Ohio Admin. Code 5123-9-24 - Home and community-based services waivers - transportation under the individual options, level one, and self-empowered life funding waivers
(A) Purpose
This rule defines transportation and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.
(B) Definitions
For the purposes of this rule, the following definitions
shall apply:
(1) "Agency provider"
has the same meaning as in
means an entity that directly employs at least one
person in addition to a director of operations for the purpose of providing
services for which the entity is certified in accordance with rule
5123-2-08 of the Administrative
Code.
(2) "Commercial vehicles"
means buses, light rail transit, livery vehicles, and taxicabs that are
available for use by the general public.
(3) "Department" means the Ohio department of
developmental disabilities.
(4)
"Independent provider" has the same meaning as
in
means a self-employed person who provides
services for which the person is certified in accordance with rule
5123-2-09 of the Administrative
Code and does not employ, either directly or through
contract, anyone else to provide the services .
(5) "Individual" means a person with a
developmental disability or for purposes of giving, refusing to give, or
withdrawing consent for services, his or
her
the person's guardian in accordance
with section 5126.043 of the Revised Code or
other person authorized to give consent.
(6) "Individual service plan" means the
written description of services, supports, and activities to be provided to an
individual.
(7) "Modified vehicle"
means:
(a) A motor vehicle to be used upon
public streets and highways that has been structurally modified in a permanent
manner to meet the physical or behavioral needs of the individual being
transported; or
(b) A motor vehicle
that has been designed, constructed, or fabricated and equipped to be used upon
public streets and highways for transportation of individuals who require use
of a wheelchair and that shall:
(i)
Have
Has permanent
fasteners to secure a wheelchair to the floor or side of the vehicle to prevent
wheelchair movement;
(ii)
Have
Has
safety harnesses or belts in the vehicle for the purpose of securing
individuals in wheelchairs;
(iii)
Be
Is equipped
with a stable access ramp specifically designed for wheelchairs or a hydraulic
lift specifically designed for wheelchairs; and
(iv)
Be
Is inspected, on
each day the vehicle is used to provide transportation, by the first driver of
the vehicle and prior to transporting an individual in a wheelchair, to ensure
the permanent fasteners, safety harnesses or belts, and access ramp or
hydraulic lift are working. The inspection shall
will be
documented by the driver that conducts the inspection.
(8) "Service documentation" means
all records and information on one or more documents, including documents that
may be created or maintained in electronic software programs, created and
maintained contemporaneously with the delivery of services, and kept in a
manner as to fully disclose the nature and extent of services delivered that
shall include
includes the items delineated in paragraph (E) of this
rule to validate payment for medicaid services.
(9) "Transportation" means a service that
enables individuals enrolled in individual options, level one, and
self-empowered life funding waivers to access waiver and other community
services, activities, and resources. This service is offered in addition to,
and shall
will not replace, medical transportation required
under 42 C.F.R.
431.53 as in effect on the effective date of
this rule, transportation services under the medicaid state plan as defined in
42 C.F.R.
440.170(a) as in effect on
the effective date of this rule, if applicable, and non-medical transportation
as defined in rule
5123-9-18 of the Administrative
Code. Whenever possible, family, neighbors, friends,
or community agencies that provide transportation without charge shall be
utilized.
(10) "Waiver
eligibility span" means the twelve-month period following either an
individual's initial waiver enrollment date or a subsequent eligibility
re-determination date.
(C) Provider qualifications
(1) Transportation shall
will be
provided by an independent provider, an agency provider, or an operator of
commercial vehicles that meets the requirements of this rule and that has a
medicaid provider agreement with the Ohio department of medicaid.
(2) An applicant seeking approval to provide
transportation shall
will complete and submit an application
through the department's website
(http://dodd.ohio.gov) and adhere to the requirements of as applicable,
rule 5123-2-08 or
5123-2-09 of the Administrative
Code.
(3) An applicant seeking
approval to provide transportation as an independent provider
shall
will
present his or her
the applicant's driving record prepared by the bureau
of motor vehicles no earlier than fourteen calendar days prior to the date of
his or her application for initial or
renewal provider certification. A person having six or more points on
his or her
the
person's driving record is prohibited from providing
transportation.
(4) An independent
provider of transportation shall
will :
(a) Hold a
valid driver's license as specified by Ohio law.
(b) Have valid liability insurance as
specified by Ohio law.
(c)
Immediately notify the department, in writing, if he
or she
the independent provider
accumulates six or more points on his or
her
the independent provider's driving
record or if his or her
has a driver's license is suspended or revoked.
(5) An agency provider of transportation
shall
will :
(a) Ensure that each driver holds a valid
driver's license as specified by Ohio law.
(b) Ensure that each driver is covered by
valid liability insurance as specified by Ohio law.
(c) Obtain, for each driver, a driving record
prepared by the bureau of motor vehicles no earlier than fourteen calendar days
prior to the date of initial employment as a driver and at least once every
three years thereafter. A person having six or more points on
his or her
the
person's driving record is prohibited from providing
transportation.
(d) Require each
driver to immediately notify the agency provider, in writing, if the driver
accumulates six or more points on his or
her
the driver's driving record or
if his or her
has
a driver's license is suspended or
revoked.
(e) Develop and implement
written policies and procedures regarding vehicle accessibility, vehicle
maintenance, and requirements for vehicle drivers.
(D)
Requirements for service delivery
(1)
Transportation shall
will be provided pursuant to an individual
service plan that conforms to the requirements of rule
5123-4-02 of the Administrative
Code. Whenever possible, family, neighbors, friends, or
community agencies that transport people without charge are to be used to meet
an individual's needs.
The individual service
plan of an individual who requires transportation to be provided in a modified
vehicle shall so indicate.
An individual's
need for transportation to be provided in a modified vehicle is to be
documented in the individual service plan.
(2) Transportation services may extend to
those times when the individual is not physically present and the provider is
performing transportation on behalf of the individual.
(E) Documentation of services
Service documentation for transportation
shall
(1) Type of service.
(2) Date of service.
(3) License plate number of vehicle used to
provide service.
(4) Name of
individual receiving service.
(5)
Medicaid identification number of individual receiving service.
(6) Name of provider.
(7) Provider identifier/contract
number.
(8) Origination and
destination points of transportation provided.
(9) Total number of miles of transportation
provided.
(10) Number of
individuals being transported.
(11)
Written or electronic signature of the person delivering the service, or
initials of the person delivering the service if a signature and corresponding
initials are on file with the provider.
(12) Description and details of the services
delivered that directly relate to the services specified in the approved
individual service plan as the services to be provided.
(F) Payment standards
(1) The billing unit, service codes, and
payment rates for transportation provided January 1,
2024 through June 30, 2024 are contained in the appendix A to
this rule. The billing unit, service codes, and payment
rates for transportation provided on or after July 1, 2024 are contained in
appendix B to this rule.
(2)
Payment rates for transportation are established on a per-person basis,
depending on the number of individuals being transported, regardless of funding
source, and whether the service is provided in a modified vehicle or in a
non-modified vehicle. The modified vehicle rate shall
will be applied
for each individual being transported when at least one individual requires the
use of a modified vehicle, as specified in his or
her
the individual service plan.
Notes
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.049, 5123.1611
Rule Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
Prior Effective Dates: 04/28/2003, 07/01/2006, 01/01/2007, 03/19/2012, 09/01/2013, 01/01/2014, 01/01/2016, 04/01/2017, 02/01/2018, 01/01/2019, 02/01/2020, 01/01/2022
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.