5160-15-12 Transportation: non-emergency services through a CDJFS: requirements and limitations.
(A)The county department of job and family services (CDJFS) must not provide transportation assistance if a medicaid-eligible individual qualifies for either of the following types of service:
(1)Transportation of a long-term care facility resident for which a per diem payment is made to the facility in accordance with Chapter 5160-3 of the Administrative Code; or
(2)Transportation provided or arranged for by a hospice in accordance with Chapter 5160-56 of the Administrative Code that is necessary for a medicaid-eligible individual to receive care related to a terminal illness.
(B)The CDJFS must provide transportation assistance if three conditions apply:
(1)Without such assistance, the medicaid-eligible individual will not be able to obtain a medicaid-coverable service (e.g., will not be able to keep an appointment with a medical practitioner);
(2)The medicaid-eligible individual either cannot use or has chosen not to use the following services:
(a) Transportation that a managed care plan (MCP) offers as an additional benefit but is not obligated to furnish under its provider agreement with the department; or
(b) Transportation that a federally qualified health center (FQHC) furnishes in accordance with Chapter 5160-28 of the Administrative Code; and
(3)No suitable transportation is readily available through a community source, either public or private, without charge to the medicaid-eligible individual.
(C)Parents and guardians are considered to be a community source of transportation for their children.
(D)Instead of using transportation assistance provided by a CDJFS, a medicaid-eligible individual who is not enrolled in an MCP may choose instead to access wheelchair van services furnished by an eligible provider on a fee-for-service basis, but is not required to do so, if the criteria specified in rule 5160-15-22 of the Administrative Code are met.
5160-15-12 2
Replaces: Part of 5160-24-01, part of 5160-24-03
Effective: 04/01/2016
Five Year Review (FYR) Dates: 04/01/2021
CERTIFIED ELECTRONICALLY
Certification
01/12/2016
Date
Promulgated Under:
119.03
Statutory Authority:
5164.02
Rule Amplifies:
Prior Effective Dates:
5164.02
05/05/1988 (Emer), 08/06/1988, 01/01/1989,
12/31/1990, 08/26/2000, 01/01/2004, 01/01/2006,
01/01/2008
Document Information
- Effective Date:
- 4/1/2016
- File Date:
- 2016-01-12
- Last Day in Effect:
- 2016-04-01
- Rule File:
- 5160-15-12_PH_FF_N_RU_20160112_1043.pdf
- Related Chapter/Rule NO.: (1)
- Ill. Adm. Code 5160-15-12. [Effective 4/1/2016] Transportation: non-emergency services through a CDJFS: requirements and limitations