(A) A consumer may initiate a request for NET by telephone, in person, or in writing.
The county department of job and family services (CDJFS) must process consumer requests for NET and make referrals as appropriate. A request for NET should be made by the consumer at least ten working days in advance unless transport is needed sooner either because the consumer is ill or injured or because the medicaid provider or managed care plan (MCP) provider has scheduled a medically necessary follow-up appointment.
(B) Access to NET depends on the availability of transportation from other sources.
(1) Medicaid consumers may not access NET if they qualify for transportation through one of the following services:
(a) Hospice services, as specified in Chapter 5101:3-56 of the Administrative Code;
(b) Ambulette, land ambulance, or air ambulance service, as specified in Chapter 5101:3-15 of the Administrative Code; or
(c) Services provided by long-term care facilities (i.e., nursing facilities or intermediate care facilities), as specified in Chapter 5101:3-3 of the Administrative Code.
(2) The CDJFS must provide transportation assistance through NET if two conditions are met:
(a) Transportation is not arranged through, or the consumer has elected not to use the transportation provided through, the following medicaid programs and services:
(i) Federally qualified health centers (FQHCs), as specified in Chapter 5101:3-28 of the Administrative Code;
(ii) Managed care plans (MCPs), as specified in Chapter 5101:3-26 of the Administrative Code; or
(iii) Pregnancy-related services, as specified in rule 5101:1-38-06 of the Administrative Code.
(b) No suitable transportation is readily available through a community source, either public or private, without charge to the consumer.
(3) No transportation service that is provided through another medicaid-funded source may be paid for through NET.
(C) "Community" is the geographical area, defined by each CDJFS, within which Medicaid consumers and the general population in the county routinely access medical services. When a particular medicaid covered service is not available within the community, the CDJFS must ensure transportation outside the community to or from the nearest medicaid provider of the medicaid covered service.
(D) In accordance with paragraph (A)(1)(i) of rule 5101:3-24-02 of the Administrative Code, the CDJFS may take reasonable measures to address the misuse of NET services by consumers. Such measures may include but are not limited to the imposition of a telephone confirmation requirement.
(1) If a consumer who has telephone access fails, without good cause, on at least three consecutive occasions during a thirty-day period either to use transportation arranged by the CDJFS through NET or to cancel the service properly, then the CDJFS may require the consumer to confirm all subsequent appointments by telephone for three consecutive months.
(2) The CDJFS must assess the consumer's situation before establishing that the consumer acted without good cause and proceeding with a telephone confirmation requirement.
(3) Before implementing a telephone confirmation requirement, the CDJFS must notify the consumer of the telephone confirmation requirement in writing. The notification must include at least the following information:
(a) The telephone confirmation requirement beginning date;
(b) The telephone confirmation requirement ending date;
(c) The reason for the telephone confirmation requirement, including the dates of three consecutive occasions on which the consumer failed to use scheduled transportation and the reason why it was determined that the consumer acted without good cause;
(d) The behavior the consumer is to demonstrate in order to successfully complete the telephone confirmation requirement;
(e) The name, telephone number, and address of the CDJFS contact employee; and
(f) The name, telephone number, and address of the contract vendor or transportation provider that the consumer is to use during the telephone confirmation requirement period.
(E) Notification of approval or denial of NET services must be given in accordance with Chapter 5101:6-2 of the Administrative Code.
R.C. 119.032 review dates: 01/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01, 5111.02
Prior Effective Dates: 05/05/1988 (Emer), 08/06/1988, 01/01/1989, 12/31/1990, 08/26/2000, 01/01/2004, 01/01/2006