(A) Payment may be made for the following wheelchair van services:
(1) Transport by wheelchair van;
(2) Mileage, wheelchair van; and
(3) Attendant services, wheelchair van.
(B) Payment may be made only if all the requirements in this paragraph are met.
(1) The necessity of the wheelchair van service is established. A necessary wheelchair van service is presumed to satisfy the criteria for medical necessity set forth in rule 5160-1-01 of the Administrative Code.
(a) The transfer by wheelchair van of a medicaid-eligible individual from one hospital to a second hospital is deemed to be necessary if two conditions apply:
(i) Both of the criteria listed in paragraph (B)(1)(b) of this rule are met; and
(ii) The services provided at the second hospital are coverable by medicaid.
(b) The necessity of all other wheelchair van services is determined by two criteria:
(i) The medicaid-eligible individual must be accompanied by a mobility-related assistive device from the point of pick-up to the point of drop-off; and
(ii) Transportation of the medicaid-eligible individual by standard passenger vehicle or common carrier is precluded or contraindicated. (Note: The use of a portable device such as a cane, crutch, or walker does not in and of itself preclude or contraindicate transportation by standard passenger vehicle or common carrier.)
(2) The transport vehicle is one of two types:
(a) A wheelchair van; or
(b) A ground ambulance used only under the following conditions:
(i) The transportation provider is an eligible provider of both wheelchair van services and ground ambulance services;
(ii) No wheelchair van is available for one of three reasons:
(a) A wheelchair van was originally scheduled for the transport but has been rendered inoperative or unavoidably delayed, and the transportation provider cannot substitute another wheelchair van within a reasonable time;
(b) The wheelchair vans operated by the transportation provider cannot accommodate the medicaid-eligible individual's mobility device; or
(c) The medicaid-eligible individual (or the medicaid-eligible individual's representative) requested a ground ambulance, and the ambulance crew discovered on arrival that wheelchair van service was needed;
(iii) The medicaid-eligible individual's mobility device can be safely transported with the medicaid-eligible individual in the ground ambulance;
(iv) The medicaid-eligible individual does not refuse the transport; and
(v) On the claim submitted for payment of wheelchair van service, the transportation provider indicates the use of a ground ambulance.
(3) The medicaid-eligible individual is transported either to or from a medicaid-coverable service.
(4) The medicaid-eligible individual is transported both to and from a recognized or approved point of transport.
(5) The services of an attendant are used only when such services are necessary for the safe transport of a medicaid-eligible individual. The transportation provider must maintain documentation of such necessity.
(6) The mobility device must be dropped off or picked up along with the medicaid-eligible individual at the location where the medicaid-coverable service is obtained.
(7) The medicaid-eligible individual must ride in or on the mobility device when moving between the wheelchair van and the location where the medicaid-coverable service is obtained.
Replaces: Part of 5160-15-03, 5160-15-05
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, 07/05/1993, 03/01/2000, 12/27/2001, 10/01/2003, 12/30/2005 (Emer), 01/01/2006, 03/27/2006