Patients in the back seat need the right coverage.

Wheelchair vans and drivers: what Title 22 and the Vehicle Code require

Title 22, section 51231.2 sets Medi-Cal's wheelchair van standard. Drivers and attendants must hold a current California driver license or California Ambulance Driver Certificate, be at least 18, hold a current American Red Cross standard first aid certificate or equivalent, and have passed a physical within the past two years with a current DL-51. The rule bars certain registered sex offenders, habitual or excessive drug or alcohol users, and anyone convicted in the preceding seven years of a felony involving narcotics, dangerous drugs or alcohol. The van needs, among other items:

• Seating for at least two patients in standard-sized wheelchairs, and an emergency exit, other than the loading entrance, that fits one.
• A lift or ramp rated for at least 450 pounds that can be secured to the vehicle, and wheelchair fasteners strong enough to hold chairs and patients if the van overturns.
• A type 4-B:C dry powder or carbon dioxide fire extinguisher, and your business name on both sides and the rear.

Wheelchair passengers must be secured to their wheelchairs while loading, unloading and riding. Each year the provider gives the local Medi-Cal Field Office its hours and service area and a vehicle certificate (see the FAQ below).

Vehicle Code 12523.6 adds a special driver certificate for anyone employed primarily to drive people with developmental disabilities for a business, nonprofit or public agency, and bars those employers from using a driver without one. It is issued only after a Department of Justice (and, if applicable, FBI) criminal history check. "Primarily" means at least half of working time, including helping riders on and off, or 20 hours a week, whichever is less. It does not apply to someone who completed another background investigation prescribed by law, including health care transport vehicle operators.

Three gaps to read for in an NEMT program

NEMT programs bundle several forms, and gaps sit where they meet. Using IRMI's descriptions of the standard forms, I read for three:

• Cars you don't own. The general liability auto exclusion removes autos owned or operated by, or rented or loaned to, any insured, and employees are automatically insureds. Hired and nonowned auto coverage is sometimes a non-ISO endorsement that varies by insurer. If you use volunteer drivers, note that CG 21 37 removes employees and volunteer workers as insureds without creating nonowned auto coverage. More on hired and non-owned auto.
• Which abuse form is attached. ISO's CG 21 46 excludes abuse or molestation across all of an insured's activities when the person is in any insured's care, custody or control; CG 21 97 excludes it only for the professional services scheduled on it. If your general liability carries either form, read the separate abuse and molestation policy for how it fits.
• The walk to the door. IRMI's example: a patient the insured drove to a hospital fell outside its doors after being left unattended, and that injury did not result from use of the auto. A professional services exclusion on the general liability separates general from professional exposures, so read which form names attendant and escort work.