Or. Admin. R. 410-141-3920 - Transportation: NEMT General Requirements

Current through Register Vol. 60, No. 12, December 1, 2021

(1) A CCO shall provide all non-emergency medical transportation (NEMT) services for its members. For purposes of OAR 410-141-3920 to 410-141-3965, references to a "member" include any individual eligible for NEMT services under this section (1) unless context dictates otherwise.
(2) A CCO shall provide a toll-free call center for members to request rides.
(3) Neither a CCO nor any of its Subcontracted transportation providers may bill a member for transport to or from covered medical services, even if the CCO or its contracted transportation provider denied reimbursement for the transportation services.
(4) Transportation providers shall be considered "participating providers" for the purposes of OAR 410-141-3520 (Record Keeping and Use of Health Information Technology).
(5) A CCO shall have written policies and procedures regarding its NEMT services. All policies and procedures must be provided to all Members either in Contractor's Member Handbook or in a stand-alone document referred to as a "NEMT rider guide" that meets the delivery and content specifications as defined by OHA. The CCO's written policies and procedures regarding NEMT services shall provide, without limitation, for the following:
(a) Allow members or their representatives to schedule:
(A) NEMT services up to 90 days in advance;
(B) Multiple NEMT services at one time for recurring appointments up to 90 days in advance; and
(C) Same-day NEMT services.
(b) Comply with the following criteria for member drop-offs and pick-up protocols:
(A) Not permit drivers to drop Members off at an appointment more than 15 minutes prior to the office or other facility opening for business unless requested by the member or, as applicable, the Member's guardian, parent, or representative; and
(B) Not permit drivers to pick up Members from an appointment more than 15 minutes after the office or facility closes for business unless the appointment is not reasonably expected to end within 15 minutes after closing, or as requested by the member, or as applicable, the Member's guardian, parent, or representative.
(c) Describe passenger rights and responsibilities as set forth in 42 CFR ยง 438.210, and as set forth in OARs 410-141-3920 through 410-141-3960, and other state and federal administrative statutes and rules relating to the rights and responsibilities of Medicaid recipients such as the right to file a grievance and request an appeal or reconsideration.
(6) The grievance and appeal processes and rights specified in OAR 410-141-3835 through 410-141-3915 are available with respect to NEMT services, with the following modifications:
(a) Prior to mailing a notice of adverse benefit determination to a member, the CCO must provide a secondary review by another employee when the initial screener denies a ride.
(b) The CCO shall mail, within 72 hours of denial, a notice of adverse benefit determination to:
(A) A member denied a ride; and
(B) CCOs shall provide a copy of the NOABD to the provider with which the affected member was scheduled for an appointment, when the provider is part of the CCO's provider network and requested the transportation on the member's behalf, in a format that is agreeable to the provider and provides sufficient documentation of notification.

Notes

Or. Admin. R. 410-141-3920
DMAP 57-2019, adopt filed 12/17/2019, effective 01/01/2020; DMAP 1-2020, temporary amend filed 01/02/2020, effective 01/02/2020 through 06/29/2020; DMAP 62-2020, amend filed 12/16/2020, effective 1/1/2021

Statutory/Other Authority: ORS 413.042 & ORS 414.625

Statutes/Other Implemented: ORS 414.625

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