5160-15-01 Medical transportation services: definitions.

(A) The following definitions are applicable to this chapter

(1) "Advanced life support services" (ALS) are defined as those services which are beyond the scope of services that may be provided by EMT-basic and within the scope of practice of an EMT-intermediate or a paramedic in accordance with Chapter 4765. of the Revised Code.

(2) "Air ambulance" is defined as an air ambulance vehicle that is equipped and staffed to handle the transport of a patient whose condition meets the criteria for transport via air ambulance specified in paragraph (C) of rule 5101:3-15-03 of the Administrative Code.

(3) "Ambulance, land ambulance, or ground ambulance" is defined as a vehicle that is designed to transport individuals in a supine position and meets the standards and license requirements specified in Chapter 4766. of the Revised Code.

(4) "Ambulette" is defined as a vehicle that is designed to transport individuals sitting in wheelchairs and meets standards specified in rule 5101:3-15-02 of the Administrative Code.

(5) "Attendant" is defined as an individual employed by the transportation provider separate from the basic crew of the ambulance or ambulette vehicle who meets the qualifications specified in paragraph (B)(2) of rule 5101:3-15-02 of the Administrative Code for ambulance and paragraph (C)(3) of rule 5101:3-15-02 of the Administrative Code for ambulette and is present to aid in the transfer of medicaid covered patients who meet the criteria for transport specified in rule 5101:3-15-03 of the Administrative Code.

(6) "Attending practitioner" is defined as the practitioner (i.e., primary care practitioner or specialist) who provides care and treatment to the patient on an ongoing basis and who can certify the medical necessity for the transport. The attending practitioner is responsible for the ongoing care and management of the patient and can certify the non-ambulatory status of the patient and the medical need for ambulance or ambulette transport, the type of certification, and length of time the non-ambulatory status will remain unchanged. Attending practitioner also refers to a designated practitioner who is covering for the attending practitioner in his or her absence or a practitioner who is a member of the same group practice as the attending practitioner and in which it is customary for the members of the practice to cross cover for each other's patients. Practitioners must hold a valid and current license or certification to practice as at least one of the following:

(a) A doctor of medicine;

(b) A doctor of osteopathy;

(c) A doctor of podiatric medicine; or

(d) An advanced practice nurse (APN).

(7) "Basic crew" is defined as the minimum necessary staff members for each type of transport as set forth in rule 5101:3-15-03 of the Administrative Code and section 4765.43 of the Revised Code.

(8) "Basic life support services" (BLS) are defined as those services which are in the scope of services of an emergency medical technician-basic as set forth under section 4765.37 of the Revised Code.

(9) "Covered medical transportation services" are defined as those transports covered in accordance with rule 5101:3-15-03 of the Administrative Code.

(10) "Dispatcher" is defined as an individual employed by the transportation provider to set the schedule of transportation runs for the ambulette and/or ambulance vehicles.

(11) "Driver" is defined as an individual employed by the transportation provider as part of the basic crew to drive the ambulette or ambulance vehicle to the medicaid covered point(s) of transport and who meets the qualifications specified in paragraph (B)(2) of rule 5101:3-15-02 of the Administrative Code for ambulance and paragraph (C)(3) of rule 5101:3-15-02 of the Administrative Code for ambulette.

(12) "Emergency service" is a service that is provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that in the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

(13) "Emergency medical technician" (EMT) is defined as an individual who holds a current, valid certificate as an emergency medical technician issued under section 4765.30 of the Revised Code.

(14) "Loaded mileage" is defined as the number of miles a patient is transported in the ambulance or ambulette to or from a medicaid covered service. Air ambulance mileage is statute miles.

(15) "Long term care facility" is defined as an intermediate care facility for the mentally retarded (ICF-MR) and/or a nursing facility (NF) as defined in paragraphs (N) and (Q) of rule 5101:3-3-01 of the Administrative Code.

(16) "Medicaid covered point(s) of transport" is defined as the origin, where transport begins or the destination, where transport ends. One of the points of transport, the origin or destination, must be a medicaid covered service. The modifier for the point(s) of transport must be specified as covered in rule 5101:3-15-03 of the Administrative Code.

(17) "Medicaid covered service" is defined as a service reimbursable under the Ohio medicaid program in accordance with Chapters 5101:3-1 to 5101:3-56 of the Administrative Code, excluding those services specified in paragraph (E) of rule 5101:3-15-03 of the Administrative Code.

(18) "Medical transportation service(s)" are defined as a general term for those service(s) covered in accordance with rule 5101:3-15-03 of the Administrative Code.

(19) "Medical transportation provider" is defined as a general term for providers of air ambulance, ambulance and ambulette services in accordance with this chapter.

(20) "Nonambulatory" for the purpose of this rule, is defined as those permanently or temporarily disabling conditions which preclude transportation in motor vehicle(s) or motor carriers as defined in section 4919.75 of the Revised Code that are not modified or created for transporting a person with a disabling condition. The permanently or temporarily disabling conditions must require transport by air ambulance, ambulance or ambulette (for example, patients requiring stretcher transportation or wheelchair-bound individuals) in accordance with this rule.

(21) "Non-emergency transportation" is defined as a prescheduled or unscheduled ambulance or ambulette transport for a patient whose medical condition does not require immediate response for the provision of medical treatment.

(22) "Paramedic" is defined as an individual who holds a current, valid certificate issued under section 4765.30 of the Revised Code.

(23) "Paramedic ALS Intercept" (PI) services are defined as ALS services furnished by an entity that does not provide the ambulance transport.

(24) "Pilot" is defined as an individual employed by the transportation provider as part of the basic crew to pilot the air ambulance and who meets the qualifications specified in paragraph (D)(2) of rule 5101:3-15-02 of the Administrative Code.

(25) "Practitioner certification form" is the general term for the JFS 01960 "Ambulance Certification of Medical Necessity Form" (rev. July 2003) that certifies the medical necessity of land ambulance services and the JFS 03452 "Ambulette Certification of Medical Necessity Form" (rev. July 2003) certifies the medical necessity of ambulette services and the written documentation required to certify medical necessity for air ambulance services.

(26) "Specialty care transport services (SCT)" is defined as a level of interhospital services which is beyond the scope of the paramedic and must be furnished by one or more health professionals who are trained in an appropriate specialty area (for example, nursing, emergency medicine, respiratory care, cardiovascular care or paramedic with additional training).

Replaces: 5101:3-15-01

Effective: 03/27/2006
R.C. 119.032 review dates: 03/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02
Prior Effective Dates: 4/7/77, 5/9/86, 12/1/89, 5/1/92 (Emer), 7/31/92, 3/01/00, 12/27/01, 10/1/03, 12/30/05 (Emer)