Lawriter - OAC - 5160-15-12 Transportation: non-emergency services through a CDJFS: requirements and limitations.

5160-15-12 Transportation: non-emergency services through a CDJFS: requirements and limitations.

(A) The county department of job and family services (CDJFS) must not provide transportation assistance if a medicaid-eligible individual qualifies for either of the following types of service:

(1) Transportation of a long-term care facility resident for which a per diem payment is made to the facility in accordance with Chapter 5160-3 of the Administrative Code; or

(2) Transportation provided or arranged for by a hospice in accordance with Chapter 5160-56 of the Administrative Code that is necessary for a medicaid-eligible individual to receive care related to a terminal illness.

(B) The CDJFS must provide transportation assistance if three conditions apply:

(1) Without such assistance, the medicaid-eligible individual will not be able to obtain a medicaid-coverable service (e.g., will not be able to keep an appointment with a medical practitioner);

(2) The medicaid-eligible individual either cannot use or has chosen not to use the following services:

(a) Transportation that a managed care plan (MCP) offers as an additional benefit but is not obligated to furnish under its provider agreement with the department; or

(b) Transportation that a federally qualified health center (FQHC) furnishes in accordance with Chapter 5160-28 of the Administrative Code; and

(3) No suitable transportation is readily available through a community source, either public or private, without charge to the medicaid-eligible individual.

(C) Parents and guardians are considered to be a community source of transportation for their children.

(D) Instead of using transportation assistance provided by a CDJFS, a medicaid-eligible individual who is not enrolled in an MCP may choose instead to access wheelchair van services furnished by an eligible provider on a fee-for-service basis, but is not required to do so, if the criteria specified in rule 5160-15-22 of the Administrative Code are met.

Replaces: Part of 5160-24-01, part of 5160-24-03

Effective: 4/1/2016
Five Year Review (FYR) Dates: 04/01/2021
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
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, 01/01/2008