5160-15-02 Medical transportation services: provider participation and documentation requirements.

 

 

 

TO BE RESCINDED

 

5160-15-02                  Medical  transportation  services:  provider  participation  and documentation requirements.

 

 

 

(A)     General  requirements  for  eligible  providers  of  air  ambulance,  ambulance  and ambulette services.

 

(1)   Verification of compliance

 

Providers of air ambulance, ambulance and ambulette services who meet the minimum requirements specified in this rule are eligible to participate in the Ohio Medicaid program upon execution of a provider agreement. In determining whether applicant providers meet such requirements, the department will require verification of compliance as identified in each of the following paragraphs of this rule. The required documentation must apply to all air ambulance, ambulance and ambulette vehicles operated by the provider and to all air ambulance, ambulance and ambulette personnel. The department may contact enrolled providers to assure continued compliance with requirements contained in this rule.

 

(2)   Federal, state and local laws and regulations

 

Providers of air ambulance, ambulance and ambulette services must operate in accordance with all applicable local, state, and federal laws and regulations, including any applicable requirements developed by the Ohio medical transportation board as provided in Chapter 4765. of the Revised Code or applicable requirements developed for transportation in accordance with Chapter 4766. of the Revised Code.

 

(3)   Vehicle and staffing documentation

 

The following information must be available in the provider's office and provided to the department upon request:

 

(a)      Documentation identifying the total number and type (ambulance, ambulette, fixed wing air ambulance or rotary wing air ambulance) of vehicles operated by the provider;

 

(b)   Documentation that all vehicles meet the standards specified in this rule or Chapter 4766. of the Revised Code where applicable;

 

(c)    A list of equipment carried in the vehicles as required in appendix A to rule 4766-11-02 of the Administrative Code for ambulance  or paragraph (C)(1) of this rule for ambulette;

 

 

(d)  Verification of personnel qualifications as required in paragraph (B)(2) of this rule for ambulance providers and paragraph (C)(3) of this rule for ambulette providers.

(B)  Eligible providers of ambulance services

(1)   Certification requirements

All providers of ground ambulance services must be certified under and participating in medicare. All Ohio providers of ground ambulance services must be licensed in accordance with Chapter 4766. of the Revised Code and comply with all specifications of Chapter 4766. of the Revised Code, unless the provider is exempt from licensure as specified in section 4766.09 of the Revised Code. Providers in states other than Ohio must be licensed by the state in which they are located.

(2)   Driver and attendant qualifications

Providers of ambulance services must maintain on file records verifying that drivers and attendants meet the following requirements on the date of the transportation service:

(a)   Each individual who functions primarily as an ambulance driver complies with local, state and federal laws and regulations.

(b)    The qualifications of each ambulance driver meets the specifications set forth in Chapters 4765. and 4766. of the Revised Code; and

(c)      Each ambulance attendant must have a current emergency medical technician (EMT) certification card issued by the division of emergency medical services (EMS) under the Ohio department of public safety; and

(d)   Ambulance attendants employed by out of state providers must have a current EMT certification issued by the appropriate agency in the state in which they are employed; and

(e)   The level of EMT certification must be appropriate to the level of service provided (i.e., advanced life support, basic life support, non-emergency).

(f)   Effective January, 1 2004, each ambulance driver must provide from the bureau of motor vehicles his/her driving record at the time of application for employment and annually thereafter. The date of the driving record submitted at the time of application must be no more than fourteen calendar days prior to the date of application for employment. Persons having six or more points on their driving record in accordance with section 4507.02 of the Revised Code cannot be an ambulance driver. Providers may use documentation from their commercial insurance carrier as proof the standard in this paragraph has been met.

(C)  Eligible providers of ambulette services.

(1)   Vehicle requirements.

