on the information previously provided.

  2. If existing documentation does not provide sufficient information to support the extension, the EAW may secure the client’s permission to contact their medical practitioner or nurse practitioner directly in order to confirm the continuing need in addition to the type and frequency of appointments requested.

  3. If the medical treatment is ongoing at the same location, the original Request for Non-Local Medical Transportation Assistance form (HR3320) may be used as supporting documentation. TAP requires a new TAP form with a confirmation number for each subsequent visit for non-local transportations. If the client must return to the specialist, hospital or specialty service as part of the same course of treatment, the destination specialist office or specialty service can complete and sign or stamp another TAP form.

  4. Initial essential medical treatments may be urgent and require a non-local medical transportation for the treatment.  But over time if the treatment is the same and ongoing, it is recommended to check for more local resources and see if the treatment can be performed locally.

  5. If updated written medical information is required, the EAW must provide the recipient with a Medical Transportation Information Checklist – For Clients [see Additional Resources].  Clients must be given reasonable time to obtain the new documentation prior to discontinuance of the supplement.

  6. If a recipient fails to provide the requested information, attempt to contact the recipient by phone or signal their cheque and send the signal letter [see policy and procedures of reasonable steps prior to cheque signalling in Individual Case Management].  Discontinuance of a supplement should only be allowed to occur once the EAW has made a review decision, the client has been notified of the decision, including reasons, in advance of discontinuance and the client has been given the opportunity to request reconsideration.

Effective: April 28, 2015

Before issuing a medical transportation supplement, ensure all of the following have been applied:

  • The applicant must provide written verification of the medical need for the requested transportation from a medical practitioner or nurse practitioner or a TAP form with confirmation number, which must be scanned and profiled.
  • There must be a completed Request for Non-Local Medical Transportation Assistance form (HR3320) on the case for the appointment(s).
  • Applicant must be eligible for Schedule C health supplements or face a life-threatening health need (requires EAO approval).
  • The destination location must be confirmed as a medical practitioner’s office or a specialty clinic.
  • The destination medical practitioner must be recognized as a specialist in a field of medicine or surgery in accordance with the bylaws made by the board for the College of Physicians and Surgeons.
  • Alternatives to issuing a medical transportation supplement must first be explored.
  • A list of the expected medical transportation costs must be provided by the applicant.
  • Only the least expensive, appropriate medical transportation supplement may be issued using the appropriate benefit plans.
  • Details of the medical transportation supplement must be noted.
  • Exceptional circumstances warranting a rate higher than 20 cents per kilometre must be approved by the Supervisor, issued under medical transportation – Med Trans Exceptional Rate/KM and noted [see Additional Resources].
  • Taxi may be authorized when all other options have been exhausted for local medical transportation only.
  • Check for local resources if the treatment is ongoing.

Effective: January 8, 2013

  • When all other options have been exhausted, a taxi may be authorized for local medical transportation only, through a Purchase Authorization Benefit Plan.
  • The EAW is to request a firm estimate of the total cost from the taxi company and advise the company that, generally, additional costs will not be considered.
  • The authorization provided for a taxi must reflect the actual cost of the trip.
  • The ministry will only pay the amount approved by the EAW spending authority on the service order.
  • The EAW is to advise the taxi company that, in the event of extraordinary circumstances where the trip exceeds the estimate provided (i.e., unexpected traffic accident, detours out of the driver’s control, etc.), the taxi company will need to contact the ministry and advise of the change before submitting their invoice for payment.
  • The EAW will provide a contact number to the taxi company.
  • If appropriate, the EAW spending authority will revise the service order and provide the new service order number to the taxi company in order for them to submit the invoice.  

Authorities and Responsibilities

Effective:  April 2, 2012

Medical Transportation

Employment and Assistance Worker

  • Determining eligibility for the medical transportation supplement for clients eligible for general health supplements to travel within BC up to $700

Supervisor

  • Approving medical transportation in excess of $700
  • Approving the medical transportation supplement for border travel outside of BC (e.g., Alberta), as per the regional medical transportation guidelines established by the Director of Service Delivery
  • Approving for medical transportation issued under exceptional circumstances [see Procedures]

Manager

  • Approving the medical transportation supplement for clients with a life-threatening health need (including those not in receipt of BCEA) who are not eligible for general health supplements and non-border travel outside BC
  • A summarized Authority Level matrix is available in Additional Resources.

Effective:  May 20, 2010

Supervisor is responsible for:

  • As required, contacting liaison Employment and Assistance Offices regarding non-local, non-emergency medical transportation as specified in the regional guidelines developed by the Director of Service Delivery

  • Approving for medical transportation issued under exceptional circumstances [see Procedures]

Director of Service Delivery is responsible for:

  • Developing regional guidelines regarding local and non-local medical transportation