Chapter 4766-3 Ambulettes
(A) "Ambulette Service" has the same meaning as "nonemergency medical service organization" as defined in division (O) of section 4766.01 of the Revised Code.
(B) "Board" means the Ohio medical transportation board as described in section 4766.02 of the Revised Code.
(C) "Client" means an individual who requires the use of a wheelchair or who is confined to a wheelchair and is transported by an ambulette in order to receive health care services at a health care facility or health practitioner's office in non-emergency circumstances.
(D) "Headquarters" means the location from which a licensee operates and designated by the licensee as the location where the records described in this chapter are maintained or readily available.
(E) "Operate" means to engage in conduct or activity in furtherance of the licensed activity at or from a physical location owned, leased or maintained by the licensee where employees report to work and vehicles or aircraft are stored. Operate also includes the act of receiving a person within Ohio for transportation to a location within Ohio.
(F) "Readily Available" means produced upon demand by the board.
(G) "Reinspection Fee" means a fee required to conduct an inspection as a result of the issuance of a notice of deficiency, also referred to as a notice of non-compliance with a provision of Chapter 4766. of the Revised Code or rule 4766 of the Administrative Code, by the board, or its designee, to a licensee or license applicant, regarding a permitted ambulette or an ambulette for which a permit application is pending.
(H) "Satellite Base" means a physical location other than headquarters from which a licensee operates.
(I) "Service Code" has the same meaning as service number.
(J) "Service Number" means the number assigned to the licensee by the Ohio medical transportation board for the purpose of identifying and validating the service or licensee.
(K) "Temporary Vehicle" means an ambulette issued a temporary permit used to replace a permitted ambulette in accordance with rule 4766-3-12 of the Administrative Code that is out of service until the permitted ambulette is returned to service not to exceed sixty days.
(A) An ambulette service applying for licensure shall file with the board an application on the form prescribed by the board, as published on the board's website at http://omtb.ohio.gov/Forms/Form2.pdf, dated April 16, 2012, in the English language, and shall submit the completed application to the board accompanied by the appropriate fee as defined in rule 4766-3-03 of the Administrative Code.
(B) In addition to the requirements set forth in section 4766.04 of the Revised Code, for each application the ambulette service applicant shall provide:
(1) The name, organizational structure and address of applicant as follows:
(b) Identification of organizational structure as a corporation (whether for profit or not-for-profit); limited liability company; partnership; limited liability partnership; government unit; or sole proprietor (individual human);
(c) All other names under which applicant plans to operate;
(d) Copies of all trade name registrations and fictitious name registrations for all other names under which applicant plans to operate on file with the Ohio secretary of state;
(e) Address of physical location of applicant's headquarters (no post office box);
(f) Mailing address of applicant;
(2) All medicare provider numbers, all medicaid provider numbers, if applicable;
(3) Service areas including county and state;
(4) The street address, city, county, state, and zip code for each satellite base;
(5) The name of the primary contact person, business or administrative office telephone number, and if applicable, office fax number and e-mail address of applicant;
(6) Names of all officers, directors, and/or owners of applicant;
(7) Year of manufacture, make, model, vehicle identification number, odometer reading, license plate number (renewal only) of each ambulette applicant seeks to be permitted;
(8) A color photograph of the side of applicant's ambulette displaying color scheme, insignia, monogram, or other distinguishing characteristic. If multiple color schemes, insignias, monograms, or other distinguishing characteristics are used, a color photograph of each must accompany application. (Digital photographs are preferred.);
(9) A current certificate of liability insurance in the name of applicant, listing Ohio medical transportation board as a certificate holder with a thirty day cancellation notice as specified in section 4766.06 of the Revised Code;
The actual name on the licensure application shall appear on the certificate of liability insurance;
(C) Each applicant shall pay the appropriate fees as specified in rule 4766-3-03 of the Administrative Code.
(D) If an application for licensure is incomplete, the board will notify the applicant that the application will not be processed until it is complete. Such notification will occur via certified mail one time for each submission.
(E) No applicant or licensee shall submit false statements in order to obtain a license or permit.
(F) A license is not transferable.
(A) Each ambulette service shall pay the following license fee annually:
Initial or renewal license fee of one hundred dollars.
