Additionally, this service is not available to children in the custody of the State of Utah: Department of Human Services, Division of Child and Family Services for the purposes of visitation to a family home. X X Provider Service Delivery Method Participant-directed as specified in Appendix E managed (check each that applies): Specify whether the service may Legally X Relative Legal Guardian be provided by Responsible (check each that Person applies): Provider Specifications Provider X Individual. List types: X Agency. List the types of agencies: Category(s) Self-directed--Non-Medical Agency-based Non-Medical Transportation (check one or Transportation both): Provider Qualifications Provider Type: License Certificate Other Standard (specify) (specify) (specify) Individual with Certified by DSPD as Under state contract with DSPD as • Non-Medical license and an authorized provider an authorized provider of services and driver’s Transportation registered vehicle, of services and supports to people with disabilities in per 53-3-202, UCA supports to people accordance with 62A-5-103, UCA and and 41-12a-301 with disabilities in R539-5. through 412, UCA accordance with Driver must possess a current Utah • UCA. Driver License and proof of auto liability insurance in amounts required by state law. Agency-based Licensed public Certified by DSPD as Under state contract with DSPD as • transportation an authorized provider an authorized provider of services and Transportation carrier of services and supports to people with disabilities in supports to people accordance with 62A-5-103, UCA. OR with disabilities in Driver must possess a current Utah • Individual with accordance with Driver License and proof of auto liability license and driver’s UCA. insurance in amounts required by state law. registered vehicle, per 53-3-202, UCA Enrolled as a Medicaid provider • and 41-12a-301 through 412, UCA Current business license Verification of Provider Qualifications Provider Type: Entity Responsible for Verification: Frequency of Verification Division of Services for People with Disabilities Annually Transportation Agency-based Division of Services for People with Disabilities Annually
Additionally, this service is not available to children in the custody of the State of Utah: Department of Human Services, Division of Child and Family Services for the purposes of visitation to a family home. Service Delivery Method (check each that applies): X Participant-directed as specified in Appendix E X Provider managed Specify whether the service may be provided by (check each that applies): Legally Responsible Person X Relative Legal Guardian Provider Specifications Provider Category(s) (check one or both): X Individual. List types: X Agency. List the types of agencies: Self-directed--Non-Medical Transportation Agency-based Non-Medical Transportation Provider Qualifications Provider Type: License (specify) Certificate (specify) Other Standard (specify) Transportation Individual with driver’s license and registered vehicle, per 53-3-202, UCA and 41-12a-301 through 412, UCA Certified by DSPD as an authorized provider of services and supports to people with disabilities in accordance with UCA. • Under state contract with DSPD as an authorized provider of services and supports to people with disabilities in accordance with 62A-5-103, UCA and R539-5. • Driver must possess a current Utah Driver License and proof of auto liability insurance in amounts required by state law. Agency-based Non-Medical Transportation Licensed public transportation carrier OR Individual with driver’s license and registered vehicle, per 53-3-202, UCA and 41-12a-301 through 412, UCA Current business license Certified by DSPD as an authorized provider of services and supports to people with disabilities in accordance with UCA. • Under state contract with DSPD as an authorized provider of services and supports to people with disabilities in accordance with 62A-5-103, UCA. • Driver must possess a current Utah Driver License and proof of auto liability insurance in amounts required by state law. • Enrolled as a Medicaid provider Verification of Provider Qualifications Provider Type: Entity Responsible for Verification: Frequency of Verification Transportation Division of Services for People with Disabilities Annually Agency-based Division of Services for People with Disabilities Annually
ABI%20Waiver%20Amendment%20-%20Final%20Draft%20for%20Public%20Comment.docx