Lawriter - OAC - 5160-15-13 Transportation: non-emergency services through a CDJFS: administration.

5160-15-13 Transportation: non-emergency services through a CDJFS: administration.

(A) Each county department of job and family services (CDJFS) must develop a community transportation plan to describe how it implements relevant provisions of this rule and rules 5160-15-11 and 5160-15-12 of the Administrative Code.

(1) The community transportation plan must include the following information:

(a) A listing of contact information for at least one CDJFS staff member who is responsible for administering county-based transportation assistance under the medicaid program;

(b) A description of how the CDJFS makes medicaid-eligible individuals aware both of the availability of transportation assistance and of the guidelines for using it;

(c) A description of how medicaid-eligible individuals request transportation assistance from the CDJFS or obtain referrals to other transportation sources;

(d) Delineation of the geographical area within which medicaid-eligible individuals and the general population in the county routinely access medical services (i.e., the "community");

(e) An explanation of the process for arranging transportation assistance for trips outside the community;

(f) For each type of transportation assistance listed in paragraph (B) of this rule, an indication of whether the CDJFS provides it routinely, provides it when other types of assistance do not fully meet a medicaid-eligible individual's needs, or cannot provide it because the service does not exist;

(g) When applicable, an explanation of how the CDJFS decides which type of transportation assistance is most cost-effective and best suited to the medicaid-eligible individual's needs;

(h) When applicable, a listing of contact information for each contract vendor and a summary of the contract, including its term and projected cost;

(i) An explanation of how the CDJFS determines that a medicaid-eligible individual needs the services of a personal assistant during transport, whether the personal assistant for a particular transport may be paid, and how the personal assistant's time is calculated;

(j) When applicable, an explanation of how the CDJFS addresses problems with or complaints about the quality of services provided by contract vendors or by CDJFS staff members; and

(k) An explanation of the policies and procedures implemented by the CDJFS to address misuse of transportation assistance by medicaid-eligible individuals.

(2) A revision of the community transportation plan, signed and dated by an appropriate CDJFS staff member, must be submitted to the department whenever changes are made but not less often than every twelve months.

(B) Every CDJFS may offer the following types of transportation assistance:

(1) Services provided under a vendor contract or agreement and billed afterward to the CDJFS:

(a) Livery service (e.g., taxicab rides);

(b) Fixed-route or demand-response transportation (e.g., rides provided by a public transit system, a human-service agency, a private company, or a transportation cooperative);

(c) The dispensing of fuel at participating service stations;

(2) Services not provided under a vendor contract or agreement:

(a) Prepayment of fares (e.g., purchase of bus tokens or passes);

(b) Prepayment for fuel at participating service stations (e.g., purchase of gasoline debit cards);

(c) Transportation of a medicaid-eligible individual by a CDJFS staff member in a CDJFS vehicle;

(d) Payment of mileage reimbursement to a medicaid-eligible individual or to a CDJFS staff member for the use of a private vehicle, at the same rate at which the county reimburses its employees for work-related travel expenses;

(e) Auxiliary services:

(i) Payment for the services of a personal assistant for up to eight hours per day, made at the greater of the current federal minimum wage or the current Ohio minimum wage, when a medicaid-eligible individual requires such services during transport, unless the personal assistant is the medicaid-eligible individual's relative (grandparent; parent, step-parent, or parent-in-law; sibling, step-sibling, or sibling-in-law; child, step-child, or child-in-law; grandchild; spouse or partner; legal guardian; or other person who stands in the place of a parent);

(ii) Payment for lodging, meals, and other travel-related expenses for a medicaid-eligible individual (and, when required, a personal assistant), at not less than the same rate at which the county reimburses its employees for work-related travel expenses;

(iii) Transportation, or payment for transportation, of a parent or legal guardian accompanying a medicaid-eligible individual who is younger than twenty-one years of age; and

(3) Other services approved in advance by the department.

(C) Documentation maintained by the CDJFS must make it possible to verify the following information concerning transportation assistance requested by a medicaid-eligible individual:

(1) The individual's medicaid identification number;

(2) The date on which the request for transportation assistance was made;

(3) The identity and location of the provider where the individual planned to obtain a medicaid-coverable service;

(4) The trip date or dates requested;

(5) The number of one-way trips involved;

(6) The type of transportation assistance provided or the reason why transportation assistance was not provided;

(7) The name of the transportation vendor, when applicable; and

(8) The name of the medicaid program area (such as pregnancy-related services, healthchek/EPSDT, or general non-emergency transportation) to which the cost should be allocated.

Replaces: Part of 5160-24-02, 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