(B) Each ambulette service shall pay a permit fee for each ambulette of fifty dollars annually;
(C) Each ambulette service shall pay an inspection fee of fifty dollars per ambulette annually;
(D) Each ambulette service shall pay a fifty dollars reinspection fee for every ambulette that requires reinspection as a result of a deficiency issued by the Ohio medical transportation board.
(E) Each ambulette service shall pay a fifty dollar fee for each temporary vehicle permit to be issued.
(A) The board shall conduct initial and renewal inspections of all ambulette services pursuant to Chapter 4766. of the Revised Code and rules 4766-3-04, 4766-3-05, and 4766-3-06 of the Administrative Code to include the following:
(1) Ambulette service headquarters;
(2) Ambulette service satellite base(s).
(B) An ambulette service shall not commence operations from its headquarters or satellite(s) until the ambulette service has met all requirements set forth in Chapter 4766. of the Revised Code and agency 4766 of the Administrative Code including satisfactory inspections of all physical locations.
(C) An ambulette service shall ensure compliance with the inspection requirements for physical facilities. The inspection requirements for physical facilities of an ambulette service are as follows:
Board issued license shall be prominently displayed in conspicuous location at every licensed facility;
(D) The board may conduct routine unannounced inspections at any location of licensed ambulette service at any time, including night or weekend inspections to determine compliance with Chapter 4766. of the Revised Code and agency 4766 of the Administrative Code to include, but not limited to, the following:
(1) Ambulette service headquarters;
(2) Ambulette service satellite base(s);
(A) Each licensed ambulette service shall maintain accurate records concerning the transportation of each client;
All client transportation records shall be generated and completed immediately upon completion of the transport and shall include the following:
(1) Client name;
(2) Address of:
(a) Client pick up location; and
(b) Client destination (drop off location);
(3) Date and time of:
(a) Ambulette arrival at client pick up location; and
(b) Ambulette arrival at client destination (drop off location);
(4) Name or ID number of ambulette driver.
(B) Each licensed ambulette service shall maintain a current certificate of liability insurance issued by an insurer licensed to do business in this state that includes a thirty day notice of cancellation to the board in compliance with the terms set forth in Chapter 4766. of the Revised Code listing Ohio medical transportation board as certificate holder.
(C) A licensed ambulette service shall make all client transportation record(s) and ambulette maintenance/repair records available to the board or its designee, upon demand, during any inspection, announced or unannounced.
(D) Client transportation records shall be maintained by the licensee for a period of seven years after the date of transport.
(A) The ambulette service shall be capable of two-way communication with all the service's permitted ambulette(s):
(B) All portable communication devices shall maintain either a one hundred ten volt or twelve volt power source backup for each communication device.
(A) The board shall inspect all ambulettes for roadworthiness and for appropriate equipment as prescribed in rule 4766-3-10 of the Administrative Code.
(B) In order to qualify for an ambulette permit, an ambulette shall contain the equipment set forth in rule 4766-3-10 of the Administrative Code.
(C) In order to receive a permit, an ambulette shall meet the requirements set forth below:
(1) Roadworthiness requirements:
(a) High and low beam headlights shall be operational;
(b) Clearance lights, marker lights and reflectors shall be operational (if applicable);
(c) High beam indicator light (on dashboard) shall be operational;
(d) Dashboard lights and interior lights shall be operational;
(e) Left and right tail lights shall be operational;
(f) Left and right front turn signals shall be operational;
(g) Left and right rear turn signals shall be operational;
(h) Left and right brake lights shall be operational;
(i) License plate light shall be operational;
(j) Back up light(s) shall be operational;
(k) Audible back up alarms shall be operational;
(l) Tread depth on each tire shall be minimum of one sixteenth inch;
(m) Tread or sidewall of tires shall be free of major deformities;
(n) Rims/wheels shall be free of significant damage;
(o) Each tire shall have full range-of-motion without rubbing chassis or body;
(p) Brake pedal travel shall not exceed:
(i) Two thirds travel in vehicles with non-assisted brakes;
(ii) Four fifths travel in vehicles with power assisted brakes;
(q) Emergency/parking brake shall be operational;
(r) Windshield shall be without breach, unobstructed;
(s) Windshield wipers and washer shall be operational;
(t) Windows shall be without breach and consistent with original equipment manufacturer specifications;
(u) Exhaust system shall be properly secured and without breach;
(v) Steering shaft shall be secure with no more than one quarter turn play;
(w) Power steering shall operate properly;
(x) Rear view mirrors and side view mirrors shall be installed in accordance with the original equipment manufacturer and shall be without any breach;
(y) Horn shall be operable and audible;
(z) Heater, defroster, and air conditioner shall be properly installed and operational;
(aa) Each seat shall be securely fastened to the floor;
(bb) Floor of vehicle shall be intact and free of holes;
(cc) Interior of vehicle shall be free of broken tubing, protruding metal, protruding plastic, debris, and trash;
(dd) Safety belts for driver and passengers, including wheelchair clients, shall be operational and free of visible damage;
(ee) Vehicle body and frame shall have structural integrity without breach;
(ff) Each shock/spring shall be mounted and intact;
(gg) Fuel tank shall be free of leaks and securely mounted;
(hh) License plates shall be properly mounted on front and rear of vehicle (if required by state law);
(2) The name of the ambulette service shall be permanently affixed with each letter being a minimum of three inches in height on both sides and each letter being a minimum of one and one half inches in height on the rear of the ambulette.
