Effective Date
Instructions
Updated: 11/2024
Purpose
The Individual Transportation Plan (ITP) is used to document how Home and Community-based Services (HCS) and Texas Home Living (TxHmL) funded transportation will be delivered to support a person’s desired outcomes and purposes for transportation as identified in the person-directed plan.
Procedure
The program provider develops an ITP with the person or LAR if transportation as a supported home living (SHL) or community support (CS) activity is identified as a need on the person’s PDP.
The ITP is used to plan for the person’s anticipated transportation needs during the year. The level of specificity included in the plan depends on the person’s specific transportation needs. HHSC knows instances may occur throughout the year that could require reasonable minor adjustments to the plan. However, instances that occur that will result in a major change to the plan must include a revised ITP.
Detailed Instructions
Person’s Name — Enter the person’s first and last name.
Medicaid No. — Enter the person’s Medicaid number.
Provider No. — Enter the program provider’s number.
Vendor No. — Enter the program provider’s vendor number.
Backup Plan Required — Mark yes or no based on the SPT's decision on a need for a service backup plan. The SPT must recommend a service backup plan if SHL or CS is identified as critical for the person.
ITP Date — Enter the date the ITP was developed or revised.
Individual Plan of Care (IPC) Begin Date — Enter the IPC begin date for the IPC year the ITP was developed.
IPC Effective Date — Enter the IPC effective date this ITP was developed because of a PDP update and IPC revision.
IPC End Date — Enter the IPC end date for the IPC year the ITP was developed.
Start Date — Enter the date the person will begin the trip.
Completion Date — Enter the date the trip is expected to be completed.
Goal or Trip Purpose — Enter the specific purpose of the trip, such as grocery shopping, going to the bank, or going to and from work.
Place of Departure — Enter the location or venue where the person’s trip began.
Destinations — Enter the location or venue the person is being transported to, such as Safeway, North Texas State Bank or Southend Mall.
Units per trip — Enter number of units per trip. A unit of service for transportation as a SHL or CS activity is one hour. If less than an hour is needed for the trip, enter a fraction of a unit of service, but the fraction must be .25, .50 or .75.
Frequency of trip — Enter the number of trips per year.
Estimated total units — Enter the estimated total units needed to complete a trip from the start date to completion date. Multiply the units per trip by the frequency of trips to obtain the estimated total units.
Non-Waivers Attempted — Check the appropriate box if non-waiver resources were attempted for the transportation activity. Note: Transportation through non-Medicaid waiver services must be used, when possible, before using transportation as a waiver service.
Work or School Schedule — If the person, adult only, works or attends school and transportation is needed, provide the person’s schedule in the space provided.
In addition to the PDP, mark the appropriate box(es) to indicate the method used to develop the ITP to assist the person accomplish the outcome(s) or purpose(s).
Signatures
The person or legally authorized representative (LAR) and program provider must sign and date Form 3598 in the designated spaces.
For HCS/TxHmL, signatures for Request for Discontinuation of this ITP — The person or LAR and program provider signs in the designated spaces to indicate an agreement to discontinue this ITP.