Transportation Restrictions

You may only claim reimbursement for miles driven with your car - while the Waiver Recipient is present in the car with you - for the following purposes:

1) Community Integration (including Hippotherapy/Companion Therapy and Community Activities - such as to access a gym or Parks & Rec activities)

2) Money Management (including banking, grocery shopping, etc.)

3) To the Individual's Home to work on goals (from school, a day program, etc.)

4) Under special circumstances, to the Staff's Home to work on goals (supervisory permission required)

Please note mileage reimbursement may be adjusted due to the following:
a) Mileage is outside of the county of residence without prior approval.
b) Mileage is incorrect when checked against Google Maps.
c) Mileage reimbursement for doctor's appointments are outside of Waiver guidelines.
d) Destinations not clearly defined or not related to service objectives.
e) Mileage exceeds miles per month allowed in Plan of Care.

Staff/Client Names & Work Week

WAIVER STAFF

WAIVER RECIPIENT

Friday's Date - First Day of Work Week