All ambulette vehicles operated by providers of ambulette services must have at a minimum the following equipment and features:

(a)     Each vehicle must be specifically designed to transport one or more patients sitting in wheelchairs and have permanent fasteners to secure the wheelchair to the floor or side of the vehicle to prevent wheelchair movement; and

(b)   Each vehicle must have safety restraints in the vehicle for the purpose of restraining the patient in the wheelchair; and

(c)   Each vehicle must be equipped with a stable access ramp or hydraulic lift; and

(d)     Each vehicle must have provisions for secure storage of removable equipment and passenger property in order to prevent projectile injuries to passengers and driver in the event of an accident; and

(e)    Each vehicle must be equipped with, at a minimum, a fire extinguisher and an emergency first-aid kit that is safely secured; and

(f)   Each vehicle must be equipped with a communication system capable of two-way communication. Cellular communication is an acceptable means of two-way communication; and

(g)   Each vehicle must display the company logo, insignia, or name on both

sides and rear of vehicle; and

(h)    Each vehicle must have a minimum ceiling to floor height of fifty-six inches.

(2)   All providers of ambulette services must comply with the following regulations and provide documentation of compliance to the department upon request:

(a)   Each provider must conduct daily inspection and testing of the hydraulic lift or access ramp prior to transporting any wheelchair bound patient; and

(b)    Each provider must complete vehicle inspection documentation in the form of a checklist to include at a minimum that the following was performed: the daily inspection and testing of the wheelchair restraints, wheelchair lifts and/or access ramps, the lights, the windshield wipers/washers, the emergency equipment, mirrors, and the brakes; and

(c)     Each provider must provide evidence that at least an annual vehicle inspection was completed on each vehicle by the Ohio state highway patrol safety inspection unit, or a certified mechanic, and the vehicle has been determined to be in good working condition.

(3)   Driver and attendant qualifications

(a)    All drivers and attendants employed by providers of ambulette services must meet the following requirements specified in paragraph (C)(3)(a) of this rule and meet those qualifications on the effective date of this rule and thereafter:

(i)    The qualifications of each driver and each attendant must comply with local, state and federal laws and regulations.

(ii)   Each driver and each attendant must have a current card issued and signed by a certified trainer as proof of successful completion of the "American Red Cross" (or equivalent certifying organization) basic course in first aid and a CPR certificate or EMT certification. A copy of both sides of the card must be maintained by the provider and provided upon request to the department or their designee. All current employees must provide their current card (not a copy) for inspection upon request to ODJFS or its designee. Providers of ambulette services may keep and produce

the current card on behalf of the employee upon request to ODJFS or its designee.

(iii)    Each ambulette driver and each attendant must submit himself or herself for criminal background checks in accordance with section

109.572 of the Revised Code. Any applicant or employee who has been convicted of or pleaded guilty to violations cited in divisions (A)(1)(a), (A)(2)(a), (A)(4)(a), and/or (A)(5)(a) of section 109.572 of the Revised Code shall not provide services to medicaid patients unless the exceptions set forth in paragraphs

(A) and (B) of rule 3701-13-06 of the Administrative Code apply.

(iv)    Each ambulette driver and each attendant must provide a signed statement from a licensed physician declaring that he or she does not have a medical condition, a physical condition, including a vision impairment (not corrected), and a hearing impairment (not corrected), or mental condition which could interfere with safe driving, safe passenger assistance, the provision of emergency treatment activity, or could jeopardize  the health or welfare  of patients being transported.

(v)      Each ambulette driver must undergo testing for alcohol and controlled substances by a laboratory certified for such testing under CLIA and be determined to be drug and alcohol free as specified in the paragraphs below:

(a)   Except as provided for in paragraph (C)(3)(b) of this rule, the tests must be performed and the results placed in the employee's file prior to rendering ambulette services;

(b)     Repeat drug and alcohol testing must be performed at a minimum whenever the driver has been involved in a motor vehicle accident for which he/she was the driver; and

(c)   The drugs to be included in the drug testing are those required in accordance with 49 C.F.R. 382 (dated October 1, 2005).

