(A) Provisions in this chapter do not necessarily apply to transportation furnished in accordance with other chapters of agency 5160 of the Administrative Code.
(B) The following definitions apply to this chapter:
(1) Terms that have the same meaning as in 42 C.F.R. 414.605 (October 1, 2020) include the following items:
(a) "Advanced life support, level 1 (ALS1)";
(b) "Advanced life support, level 2 (ALS2)";
(c) "Basic life support (BLS)";
(d) "EMT-basic," "EMT-intermediate, and "EMT-paramedic" (collectively, "advanced life support (ALS) personnel");
(e) "Fixed wing air ambulance";
(f) "Rotary wing air ambulance"; and
(g) "Specialty care transport (SCT)."
(2) "Ambulance" is a collective term for air ambulance and ground ambulance.
(a) "Air ambulance" is a collective term for "fixed wing air ambulance" and "rotary wing air ambulance."
(b) "Ground ambulance" is a collective term for land ambulance and water ambulance.
(3) "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 need extra assistance.
(4) "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.
(5) "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.
(6) "Eligible provider" has the same meaning as in Chapter 5160-1 of the Administrative Code.
(7) "Emergency" is a situation that calls for an 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, needs 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; or
(c) Transport to a trauma center.
(8) "Emergency medical technician (EMT)" is a collective term for EMT-basic, EMT-intermediate, and EMT-paramedic.
(9) "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.
(10) "Long-term care facility" is a collective term for intermediate care facility for individuals with intellectual disabilities (ICFIID), nursing facility (NF), and skilled nursing facility (SNF). Neither an assisted living facility nor a group home is an LTCF.
(11) "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.
(12) "Medicaid-eligible individual" is an individual who meets eligibility criteria of the medicaid program.
(13) "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.
(14) "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).
(15) "Non-emergency" is a situation for which immediate response is not needed for the provision of medical treatment.
(16) "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.
(17) "Point of transport" is the terminus of a trip, either the place of origin or the destination.
(18) "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.
(19) "Transportation provider" is an eligible provider that furnishes wheelchair van or ambulance services and meets the minimum criteria 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 medicaid transportation provider.
(20) "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 conditions for licensure specified in Chapter 4766. of the Revised Code, and meets standards specified in Chapter 4766-3 of the Administrative Code.
Last updated July 1, 2021 at 11:00 AM