How to Fill Out and Submit Illinois HFS 2271: Certificate of Transportation Services

Illinois HFS 2271, the Certificate of Transportation Services (CTS), is the one-page medical form a licensed healthcare professional completes to authorize non-emergency transportation for a Medicaid participant whose trip starts at a private residence. It tells the state’s transportation broker what level of transport the patient actually needs, from a basic service car up to a non-emergency ambulance, and it is the documentation the broker relies on to approve the trip and pay the provider.¹ The form applies to patients covered under Medicaid fee-for-service, HealthChoice Illinois managed care, and Medicare-Medicaid Alignment Initiative plans.

When You Need the HFS 2271 (and When You Don’t)

Use the HFS 2271 for non-emergency ground ambulance, medicar or wheelchair van, and service car transports that begin at the patient’s home. If the trip starts at a hospital or long-term care facility, use the HFS 2270 Physician Certification Statement instead; the HFS 2271 does not cover facility-originating trips. Private automobile transports do not require a CTS at all.²

Fill the form out before the transport, not after. One copy goes to the broker for approval, and a second copy goes to the transportation provider at the time of pickup.¹

Who Can Sign the Form

Only a licensed medical professional involved in the patient’s care may complete and sign the HFS 2271. The non-emergency transportation (NET) provider is explicitly prohibited from filling it out, and that restriction is printed in bold at the top of the form.³ The provider handbook lists these eligible signers:

Physicians (MD or DO)
Physician Assistants, Nurse Practitioners, and Clinical Nurse Specialists
Registered Nurses and Licensed Practical Nurses
Discharge Planners and Licensed Clinical Social Workers

Whoever signs must be able to credibly certify the patient’s medical condition and transport needs from the medical record.²

Patient Information at the Top of the Form

The top block asks for three things: full name, date of birth, and Customer Identification Number. The Customer ID is the nine-digit Recipient Identification Number (RIN) printed on the patient’s MediPlan Card.⁴ If the card is not on hand, the number can be pulled from the HFS eligibility verification system. Get this wrong and approval stalls, because the broker checks eligibility against the HFS file before authorizing anything.⁵

Choosing the Category of Service

The form instructs the signer to “select the most economical category of service that will meet the customer’s needs.” This is the heart of the form. The five options, from least to most intensive, are:

Fixed Route Transportation: public transit for patients who can safely use a bus or train.
ADA Paratransit: door-to-door shared-ride service for patients who cannot use fixed-route transit.
Service Car or Taxi: a passenger vehicle for patients who do not need a wheelchair-accessible vehicle or ambulance.
Medicar: a wheelchair van with a lift and lockdown for patients who are wheelchair-bound but do not need medical monitoring during the ride.
Non-Emergency Ambulance: for patients whose condition requires stretcher transport, medical observation, or equipment only an ambulance crew can provide. Choosing this option triggers a second choice among Basic Life Support (BLS), Advanced Life Support (ALS), or Specialty Care Transport (SCT).

Medical necessity is the standard, not patient preference or scheduling convenience. A patient qualifies for ambulance transport only when every less-intensive option is medically contraindicated at the time of the trip.²

Checking the Medical Conditions

The middle of the form has two checklists: one for non-ambulance transports and one for ambulance requests. Check every condition that applies, then write a narrative explaining the diagnoses and why the selected transport level is required.

For Service Car, Medicar, or Paratransit

The non-ambulance checklist covers mobility and safety factors: whether the patient is ambulatory (with or without a walking device), whether the patient uses a wheelchair and can or cannot step into a regular car, contractures, dementia or mental health history, obesity (with weight noted), paralysis, and whether an attendant is needed during the ride. A patient who self-administers oxygen or uses it only as needed belongs in this category rather than the ambulance category.³

For Non-Emergency Ambulance

If you select non-emergency ambulance, check at least one condition from the ambulance list. Under Illinois administrative code, the patient must meet at least one of these criteria:⁶

Isolation precautions for a communicable disease.
Oxygen that must be administered or adjusted by a third party rather than self-administered.
Continuous advanced airway management through an artificial airway.
Suctioning, assisted ventilation, or apnea monitoring.
Active order for IV fluids before, during, and after transport.
Chemical or physical restraints for a patient who is a danger to self or others.
One-on-one supervision due to risk of harm or elopement.
Cardiac, respiratory, or hemodynamic monitoring during the trip.
Special handling or positioning (for example, bilateral lower-extremity amputation or poor trunk control preventing a sitting position).
Ongoing clinical observation during transit.
Bed confinement: the patient cannot get up without assistance, cannot walk, and cannot sit in a chair or wheelchair.