If an ambulette service is under contract which requires other signage, the ambulette service's name and service code shall be permanently affixed with each letter being at a minimum of three inches in height on both sides and one and one half in height on the rear of vehicle.
(3) All board identified deficiencies must be corrected. The vehicle shall be placed out-of-service until it passes reinspection by the board.
(4) Ambulette configuration
(a) For vehicles in excess of twenty-two feet in length, the overhead clearance between the top of the door opening and the raised lift platform, or highest point of a ramp, shall be a minimum of sixty-eight inches. For vehicles of twenty-two feet in length or less, the overhead clearance between the top of the door opening and the raised lift platform, or highest point of a ramp, shall be a minimum of fifty-six inches;
(b) 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;
(c) Each vehicle must have safety restraints in the vehicle for the purpose of restraining the patient in the wheelchair;
(d) Each vehicle must be equipped with a stable access ramp or hydraulic lift;
(e) 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.
(D) Upon issuance of a vehicle permit, each licensed ambulette service shall apply the decal on the outside of the right rear window in accordance with division (B)(2) of section 4766.07 of the Revised Code on each ambulette.
The permit must be unobstructed at all times.
(E) A permit is not transferable.
(F) The board may conduct routine unannounced inspections at any location of licensed ambulette service at any time, including night or weekend inspections to determine compliance with Chapter 4766. of the Revised Code and agency 4766 of the Administrative Code to include, but not limited to, ambulettes.
(G) A permitted ambulette shall maintain compliance with roadworthy requirements set forth in this rule at any time it is used as an ambulette.
(H) Each permitted ambulette shall be free from dirt, stains, impurities, and/or foreign matter in driver's compartment and ambulette client compartments.
(A) All licensed ambulette services shall maintain documentation of all periodical maintenance and repairs performed on each permitted ambulette to include:
(1) Date of service or repair;
(2) Description of service/repair performed;
(3) Documentation of who performed service/repair.
(B) Out of service permitted ambulettes
(1) If a licensed ambulette service removes a permitted ambulette from service it shall place an "out of service" sign in the permitted ambulette to be visible through the windshield with the following information included on the sign:
(a) Date permitted ambulette was taken out of service;
(b) Odometer reading at time permitted ambulette was taken out of service;
(c) Reason permitted ambulette was taken out of service;
(d) Printed name and signature of person responsible for taking permitted ambulette out of service;
(e) The words "out of service" utilizing not less than three inch lettering on front of sign.
(2) If the permitted ambulette is off premises at a repair/maintenance shop for maintenance purposes, no "out of service" sign is required.
(C) Ambulette maintenance/repair records shall be kept for a period of twelve months after the vehicle is removed from inventory.
Replaces: 4766-3-04, 4766-3-08
(A) Each ambulette shall maintain the following equipment on-board at all times:
(1) One five pound ABC fire extinguisher, permanently mounted;
(2) One blanket;
(3) Disinfectant for surfaces & equipment;
(4) Waterless disinfectant for hands;
(5) Permanent mount oxygen cylinder securement device;
(6) One bio-hazard disposal kit
(a) Bio-hazard disposal kit shall include, at a minimum:
(i) Safety shield/mask;
(ii) Impervious gown;
(iii) Disposable gloves;
(iv) Bio-waste bag;
(v) Antimicrobial hand wipes;
(vi) Disposal bag with ties;
(vii) Germicidal disinfectant with dry wipe;
(viii) Pick-up scoop with scraper; and
(ix) Solidifying agent;
(b) Biohazard disposal kit may be combined with first aid kit to create combination box;
(7) One first aid kit
(a) First aid kit shall include, at a minimum:
(i) Adhesive bandages;
(ii) Sterile 4 x 4 gauze pads;
(iii) Individually wrapped roller bandages;
(v) CPR mask; and
(vi) Antiseptic/alcohol preps;
(8) Three red reflectors or three flares for emergency purposes;
(9) All items in the vehicle need to be secured in such a manner that they will not become a projectile.