(vi)     Each ambulette driver must provide from the bureau of motor vehicles his/her driving record at the time of application for employment and annually thereafter. The date of the driving record submitted at the time of application must be no more than fourteen calendar days prior to the date of application for employment. Persons having six or more points on their driving

record in accordance with section 4507.02 of the Revised Code cannot be an ambulette driver. Providers may use documentation from their commercial insurance carrier as proof the standard in this paragraph has been met.

(vii)    Each ambulette driver and each attendant must have completed a passenger assistance training course to include at a minimum the basic characteristics of major disabling conditions affecting ambulation, basic considerations for functional factors, management of wheelchairs, assistance and transfer techniques, environmental considerations, and emergency procedures.

(viii)    Each ambulette driver must have a valid driver's license and be eighteen years or older.

(ix)       Each ambulette driver and each attendant must have an identification card visible to the patient identifying at a minimum his/her first name and last initial or unique identifier and company affiliation.

(b)    A provider may employ an applicant on a temporary provisional basis pending the results of the required information set forth in paragraphs (C)(3)(a)(iii), (C)(3)(a)(iv) and (C)(3)(a)(v) of this rule if the following conditions are met. Providers who are in the process of becoming an enrolled provider cannot hire applicants on a temporary provisional basis.

(i)   The length of the temporary provisional period shall be sixty days or the period established by another state government agency or board with the authority under Ohio law to regulate providers of ambulette services, whichever is greater.

(ii)     No applicant shall be accepted for permanent employment as an ambulette driver or attendant unless all the requirements of paragraph (C)(3)(a) of this rule have been met.

(iii)     A provider may employ an applicant only conditionally prior to obtaining the results of a criminal records check, the results of the drug and alcohol testing and/or the physician's statement for the applicant if the requirements listed in this paragraph are met.

(a)   A provider shall not employ an applicant prior to obtaining the

completed form(s) and fingerprint impression sheet(s) from the applicant as required in paragraph (F) of rule 3701-13-03 of the Administrative Code. For purposes of this prohibition, the applicant cannot perform or participate in any job related activity pertaining to a position involving the provision of direct care to an older adult that places the applicant in an active pay status.

(b)      A provider shall request a criminal records check by submitting the request to BCII, no later than five business days after the individual begins conditional employment.

(c)   The sample for the drug and alcohol testing has been obtained and submitted to the laboratory for testing.

(d)   Arrangements have been made for the required physical.

(iv)   A provider shall terminate the individual's conditional employment as an ambulette driver if:

(a)   The results of any part of the records check, are not obtained within sixty days after the date the request is made; or

(b)   The results of any part of the records check indicate that the individual has been convicted of or pleaded guilty to any of the offenses listed or described in paragraph (A) of rule 3701-13-05 of the Administrative Code, unless the organization chooses to employ the applicant pursuant to rule 3701-13-06 of the Administrative Code.

(c)   The results of the drug and alcohol test do not come back as negative, or have not been received within the sixty days; or

(d)    The signed physician statement is not obtained, or does not support that the individual meets the provisions of paragraph (C)(3)(a)(iv) of this rule.

(4)   Insurance requirements

All ambulette vehicles operated by providers of ambulette services must have at a minimum the following insurance coverage:

(a)    Every provider of ambulette services directed under this chapter must maintain and disclose upon the request of the department adequate evidence of liability insurance coverage, in an amount of not less than five hundred thousand dollars per occurrence and not less than five hundred thousand dollars in the aggregate, for any cause for which the provider would be liable.

(b)    In addition to the insurance requirements of paragraph (C)(4)(a) of this rule, every provider shall carry bodily injury and property damage insurance with solvent and responsible insurers licensed to do business in this state for any loss or damage resulting from any occurrence arising out of or caused by the operation or use of any ambulette vehicle. The insurance plan shall insure each vehicle for the sum of not less than one hundred thousand dollars for bodily injury to or death of more than one person in any one accident and for the sum of fifty thousand dollars for damage to property arising from any one accident.

(c)   Each policy or contract of insurance issued shall provide for the payment and satisfaction of any financial judgement entered against the provider and any person operating the vehicle and for a thirty-day cancellation notice to ODJFS.