Two checklist items need extra detail. Item 4 (unable to sit upright) and item 11 (stair assistance or lifting) require the signer to write out the specific medical condition behind the checkmark. A bare check with no explanation will not pass review.

Below the checklist, write the primary and secondary diagnoses in the narrative box, then explain in your own words why the requested level is medically necessary. If the patient needs different modes for different appointments (for example, ambulance for dialysis three times a week but medicar for a quarterly follow-up), spell those circumstances out separately. The form itself warns that a higher level of service “cannot be requested out of convenience, it must be medically necessary.”³

Signature, Dates, and How Long the Authorization Lasts

By signing, the medical professional certifies that everything on the form is true, accurate, and supported in the patient’s medical record. The form warns that falsifying entries or concealing material facts can result in fines, civil monetary penalties, imprisonment, and recoupment of funds paid.³

At signature, fill in four fields: printed name and title, a direct phone number the broker can use for questions, the date signed, and an authorization expiration date. The maximum authorization window is six months from the date of signing. For recurring trips, the practical limit depends on the mode: ambulance authorizations last up to 60 days per CTS, while medicar, wheelchair van, and service car authorizations last up to 180 days. A new CTS is required any time the patient’s condition or transport needs change, regardless of how much time is left on the current one.²

Submitting the Form

Send the completed, signed CTS to the state’s contracted transportation broker, currently Transdev, for approval. Give a copy to the transportation provider at the time of transport.² The broker verifies Medicaid eligibility and reviews the medical justification before issuing approval.

If you are seeking post-approval after a trip has already occurred, the request must reach HFS or its agent within 30 calendar days of the date of service. When the patient’s Medicaid application was still pending at the time of transport, the deadline extends to 90 calendar days after HFS issues the notice of decision approving the application.⁷

Why a CTS Gets Rejected

The most common failure is a mismatch between the transport level selected and the conditions documented. Checking “non-emergency ambulance” but only marking items from the non-ambulance list (needing a walker, using a transfer wheelchair) will produce a downgrade or denial, because Table A criteria have not been met. Other recurring problems:

Wrong or missing RIN, which prevents eligibility verification.
Missing signature, which makes the form invalid.
Form completed by the transportation provider rather than a licensed medical professional.³
Items 4 or 11 checked without the required written medical condition.
Justifications that cite patient preference or vehicle availability instead of medical necessity.

Where to Download the Form

The current HFS 2271 is a downloadable PDF on the Illinois Department of Healthcare and Family Services website.³ Medical offices, home health agencies, and primary care practices that regularly certify transport for homebound Medicaid patients should keep blank copies on hand. For hospital discharges or trips originating in a facility, use the HFS 2270 instead.

1
Illinois Department of Healthcare and Family Services. Reinstatement of the Certificate of Transportation Services (CTS) as the HFS 2271 Form Effective May 1, 2022
2
Illinois Department of Healthcare and Family Services. Handbook for Providers of Transportation Services – Section 205.2
3
Illinois Department of Healthcare and Family Services. Certificate of Transportation Services (CTS) – HFS 2271
4
Illinois Department of Healthcare and Family Services. Instructions – Transportation Invoice
5
Illinois Department of Healthcare and Family Services. ACE-CCE Member Services Toolkit, Installment 5 – Non-Emergency Medical Transportation
6
Legal Information Institute. Illinois Admin Code Title 89, Part 140, Subpart L, Table A – Criteria for Non-Emergency Ambulance Transportation
7
Legal Information Institute. Illinois Admin Code Title 89, Section 140.491 – Medical Transportation