(A) In the event of a disaster situation when permitted ambulette(s) based in the locality of the disaster situation are incapacitated or insufficient in number to render ambulette(s) needed, a licensed ambulette service may utilize whatever means necessary to transport.
(B) An ambulette that has not been issued a permit by the board may be issued a temporary permit, for a period not to exceed sixty days, if the ambulette is used to replace a permitted ambulette that has been temporarily taken out of service for repair or maintenance. In order to obtain a temporary permit, an ambulette service shall submit a written application to the board containing:
(1) Vehicle identification number of the permitted ambulette;
(2) Date permitted ambulette was placed out of service;
(3) Vehicle identification number of the ambulette to receive a temporary permit;
(4) Date temporarily permitted ambulette is to be placed in service;
(5) Reason the permitted ambulette was taken out of service.
(C) The licensed ambulette service shall ensure that the fifty dollar fee prescribed in paragraph (E) of rule 4766-3-03 of the Administrative Code shall be received by the board within seven days of issuance of a temporary permit.
(D) A temporarily permitted ambulette shall not be operated unless it meets the requirements set forth in paragraph (B) of rule 4766-3-08 and rule 4766-3-10 of the Administrative Code and the insurance requirement set forth in Division (B) of section 4766.06 of the Revised Code.
(E) The ambulette service shall note the date of return to service of the permitted ambulette on the temporary permit.
(F) The licensed ambulette service shall return the temporary permit to the board within two days after the permitted ambulette is returned to service.
(A) The ambulette service shall maintain and provide adequate documentation of the following driver operator requirements for each of its drivers:
(1) A copy of a valid driver/operator license issued pursuant to Chapter 4506. or 4507. of the Revised Code or its equivalent if the applicant is a resident of another state:
(a) Driver/operator must be at least eighteen years of age to operate an ambulette;
(b) Each ambulette driver must have at least two years driving experience;
(2) A copy of a valid driver/operator's abstract obtained from the bureau of motor vehicles at the time of the application for employment and annually thereafter;
(a) The date of the driving abstract submitted at the time of application shall be no more than fourteen calendar days prior to the date of application for employment;
(b) Driver/operators having six points or more on their driving abstract in accordance with section 4510.037 of the Revised Code cannot be an ambulette service driver;
(c) Ambulette service may use documentation from their commercial insurance carrier as proof the standard in this paragraph has been met.
(3) A copy of a valid certification in CPR and at least one of the following:
(a) Basic first aid;
Each driver/attendant must have proof of successful completion of the "American Red Cross" or equivalent certifying organization basic course in first aid as approved by the board;
(b) First responder;
(c) Emergency medical technician;
(4) Satisfactory completion of a passenger assistance training course to include the following elements:
(a) Major disabling conditions;
(b) Basic considerations for functional factors;
(c) Management of wheelchairs;
(d) Assistance and transfer techniques;
(e) Environmental considerations;
(f) Emergency procedures;
(5) A copy of a valid criminal background check in accordance with section 109.572 of the Revised Code .
(6) A copy of a valid signed statement from a physician acting within their scope of practice declaring that the driver/operator does not have a medical condition, physical condition, including vision impairment (not corrected), which could interfere with safe driving, passenger assistance, the provision of emergency treatment activity, or could jeopardize the health and welfare of client and/or general public;
(7) A copy of valid test results from an alcohol and controlled substances test to be conducted by a laboratory certified for such testing under "CLIA" and determined to be free of alcohol, drug of abuse, controlled substance, or metabolite of a controlled substance.
(a) Except as provided for in paragraph (C) 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.
(8) The ambulette service shall provide each driver/operator with an identification card visible to the client identifying their first name and last initial or a unique identifier and ambulette service affiliation.