(D)  Eligible providers of air ambulance services

(1)   Vehicle requirements

Providers of air ambulance services must assure their vehicles are operating in accordance with all applicable state laws for air ambulance.

(2)   Providers of air ambulance services must maintain on file, records verifying that the pilot and basic crew meet the following requirements:

(a)    A pilot must have a currently effective airman's license issued by the federal aviation administration.

(b)    A paramedic must hold a current, valid certificate issued under section

4765.30 of the Revised Code.

(c)    A respiratory therapist must hold a current, valid license issued under section 4761.05 of the Revised Code.

(d)   A registered nurse must hold a current, valid license in accordance with section 4723.09 of the Revised Code.

(e)    A doctor of medicine or doctor of osteopathy must hold a current, valid license in accordance with Chapter 4731-6 of the Administrative Code.

(E)  Documentation requirements

(1)    Providers of air ambulance, ambulance and ambulette services must maintain records which fully describe the extent of services provided. Services are not eligible for reimbursement if the documentation specified is not obtained prior to billing the department and maintained in accordance with paragraphs (E)(2)(a) to (E)(2)(d) of this rule.

(2)    Records which must be maintained include, but are not limited to, the records listed in paragraphs (E)(2)(a) to (E)(2)(d) of this rule. All records and documentation required by this rule must be retained in accordance with rules 5101:3-1-17.2 and 5101:3-1-27 of the Administrative Code.

(a)   A record or set of records for all transports on that date of service which documents time of scheduled pick up and drop off, full name(s) of attendant(s), full name(s) of patient(s), medicaid patient number, full name of driver, vehicle identification, full name of the medicaid covered service provider which is one of the medicaid covered point(s) of transport, pick-up and drop-off times, complete medicaid covered point(s) of transport addresses, the type of transport provided, and mileage; and

(b)   The original "practitioner certification form", completed by the attending practitioner, documenting the medical necessity of the transport, in accordance with this rule; and

(c)   Copies of prior authorization forms, when applicable; and

(d)   Copies of the pilot's/driver's/attendant's certification or licensure, which must be current at the time of the transport, in accordance with paragraph (D)(2) of this rule for air ambulance, paragraph (B)(2) of this rule for ambulance and paragraph (C)(3) of this rule for ambulette.

(3)   Should ODJFS determine that the medical transportation provider was/is not in compliance with all licensure, certification and documentation requirements

of this rule and all other provisions in Chapter 5101:3-15 of the Administrative Code on the date of the transportation service and was unable to supply the required documentation upon request, ODJFS will proceed in accordance with the provider agreement termination and denial provisions of rule 5101:3-1-17.6 of the Administrative Code. In addition, the department will seek remuneration for medicaid payments for the services that did not comply with Chapter 5101:3-15 of the Administrative Code.

(4)   Practitioner certification form

(a)   The attending practitioner, or a hospital discharge planner or a registered nurse acting under the orders of the attending practitioner in accordance with paragraph (E)(4)(b) of this rule, must complete a "Practitioner Certification Form" for all medical transportation services except:

(i)    ALS and/or BLS ambulance transportation to a hospital emergency room in an emergency situation; or

(ii)    Ambulance or ambulette transfer of a non-ambulatory patient from one hospital to another hospital if the services provided at the second hospital are covered by medicaid.

(b)    For the purpose of this rule, a registered nurse, with an order from the attending practitioner, may write the practitioner's name on the ordering line of the practitioner certification form, sign his or her own full name and the professional letters "R.N." after the practitioner's name on the signature line and enter the date of signature. The professional letters "R.N." must follow the nurse's last name or;

A hospital discharge planner with a written order from the attending practitioner, may write the practitioner's name on the ordering line of the practitioner certification form, sign his or her own full name on the signature line and enter the date of signature. The discharge planner must be employed by the hospital where the patient is being treated and from which the patient is transported. The discharge planner must be a social worker who is practicing within his or her scope of practice in accordance with Chapter 4757. of the Revised Code.

