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
(3)(2) "Department" means
the Ohio department of developmental disabilities.
(4)(3) "Independent
provider" 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)(4) "Individual" means
a person with a developmental disability or for purposes of giving, refusing to
give, or withdrawing consent for services, the person's guardian in accordance
with section 5126.043 of the Revised Code or
other person authorized to give consent.
(6)(5)
"Individual service plan" means the written description of services, supports,
and activities to be provided to an individual.
(7)(6) "Modified vehicle"
means:
(8)(7) "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 includes the items delineated in paragraph (E) of this
rule to validate payment for medicaid services.
(9)(8) "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 will not replace, medical transportation required under
42 C.F.R.
431.53 as in effect on the effective date of
this rule,
or
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.
For the purposes of this rule, the following definitions apply:
(1) "Agency provider" 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.
(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:
(i) Has permanent
fasteners to secure a wheelchair to the floor or side of the vehicle to prevent
wheelchair movement;
(ii) Has
safety harnesses or belts in the vehicle for the purpose of securing
individuals in wheelchairs;
(iii)
Is equipped with a stable access ramp specifically designed for wheelchairs or
a hydraulic lift specifically designed for wheelchairs; and
(iv) 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 will be documented by the driver that conducts the
inspection.
(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 will be provided by an
independent provider,
or 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 will complete and submit an
application 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 will present the
applicant's driving record prepared by the bureau of motor vehicles no earlier
than fourteen calendar days prior to the date of application for initial or
renewal provider certification. A person having six or more points on the
person's driving record is prohibited from providing transportation.
(4) An independent provider of transportation
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 the independent provider accumulates six or more points on the
independent provider's driving record or has a driver's license suspended or
revoked.
(d)
Complete testing for controlled substances by a
laboratory certified for such testing within thirty-two hours and complete
testing for blood alcohol level by an entity certified for such testing within
eight hours of a motor vehicle accident involving the driver while the driver
was providing transportation when:
(i)
The accident involves the loss of human life;
or
(ii)
The driver receives a citation under state or local law
for a moving traffic violation arising from the accident, if the accident
involved:
(a)
Bodily injury to any person who, as a result of the injury,
immediately receives medical treatment away from the scene of the accident;
or
(b)
One or more motor vehicles incurred disabling damage as
a result of the accident, requiring the motor vehicle to be transported away
from the scene by a tow truck or other motor vehicle.
(5) An
agency provider of transportation will:(e)(f) Develop and
implement written policies and procedures regarding vehicle accessibility,
vehicle maintenance, and requirements for vehicle drivers.
(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 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 the driver's driving record or has a driver's license suspended or
revoked.
(e)
Ensure that each driver completes testing for
controlled substances by a laboratory certified for such testing within
thirty-two hours and completes testing for blood alcohol level by an entity
certified for such testing within eight hours of a motor vehicle accident
involving the driver while the driver was providing transportation when:
(i)
The accident
involves the loss of human life; or
(ii)
The driver
receives a citation under state or local law for a moving traffic violation
arising from the accident, if the accident involved:
(a)
Bodily injury to
any person who, as a result of the injury, immediately receives medical
treatment away from the scene of the accident; or
(b)
One or more motor
vehicles incurred disabling damage as a result of the accident, requiring the
motor vehicle to be transported away from the scene by a tow truck or other
motor vehicle.
(D)
Requirements for service delivery
(1)
Transportation 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.
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 will 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.
(9)
The number of
miles in each trip, as indicated by recording beginning and ending odometer
readings or via tracking or mapping by a global positioning system.
(10) Number of individuals being
transported.
(10)
Names of all individuals who were in the vehicle during
any portion of the trip.
(11)
Written or electronic signature of the person
delivering the service,
driver of the
vehicle or initials of the person delivering
the service
driver of the vehicle 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 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.
(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 will be applied for each
individual being transported when at least one individual requires the use of a
modified vehicle, as specified in 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, 01/01/2024
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.