(B) An ambulette service shall at all times maintain staffing of ambulette(s) by an ambulette driver who meets the requirements of division (A) of section 4766.15 of the Revised Code.
(C) An ambulette service may employ an applicant on a temporary provisional basis pending the completion of the requirements set for in paragraphs (A)(1) to (A)(7) of this rule. The provisional period shall be no more than sixty days.
(D) No ambulette service shall employ as an ambulette driver, any person who has been convicted of or plead guilty to violations described in divisions (A)(1)(a), (A)(2)(a), (A)(4)(a), and/or (A)(5)(a) of section 109.572 of the Revised Code or their equivalent in any jurisdiction unless the exceptions set forth in paragraphs (A) and (B) of rule 3701-13-06 of the Administrative Code apply.
(E) No ambulette service shall employ as an ambulette driver any person who has six points or more on their driving abstract in accordance with section 4510.037 of the Revised Code.
(F) No ambulette service shall employ any person as an ambulette driver unless that person has a valid driver/operator license issued pursuant to Chapter 4506. or 4507. of the Revised Code or its equivalent if the person is a resident of another state.
(G) No ambulette service shall employ any person as an ambulette driver unless the person is at least eighteen years of age and has at least two years driving experience.
(H) No ambulette service shall employ any person as an ambulette driver unless the person is currently certified in CPR and one of the following:
(1) Basic first aid;
(2) First responder;
(3) Emergency medical technician.
(I) No ambulette service shall employ any person as an ambulette driver unless the person has successfully completed a program designed for transporting clients with special needs described in paragraph (A)(4) of this rule.
R.C. 119.032 review dates: 12/22/2011 and 04/16/2017
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04, 4766.15
Prior Effective Dates: 08/18/2005, 07/02/2009
The exemption from licensure in division (B) of section 4766.09 of the Revised Code exempts out of state ambulette services receiving a client in Ohio for transport to a location not within Ohio or when transporting a client received in another state to an Ohio destination. An out of state ambulette service that receives a client in Ohio for transportation to a location in Ohio shall be licensed and is subject to Chapter 4766. of the Revised Code and rules under this chapter and to all applicable fines and sanctions for any violation thereof.
(A) Ambulette service shall give written notification to the board prior to or not less than ten days after changes in:
(1) Executive officers or board members;
(4) Purchase or acquisition of a licensed ambulette service;
(a) With any purchase or acquisition of a licensed ambulette service, the ambulette service shall be required to submit a new application for licensure, complete appropriate inspections, and pay all applicable fees;
(b) All ambulette(s) shall be retitled, rebranded in accordance with paragraph (B)(6)(e) of rule 4766-3-01 of the Administrative Code, inspected by the board, and display new ambulette license plates within sixty days.
(B) Within ten days of the date a permitted ambulette is permanently withdrawn from service, the licensed ambulette service shall return to the board a deletion form prescribed by the board, as published on the board's website at http://omtb.ohio.gov/Forms/Form12.pdf, dated April 16, 2012, and the permit decal from the right rear window.
(C) Within ten days of the date a licensed ambulette service ceases to operate, it shall return to the board all vehicle permits and the certificate of licensure.
(D) Within ten days of the date a licensed ambulette service ceases to operate a satellite location, it shall return to the board the certificate of licensure.
(A) The board may investigate alleged violations of Chapter 4766. of the Revised Code and the rules promulgated thereunder.
(B) Board investigations may include but not be limited to the following:
(1) Interviews of:
(d) Health care workers;
(e) Public safety personnel;
(f) General public;
(2) Record review of:
(a) Transportation documentation;
(b) Incident report;
(c) Crash and/or injury report;
(d) First report of injury;
(e) Employee records;
(f) Physical inspection;
(h) Audio recording;
(i) Physician and/or coroner findings;
(j) Written and/or verbal complaints;
(k) Factual evidence;
(l) Any other item(s) deemed appropriate for specific investigation.
(C) The board may issue a violation notification during any inspection or investigation.
(D) The board may, at its discretion, summarily suspend a license under the authority of section 4766.11 of the Revised Code.
R.C. 119.032 review dates: 12/22/2011
Promulgated Under: 119.03
Statutory Authority: 4766.03
Rule Amplifies: 4766.04, 4766.05, 4766.06, 4766.07, 4766.08, 4766.13, 4766.15, 4766.99
Prior Effective Dates: 08/18/2005