(A) This chapter sets forth the transportation services that are available as benefits under the medicaid state plan. Provisions in this chapter do not apply to transportation services for which a per diem payment is made to a long-term care facility (LTCF) in accordance with Chapter 5160-3 of the Administrative Code.
(B) The following definitions apply to this chapter:
(1) "Advanced life support, level 1 (ALS1)" is transport by ground ambulance and the provision of medically necessary supplies and services at a level beyond the scope of an EMT-basic but within the scope of an EMT-intermediate or EMT-paramedic specified in Chapter 4765. of the Revised Code.
(2) "Advanced life support, level 2 (ALS2)" is ALS1 during which at least one of the following procedures is performed:
(a) At least three separate administrations of one or more medications (except crystalloid fluids) by intravenous means or by continuous infusion;
(b) Manual defibrillation or cardioversion;
(c) Endotracheal intubation;
(d) Establishment of a central venous line;
(e) Cardiac pacing;
(f) Chest decompression;
(g) Opening of a surgical airway; or
(h) Establishment of an intraosseous line.
(3) "Air ambulance transport" is transport by air ambulance and the provision of medically necessary supplies and services.
(4) "Ambulance" is an air ambulance or ground ambulance.
(a) "Air ambulance" is an aircraft that meets the definition of "fixed wing air ambulance" or "rotorcraft air ambulance" set forth in section 4766.01 of the Revised Code and meets the standards and license requirements specified in Chapter 4766. of the Revised Code.
(i) "Fixed-wing air ambulance" has the same meaning as "fixed wing air ambulance."
(ii) "Rotary-wing air ambulance" has the same meaning as "rotorcraft air ambulance."
(b) "Ground ambulance" is a vehicle that meets the definition of "ambulance" set forth in section 4766.01 of the Revised Code and meets the standards and license requirements specified in Chapter 4766. of the Revised Code.
(5) "Attendant" is an individual employed by a transportation provider, in addition to the minimum crew of a wheelchair van or a ground ambulance, who aids in the non-emergency transportation of medicaid-eligible individuals who require extra assistance.
(6) "Basic life support (BLS)" is transport by ground ambulance and the provision of medically necessary supplies and services at a level within the scope of an EMT-basic specified in Chapter 4765. of the Revised Code.
(7) "County department of job and family services (CDJFS)" is an entity established under section 329.01 of the Revised Code or a group of such entities acting together under a formal collaborative agreement.
(8) "Documentation" is information recorded in an appropriate medium for the purpose of substantiating an assertion. Information that is not relevant to a situation or does not support a statement about a situation is not documentation.
(9) "Eligible provider" has the same meaning as in Chapter 5160-1 of the Administrative Code.
(10) "Emergency" is a situation that requires immediate response for the provision of medical treatment, particularly a situation in which the sudden onset of a medical condition manifests itself in acute symptoms so severe that the absence of immediate medical attention could reasonably be expected to result in serious harm to an individual's health, significant impairment of a body function, or failure of a body organ or part. An ambulance service may be considered to be of an emergency nature when an individual, at the time of transport, requires health-related assistance including but not limited to the following services:
(a) Immediate medical attention for a serious injury, an acute illness, or the sudden instability of a physical condition;
(b) Prophylactic immobilization (e.g., for a possible fracture); or
(c) Transport to a trauma center.
(11) "Emergency medical technician (EMT)" is an individual who holds a current, valid certificate issued under Chapter 4765. of the Revised Code at one of three levels: EMT-basic, EMT-intermediate, or EMT-paramedic.
(12) "Loaded mileage" is the distance traveled to or from a medicaid-coverable service with a medicaid-eligible individual in the vehicle. Air ambulance mileage is expressed in statute miles.
(13) "Long-term care facility" is either an intermediate care facility for individuals with intellectual disabilities or a nursing facility, both of which are defined in Chapter 5160-3 of the Administrative Code.
(14) "Manual review" is the examination of a claim by an employee of the department for the purpose of determining whether it meets criteria for payment.
(15) "Medicaid-eligible individual" is an individual who meets eligibility requirements of the medicaid program.
(16) "Medicaid-coverable service" is a service or procedure, exclusive of the transportation services specified in this chapter, that either is itself payable under the Ohio medicaid program in accordance with agency 5160 of the Administrative Code or is intrinsically related to a payable service or procedure (e.g., a follow-up visit within a defined period after surgery).
(17) "Mobility-related assistive device" (or "mobility device") is a piece of equipment that is intended primarily to facilitate human locomotion and cannot be classified as a motor vehicle, common carrier, or similar conveyance. For purposes of this chapter, a mobility device is a manual wheelchair, power wheelchair, power-operated vehicle (scooter), or wheelbench (a device, similar in function to a wheelchair, that is used by a person in a recumbent position).
(18) "Non-emergency" is a situation that does not require immediate response for the provision of medical treatment.
(19) "Non-emergency transportation" is transportation for an individual whose medical condition does not require immediate response for the provision of medical treatment.
(20) "Personal assistant" is an individual who accompanies and provides necessary assistance to a medicaid-eligible individual during non-emergency transport that has been arranged through a county department of job and family services.
(21) "Point of transport" is the terminus of a trip, either the place of origin or the destination.
(22) "Signature" is a distinctive mark (usually taking the form of a name) that is made in order to indicate a person's responsibility for a document or other material. A signature may be written in someone's own hand or produced in any other legally valid manner.
(23) "Specialty care transport (SCT)" is interfacility transport of a critically injured or ill individual by ground ambulance and the provision of medically necessary supplies and services at a level beyond the scope of an EMT-paramedic that must be furnished by one or more health professionals in an appropriate specialty area (e.g., emergency or critical care nursing, emergency medicine, respiratory care, cardiovascular care) or by an EMT-paramedic with additional training.
(24) "Transportation provider" is an eligible provider that furnishes wheelchair van or ambulance services and meets the minimum requirements specified or referenced in this chapter. For purposes of this chapter, a vendor under contract with a CDJFS to transport medicaid-eligible individuals is not considered to be a transportation provider.
(25) "Wheelchair van" is a vehicle that meets the definition of "ambulette" set forth in section 4766.01 of the Revised Code, meets the standards and license requirements specified in Chapter 4766. of the Revised Code, and meets standards specified in Chapter 4766-3 of the Administrative Code.
Replaces: 5160-15-01, part of 5160-15-03
Cite as Ohio Admin. Code 5160-15-01
Five Year Review (FYR) Dates: 04/01/2021
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 04/07/1977, 05/09/1986, 12/01/1989, 05/01/1992 (Emer), 07/31/1992, 07/05/1993, 03/01/2000, 12/27/2001, 10/01/2003, 12/30/2005 (Emer), 03/27/2006