5160-15-22 Transportation: services from an eligible provider: wheelchair van services.

 

 

 

5160-15-22                  Transportation: services from an eligible provider: wheelchair van services.

 

 

 

(A)Payment may be made for the following wheelchair van services:

 

(1) Transport by wheelchair van;

 

(2) Mileage, wheelchair van; and

 

(3) Attendant services, wheelchair van.

 

(B)Payment may be made only if all the requirements in this paragraph are met.

 

(1)The necessity of the wheelchair van service is established. A necessary wheelchair van service is presumed to satisfy the criteria for medical necessity set forth in rule 5160-1-01 of the Administrative Code.

 

(a) The transfer by wheelchair van of a medicaid-eligible individual from one hospital to a second hospital is deemed to be necessary if two conditions apply:

 

(i) Both of the criteria listed in paragraph (B)(1)(b) of this rule are met; and

 

(ii) The  services  provided  at  the  second  hospital  are  coverable  by medicaid.

 

(b) The necessity of all other wheelchair van services is determined by two criteria:

 

(i) The medicaid-eligible individual must be accompanied by a mobility-related assistive device from the point of pick-up to the point of drop-off; and

 

(ii) Transportation of the medicaid-eligible individual by standard passenger vehicle or common carrier is precluded or contraindicated. (Note: The use of a portable device such as a cane, crutch, or walker does not in and of itself preclude or contraindicate transportation by standard passenger vehicle or common carrier.)

 

(2) The transport vehicle is one of two types:

 

(a) A wheelchair van; or

 

(b) A ground ambulance used only under the following conditions:

 

(i) The   transportation   provider   is   an   eligible   provider   of   both

 

 

 

wheelchair van services and ground ambulance services;

(ii) No wheelchair van is available for one of three reasons:

(a) A wheelchair van was originally scheduled for the transport but has been rendered inoperative or unavoidably delayed, and the transportation provider cannot substitute another wheelchair van within a reasonable time;

(b) The wheelchair vans operated by the transportation provider cannot accommodate the medicaid-eligible individual's mobility device; or

(c) The medicaid-eligible individual (or the medicaid-eligible individual's representative) requested a ground ambulance, and the ambulance crew discovered on arrival that wheelchair van service was needed;

(iii) The medicaid-eligible individual's mobility device can be safely transported with the medicaid-eligible individual in the ground ambulance;

(iv) The medicaid-eligible individual does not refuse the transport; and

(v) On the claim submitted for payment of wheelchair van service, the transportation provider indicates the use of a ground ambulance.

(3) The   medicaid-eligible   individual   is   transported   either   to   or   from   a medicaid-coverable service.

(4) The medicaid-eligible individual is transported both to and from a recognized or approved point of transport.

(5) The services of an attendant are used only when such services are necessary for the safe transport of a medicaid-eligible individual. The transportation provider must maintain documentation of such necessity.

(6) The mobility device must be dropped off or picked up along with the medicaid-eligible individual at the location where the medicaid-coverable service is obtained.

(7) The medicaid-eligible individual must ride in or on the mobility device when moving between the wheelchair van and the location where the medicaid-coverable service is obtained.

Replaces:                                                              Part of 5160-15-03, 5160-15-05

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:	5164.02
Prior Effective Dates:	04/07/1977, 05/09/1986, 07/05/1993, 03/01/2000, 12/27/2001, 10/01/2003, 12/30/2005 (Emer), 01/01/2006, 03/27/2006