Or. Admin. Code § 410-146-0240 - Transportation
(1) The Division
may reimburse IHCP for medically appropriate sedan car or wheelchair van
transportation services provided to OHP AI/AN clients who receive medical
services through an IHCP. (Refer to OAR 410 Division 136, Medical
Transportation.)
(2) Federal
regulations in
42 CFR
431.53 require the state to ensure necessary
transportation for Medicaid recipients to and from providers. The IHCP must
ensure that:
(a) The service to be provided
is the most cost-effective method that meets the medical needs of the client;
and
(b) The service to be provided
at the point of origin and destination is a Division Medicaid-covered service
according to a client's OHP benefit package;
(c) In addition, AI/AN OHP clients may be
transported to the nearest Tribal Health facility and are not restricted to the
nearest (non-tribal) facility able to meet the client's medical needs.
(3) For the purpose of
this rule, the most "cost effective" method is a transportation service that
cannot, in the judgment of the Division, be provided through a less expensive
alternative while meeting the medical needs of the client. Reimbursement by the
Division to an IHCP may not exceed the most cost-effective method and is the
lesser of:
(a) The providers costs for
furnishing transportation services; or
(b) The amount reimbursed by the Division to
non-emergency transportation providers under OAR 410 Division 136 Medical
Transportation Program.
(4) The Division shall reimburse
transportation services fee-for-service, and outside of the IHS encounter rate,
when the IHCP meets the following conditions:
(a) The IHCP owns or leases the sedan car or
wheelchair van; and
(b) The
individual providing the service is an employee of the IHCP.
(5) IHCPs do not need to enroll
separately as a transportation provider if they furnish either sedan car or
wheelchair van transportation. As used in this rule, transportation services by
IHCPs are defined as follows:
(a)
Transportation provided by a 4-door sedan or mini-van motor vehicle having a
seating capacity of not less than four and not more than seven passengers;
(b) Transportation provided by a
wheelchair lift equipped vehicle for a client who uses a wheelchair.
Transportation is generally a "door to door" service. At times, an individual
being transported must be picked up inside their residence and taken inside
their destination (escort by the driver).
(6) Under the following conditions, an IHCP
is required to separately enroll with the Division as a provider of medical
transportation services:
(a) The IHCP serves
all clients as a whole and does not limit services to the AI/AN community
(e.g., Native American clients);
(b) The IHCP owns and operates a taxi
service; or
(c) The IHCP owns and
operates an ambulance service.
(7) Non-emergency ambulance, air ambulance,
commercial air, bus, or train are not reimbursed under this rule to IHCPs and
requires advance arrangement and prior authorization (PA) through the local
Aging and People with Disabilities Division (APD) or Self Sufficiency Programs
branch office.
(8) For all claims
submitted to the Division, the provider records must contain completed
documentation (pertinent to the service provided) that includes but is not
limited to:
(a) Trip information including:
(A) Date of service;
(B) If one way, round trip, or three-way and
if transportation needs are ongoing;
(C) Physical address of the point of origin,
e.g., client address, nursing home name and address, etc.;
(D) Number of actual patient miles traveled;
and
(E) Physical address and name
of the destination point, e.g., hospital name, doctor name, address, etc.
(b) Client information
including:
(A) Client name;
(B) ID number; and
(C) Medical assistance needs (e.g., requires
wheelchair, walker, cane, needs assistance, requires portable oxygen, etc.);
and
(c) Justification for
extra attendant beyond one if wheelchair van.
(9) All required documentation must be
retained in the provider files for the period of time specified in the General
Rules (OAR 410 Division 120).
(10)
Medical transportation services must be billed in the professional claim format
using the billing instructions and procedure codes in this rule and in
conjunction with OAR 410 division 136 Medical Transportation Program.
(11) If two or more Medicaid
clients are transported by the same mode (e.g., wheelchair van) at the same
time, the Division shall reimburse at the full base rate for the first client
and one-half the appropriate base rate for each additional client. If two or
more Division clients are transported by mixed mode (e.g., wheelchair van and
ambulatory) at the same time, the Division shall reimburse at the full base
rate for the highest mode for the first client and one-half the base rate of
the appropriate mode for each additional client. Reimbursement may not be made
for duplicated miles traveled. If more than one client is transported from a
single pickup point to different destinations or from different pickup points
to the final destination, the total mileage may be billed. The first ten miles
is included in the base rate and should be included in the total number of
miles on the CMS-1500 (OAR
410-136-0080, Additional Client
Transport).
(12) Tribal facility
owned/leased sedan car:
(a) S0215 --
Non-emergency transportation; mileage, per mile;
(b) Not eligible for base rate or extra
attendant reimbursement.
(13) Tribal facility owned/leased wheelchair
car/van. The Division's reimbursement of the first ten miles of a transport is
included in the payment for the base rate. A service from point of origin to
point of destination (one-way) is considered a "transport."
(14) Tribal facility owned/leased wheelchair
van:
(a) If a client is able to transfer from
wheelchair to car/van, the Division may not make payment for wheelchair
services for transportation of ambulatory (capable of walking) clients (e.g.,
base rate, extra attendant);
(b)
Wheelchair van -- Bill using the following procedure codes:
(A) A0130 -- Non-emergency transportation,
wheelchair car/van base rate;
(B)
S0209 -- Wheelchair van, ground mileage, per statute mile;
(C) T2001 -- Extra attendant (each).
(15) When
billing transportation services, use the appropriate place of service (POS)
codes and modifiers as listed in the Medical Transportation Services
Supplemental Information guidebook to indicate the type of transportation
service and point of origin and destination.
(16) The Division may recoup such payments
if, on subsequent review, it is found that the provider did not comply with the
Division's administrative rules. Non-compliance includes, but is not limited
to, failure to adequately document the service and the need for the service.
Notes
Statutory/Other Authority: ORS 413.042 & ORS 414.065
Statutes/Other Implemented: ORS 414.065
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.