Or. Admin. R. 410-141-3960 - Transportation: Member Reimbursed Mileage, Meals, and Lodging

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

(1) A CCO may prior authorize a member's mileage, meals, and lodging to covered medical service in order for the member to qualify for reimbursement.
(2) A CCO may disallow a client reimbursement request received more than 45 days after the travel.
(3) A CCO shall reimburse a member for mileage, meals, and lodging at rates not less than the Authority's allowable rates. The OHP fee schedule is available on the Authority's website.
(4) The member must return any documentation a CCO requires before receiving reimbursement.
(5) A CCO may hold reimbursements under the amount of $10 until the member's reimbursement reaches $10.
(6) A CCO shall reimburse members for meals when a member travels:
(a) Out of their local area as outlined in OAR 410-141-3515(4)(a) and (b); and
(b) For a minimum of four hours round-trip.
(7) A CCO's brokerage or other transportation subcontractor shall reimburse members for lodging when:
(a) A member would otherwise be required to begin travel before 5 a.m. in order to reach a scheduled appointment;
(b) Travel from a scheduled appointment would end after 9 p.m.; or
(c) The member's health care provider documents a medical need.
(8) A CCO may reimburse members for lodging under additional circumstances at the CCO's discretion.
(9) A CCO shall reimburse for meals or lodging for one attendant, which may be a parent, to accompany the member if medically necessary, if:
(a) The member is a minor child and unable to travel without an attendant;
(b) The member's attending physician provides a signed statement indicating the reason an attendant must travel with the member;
(c) The member is mentally or physically unable to reach their medical appointment without assistance; or
(d) The member is or would be unable to return home without assistance after the treatment or service.
(10) A CCO may reimburse members for meals or lodging for additional attendants or under additional circumstances at the CCO's discretion.
(11) A CCO may recover overpayments made to a member. Overpayments occur when a CCO's brokerage or other transportation subcontractor paid the member:
(a) For mileage, meals, and lodging, and another resource also paid:
(A) The member; or
(B) The ride, meal, or lodging provider directly;
(b) Directly to travel to medical appointments, and the member did not use the money for that purpose, did not attend the appointment, or shared the ride with another member whom the brokerage also paid directly;
(c) For common carrier or public transportation tickets or passes, and the member sold or otherwise transferred the tickets or passes to another individual.
(12) If an individual or entity other than the member or the minor member's parent or guardian provides the ride, a CCO's brokerage or other transportation subcontractor may reimburse the individual or entity that provided the ride.


Or. Admin. R. 410-141-3960
DMAP 57-2019, adopt filed 12/17/2019, effective 1/1/2020

Statutory/Other Authority: ORS 413.042 & ORS 414.625

Statutes/Other Implemented: ORS 414.625

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