Ohio Admin. Code 5160-15-30 - Transportation: services from an eligible provider: supplemental payment for ground emergency medical transportation service providers

(A) Purpose. This rule implements section 5164.96 of the Revised Code regarding supplemental medicaid payments to eligible emergency medical services organizations operated by a government entity.

(B) Definitions applicable to this rule.

(1) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code.

(2) "Ground ambulance transport" comprises the following service categories:

(a) Basic life support, provided in an emergency (BLS emergency);

(b) Basic life support, provided in a non-emergency (BLS non-emergency);

(c) Advanced life support, level 1, provided in an emergency (ALS1 emergency);

(d) Advanced life support, level 1, provided in a non-emergency (ALS1 non-emergency);

(e) Advanced life support, level 2 (ALS2);

(f) Specialty care transport (SCT);

(g) Ground mileage; and

(h) Extra ambulance attendant.

(3) "Ground emergency medical transportation service provider" is an emergency medical service organization that renders emergency medical services in ground ambulance vehicles.

(4) "Qualified ambulance provider (QAP)" is a ground emergency medical transportation service provider that is operated by a government entity and is enrolled in medicaid as an eligible provider.

(C) Process for requesting participation in the supplemental payment program.

(1) Each QAP seeking to participate in the supplemental payment program submits the following documents and information:

(a) A voluntary election to participate on form ODM 10378, "Application for Supplemental Medicaid Payment to a Government-Operated Emergency Medical Service (EMS) Provider";

(b) An agreement with the Ohio department of medicaid that sets forth the responsibilities of the parties with respect to the supplemental payment program; and

(c) Data necessary for ODM to establish the payment ceiling and supplemental payment gap.

(2) For the budget biennium beginning on July 1, 2025, the submission deadline for the documents and information listed in paragraphs (C)(1)(a) to (C)(1)(c) of this rule is the first business day after the thirtieth calendar day following the effective date of this rule. For each subsequent budget biennium, the submission deadline is one year before the start of the biennium.

Notes

Ohio Admin. Code 5160-15-30

Effective: 4/7/2025
Five Year Review (FYR) Dates: 04/07/2030
Promulgated Under: 119.03
Statutory Authority: 5164.02, 5164.96
Rule Amplifies: 5164.02, 5164.96