(c)   Medical condition

The practitioner certification form must state the specific medical conditions related to the ambulatory status of the patient which contraindicate transportation by any other means on the date of the

transport, and use the correct form which specifies the mode of medical transportation (ambulance or ambulette) the patient will require. The attending practitioner must clearly specify the condition of the patient which renders transport by ambulance or ambulette medically necessary.

(d)   The practitioner certification form is required to certify that ambulance and ambulette services are medically necessary. The completed practitioner certification form must be signed and dated no more than one hundred eighty days after the first date of transport. The completed, signed and dated practitioner certification form must be obtained by the transportation provider before billing the department for the transport. The date of signature entered on the practitioner certification form must be the date that the practitioner certification form was actually signed and must be prior to the date of the claim submission

(i)     Providers must always obtain the completed, signed and dated practitioner certification form before billing the transport. However, the following documented exceptions will be accepted if the practitioner certification form is not obtained within the one hundred- eighty-day period after the first date of transport.

(a)   Patient is pending medicaid eligibility as specified in Chapters 5101:1-38 to 5101:1-40 of the Administrative Code;

(b)   No response from patient's insurance after monthly (i.e., every thirty days) attempts to obtain the signed certification form;

(c)   No response from practitioner after monthly (i.e., every thirty days) attempts to obtain the signed certification form;

(d)   Process of trying to exhaust other insurance coverage is longer than one hundred eighty days;

(e)   Documentation of the above reasons for the extension must be made in writing and maintained in the individuals patient's file.

(ii)   The practitioner certification form must be maintained on file at the provider's office for a minimum of six years from the date of receipt of payment based upon those records or until any initiated audit   or   review   is   completed,   whichever   occurs   later,   in

accordance with rule 5101:3-1-17.2 of the Administrative Code.

(iii)     The practitioner certification form is non-transferrable from one transportation provider to another.

(e)    The practitioner certification form is only valid as long as the patient's ambulatory status does not change. If a transportation provider suspects a patient has had a change in their ambulatory status the transportation provider will need to obtain a new form from the attending practitioner.

(f)   Practitioner certification for patients who are permanently nonambulatory. The practitioner certification form is required to certify that ambulance and ambulette services are medically necessary. Providers  may maintain annual certification for permanently nonambulatory patients. If a patient is determined by the attending practitioner to  be permanently nonambulatory, the practitioner certification form documenting the permanently nonambulatory status is valid for three hundred sixty-five days from the date of first transport for ambulance and ambulette transports to all medicaid covered services.

(g)   Practitioner certification for patients who are nonambulatory at the time of transport, but are temporarily nonambulatory. The practitioner certification form is required to certify that ambulance and ambulette service are medically necessary. The attending practitioner must certify the estimated length of time that individual is temporarily nonambulatory and transport by ambulance or ambulette would be required. The certification form documenting the temporary nonambulatory status is valid for the estimated length of time as designated by the attending practitioner unless the temporary nonambulatory status length of time exceeds ninety days. If the length of time exceeds ninety days a new certification form must be obtained to certify a new estimated length of time. Transport is certified for those only temporarily nonambulatory for the indicated time period to all medicaid covered services, except for persons certified solely because they are receiving dialysis treatment. These individuals can only be transported from their dialysis treatment as medically indicated.

Effective:	04/01/2016
Five Year Review (FYR) Dates:	10/23/2015
CERTIFIED ELECTRONICALLY
Certification
01/12/2016
Date
Promulgated Under:	119.03
Statutory Authority:	5164.02
Rule Amplifies:	5162.03, 5164.02, 5164.70
Prior Effective Dates:	04/07/1977, 12/21/1977, 12/30/1977, 12/03/1981,
	08/15/1982, 05/09/1986, 12/01/1990, 05/01/1992 (Emer), 08/13/1992, 07/05/1993, 01/01/1994, 04/01/1994, 10/01/1997, 03/01/2000, 12/31/2001, 10/01/2003, 12/30/2005 (Emer), 03/27/2006