5160-24-03 Non-emergency transportation (NET): accessing NET.

 

 

 

FEDERAL MEDICAID NOTICE AND PUBLIC HEARING NOTICE OHIO DEPARTMENT OF MEDICAID

 

DATE:   November 23, 2015

TIME:   10:00 a.m.

LOCATION:   Room A501, Lazarus Government Center

50 West Town Street, Columbus, OH 43215

 

Pursuant to section 5164.02 and Chapter 119. of the Ohio Revised Code and 42 CFR 447.205, the director of the Ohio Department of Medicaid gives notice of the Department's intent to consider the amendment, rescission, or adoption of the rules identified below and to hold a public hearing on these rules.

 

The existing rules in Chapters 5160-15 and 5160-24 of the Ohio Administrative Code are being combined into a single chapter, numbered 5160-15.

 

The following rules will be rescinded:

                                                                                     Medical transportation services: definitions

                                                                                     Medical transportation services: provider participation and documentation requirements

5160-15-02.8  Medical transportation services: eligible providers

                                                Medical transportation: covered services and limitations 5160-15-04         Medical transportation services: reimbursement

5160-15-05      Medical transportation services: ambulette services provided by ground ambulance vehicles

5160-24-01      Non-emergency transportation (NET): general provisions 5160-24-02         Non-emergency transportation (NET): administration 5160-24-03   Non-emergency transportation (NET): accessing NET

 

The following rules will be adopted:

5160-15-01      Transportation: definitions

5160-15-11      Transportation: non-emergency services through a CDJFS: general provisions 5160-15-12         Transportation: non-emergency services through a CDJFS: requirements and

limitations

5160-15-13      Transportation: non-emergency services through a CDJFS: administration 5160-15-21  Transportation: services from an eligible provider: general requirements 5160-15-22     Transportation: services from an eligible provider: wheelchair van services

5160-15-23      Transportation: services from an eligible provider: ground ambulance services 5160-15-24 Transportation: services from an eligible provider: air ambulance services 5160-15-25 Transportation: services from an eligible provider: points of transport

                                                                                     Transportation: services from an eligible provider: service limitations and allowances

                                                Transportation: services from an eligible provider: documentation 5160-15-28 Transportation: services from an eligible provider: payment

 

Some of the revisions to the rules involve significant structural or conceptual changes:

 

 

 

 

 

 

·         The consolidation of the current rules governing fee-for-service transportation and county-administered transportation assistance into a single chapter reflects the interrelatedness of the different transportation options available under Medicaid, and it also makes the rules easier to read and understand.  Within the chapter, the new rules are numbered by subject matter:  Rule 5160-15-01 lists definitions used in the chapter; rules 5160-15-11, -12, and -13 deal with county-administered transportation assistance; rules 5160-15-21 through -28 deal with transportation provided on a fee-for-service basis or through a Medicaid managed care plan (MCP).

·         The requirement that a County Department of Job and Family Services (CDJFS) compile and submit a report of transportation assistance each quarter is discontinued, and form JFS 04208 becomes obsolete.  Each CDJFS, however, must continue to maintain sufficient documentation of transportation assistance requested by Medicaid-eligible individuals.

·         Terminology is updated.  In particular, the outmoded term ambulette is replaced by wheelchair van (a phrase used by the Centers for Medicare and Medicaid Services).

·         In the past, a sharp distinction was drawn between "ambulette" service and transportation assistance available through a CDJFS. Because of improvements in accessibility over the past two decades, vehicles that can simultaneously transport both passengers who use mobility devices and passengers who do not use mobility devices are now common, and many CDsJFS contract with transportation vendors that operate such accessible vehicles. All Medicaid-eligible individuals, therefore, may request county-administered transportation assistance.  If transportation by wheelchair van is more appropriate, however, then it is still available for individuals who qualify.

·         In payment for ground transport, the distinction between first passenger, second passenger, and so on is eliminated.  This distinction is meaningful only for transports of multiple passengers from one location to the same destination, and in such cases the difference in payment actually serves as a disincentive to transport more than one passenger at a time.

·         The imprecise and confusing term nonambulatory is abandoned.  Criteria for wheelchair van service now focus on the need for a mobility device.

·         The list of items required to document the provision of transportation by ambulance or wheelchair van is largely replaced by a reference to the portion of the Ohio Administrative Code governing the State Board of Emergency Medical, Fire, and Transportation Services.  A few Medicaid-specific items are required, such as the passenger's Medicaid identification number and signature.

·         The payment rule for fee-for-service transportation now includes, as an appendix, a schedule of Medicaid maximum amounts for the various services.  This information is being relocated from the main Medicaid non-institutional schedule (Appendix DD to rule 5160-1-60 of the Ohio Administrative Code).

·         The maximum payment for transportation by wheelchair van (represented by HCPCS procedure code A0130) is increased by five per cent.

Some of the revisions are refinements of previous rules:

·         More types of practitioners can certify the necessity of transportation by wheelchair van. Physician assistants can also certify the necessity of transportation by ambulance.

·         Lengthy specifications of requirements for ambulances, wheelchair vans, and their crews are replaced by references to other portions of the Ohio Administrative Code and the Ohio Revised Code (primarily provisions governing the State Board of Emergency Medical, Fire, and Transportation Services).

·         The conditions under which wheelchair van service can be provided in a ground ambulance are stated more concisely.

·         A distinction is made between a workplace and a school as the endpoint of a trip (origin or destination), and new modifier combinations are established with which transportation providers can report this information on claims.

·         Payment for loaded mileage is clarified for transports involving more than one passenger.

·         Payment of claims is clarified for transportation services provided to individuals dually eligible for Medicare and Medicaid.

·         Various dates relevant to practitioner certification are clarified.

·         A stipulation is added that a certifying practitioner must be fiscally, administratively, and contractually independent from a transportation provider.

·         Requirements for obtaining a practitioner certification form are clarified.

·         The ODM 01960 and ODM 03452 certification forms have been streamlined and converted to fillable Portable Document Format (PDF). Whenever possible, items on the form are presented as checklist options rather than short-answer essay questions. Checklist items that must always be marked have been replaced with statements of attestation.

It is estimated that the changes to these rules will result in an increase in annual aggregate Medicaid expenditures of approximately $1 million.

The public hearing will be held at the date, time, and location listed at the top of this notice. Both written and oral testimony will be accepted at the public hearing, and written comments submitted or postmarked no later than the date of the public hearing will be treated as testimony.

Any person affected by these rules may examine them and obtain a copy, without charge, at the following locations:

Ohio Department of Medicaid, 50 West Town Street, Suite 400, Columbus, Ohio 43215; Any county department of job and family services; or

On the internet at http://www.registerofohio.state.oh.us/.

Testimony on the proposed rules may also be reviewed at the Ohio Department of Medicaid, 50 West Town Street, Suite 400, Columbus, Ohio 43215.

Requests for a copy of the proposed rules or a copy of testimony on the rules should be submitted in any of the following ways:

By mail to the Rule Administrator, Office of Chief Legal Counsel, Ohio Department of Medicaid, 50 West Town Street, Suite 400, Columbus, OH 43215;

By fax to [phone]; or

By e-mail to [e-mail].