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Ohio Administrative Code (Last Updated: January 12, 2021) |
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5160 Medicaid |
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Chapter5160-15. Medical Transportation Services |
5160-15-14. Transportation: non-emergency services through a CDJFS: program integrity provisions
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(A) Definitions.
(1) "Private transportation vendor (PTV)" is an entity (e.g. individual person, for- profit company, not-for-profit organization) that meets the following criteria:
(a) It seeks to establish or to maintain a contract with a county department of job and family services (CDJFS) to supply transportation service to medicaid recipients in accordance with rule 5160-15-13 of the Administrative Code; and
(b) It is not a government agency, transit authority, public transportation system, or other quasi-governmental organization.
(2) "PTV owner/manager" is a person having an ownership or control interest in the PTV, as defined in 42 C.F.R. 455.101 (October 1, 2016).
(3) "Related enterprise" is any other business in which a PTV owner/manager has an ownership or control interest.
(4) "Direct-service PTV employee" is a PTV employee who provides direct services to medicaid recipients.
(B) A CDJFS may hold a contract with a PTV only if the following conditions are met:
(1) Each PTV owner/manager meets the disclosure requirements set forth in 42 C.F.R. Part 455, Subpart B (October 1, 2016).
(2) Each PTV owner/manager identifies all related enterprises, and with respect to those businesses the PTV owner/manager also meets the disclosure requirements set forth in 42 C.F.R. 455 (October 1, 2016).
(3) The PTV discloses the following information for the PTV, each PTV owner/ manager, and any related enterprise:
(a) Name;
(b) Medicaid provider name if applicable;
(c) Physical address;
(d) Mailing address if different;
(e) Tax identification number;
(f) Medicaid provider number if applicable; and
(g) National provider identifier (NPI) if applicable.
(4) Whenever a contract between the CDJFS and the PTV is established or renewed and whenever the PTV is considering an applicant for a position as a direct-service PTV employee, the following actions are taken:
(a) A criminal background check is performed in accordance with section 109.572 of the Revised Code on each direct-service PTV employee or applicant. The result of the criminal background check must substantiate that no direct-service PTV employee or applicant on whom the criminal background check was performed has ever been convicted of or pleaded guilty to an offense listed in divisions (A)(3)(a) to (A)(3)(e) of section 109.572 of the Revised Code.
(b) The CDJFS performs a search of the databases listed in rule 5160-43-09 of the Administrative Code for the PTV, each PTV owner/manager, and each direct-service PTV employee or for each applicant. The result of the search must substantiate that none of the entities for which the search was performed is currently listed in any of the databases as sanctioned or excluded.
(C) Not later than thirty calendar days either after a contract period has started or after a criminal background check and database search has been performed for an applicant, the CDJFS must document and submit to the department or its designee the relevant information indicated in paragraph (B) of this rule, in the format specified by the department or its designee.