(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"
means an entity that employs at least one person in
addition to the chief executive officer for the purpose of providing services
for which the entity must be certified in accordance with rule
5123:2-2-01
of the Administrative Code
has the same
meaning as in 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"
means a self-employed person who provides services
for which he or she must be certified in accordance with rule
5123:2-2-01
of the Administrative Code and does not employ, either directly or through
contract, anyone else to provide the services
has the same meaning as in rule 5123-2-09 of the
Administrative Code.
(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
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
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 permanent fasteners to secure a
wheelchair to the floor or side of the vehicle to prevent wheelchair
movement;
(ii) Have safety
harnesses or belts in the vehicle for the purpose of securing individuals in
wheelchairs;
(iii) Be equipped with
a stable access ramp specifically designed for wheelchairs or a hydraulic lift
specifically designed for wheelchairs; and
(iv) Be 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 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 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 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 redetermination
date.
(C) Provider
qualifications
(1) Transportation shall 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 complete and submit an application through the
department's website (
http://dodd.ohio.gov) and adhere to the
requirements of
rule
5123:2-2-01
of the Administrative Code except that paragraphs (D)(1), (D)(2), (D)(5),
(D)(8), and (D)(17) of that rule do not apply to operators of commercial
vehicles
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 present his or her 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 driving record is prohibited from providing transportation.
(4) An independent provider of transportation
shall:
(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 accumulates six or more points on his or her driving
record or if his or her driver's license is suspended or
revoked.
(5) An agency
provider of transportation shall:
(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
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 driving record or if his or her 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.
(6) Failure to comply with this rule and
rule
5123:2-2-01
as applicable, rule 5123-2-08 or 5123-2-09 of the
Administrative Code
, may result in the denial,
suspension, or revocation of the provider's certification.
(D) Requirements for service delivery
(1) Transportation shall be provided pursuant
to an individual service plan that conforms to the requirements of rule
5123:2-1-11
5123-4-02 of the Administrative Code. The individual
service plan of an individual who requires transportation to be provided in a
modified vehicle shall so indicate.
(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 include each of
the following to validate payment for medicaid services:
(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 are contained in the appendix 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 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 individual service plan.
(3) Under the level one waiver,
transportation is subject to the payment limitation set forth in paragraph
(D)(1) of rule
5123-9-06
of the Administrative Code.
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Appendix
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Appendix
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Appendix
Notes
Ohio Admin. Code 5123-9-24
Effective:
1/1/2022
Five Year Review (FYR) Dates:
1/1/2024
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