Current through Register Vol. 49, No. 9, September, 2024
261.000 Arkansas
Medicaid Participation Requirements for DDTCS
Transportation Providers
All non-emergency medical transportation will be provided by
the transportation broker for the region in which the beneficiary lives with
the exception of transportation to and from a Developmental Day Treatment
Clinic Services (DDTCS) center when the transportation is provided by the
center.
The DDTCS provider may choose to provide transportation
services for the developmentally disabled (DD) population as a fee-for-service
provider to and from a DDTCS facility. A transportation broker must provide
transportation to and from medical providers.
The DDTCS transportation providers must meet the following
criteria to be eligible for participation in the Arkansas Medicaid
Program:
A. The provider must complete
a provider application (Form DMS-652), a Medicaid contract (Form DMS-653, an
Ownership and Conviction Disclosure (Form DS-675), a Disclosure of Significant
Business Transactions (Form DMS-689) and a Request for Taxpayer Identification
Number and Certification (Form W-9) with the Arkansas Medicaid Program.
View or print a provider application (Form DMS-652). Medicaid
contract (Form DMS-653). Ownership and Conviction Disclosure (Form DMS-675),
Disclosure of Significant Business Transactions (Form DMS-689) and Request for
Taxpayer Identification Number and Certification (Form
W-9).
B. The
provider application and Medicaid contract must be approved by the Arkansas
Medicaid Program.
C. The provider
must submit:
1. A copy of his or her current
vehicle registration for each vehicle to be used for DDTCS
transportation,
2. A copy of the
driver's current commercial and/or non-commercial driver's license(s)
appropriate for the operation of any motor vehicle(s) the driver will be
operating/driving to transport DDTCS beneficiaries,
3. Proof of automobile insurance for each
vehicle with minimum liability coverage of $50,000.00 per person per
occurrence,
4. Consent for Release
of Information, Form DMS-619, completed by each driver. .View
or print Consent for Release of Information Form
DMS-619.
5.
Provider agreement.
D.
The provider must subsequently submit upon receipt, proof of the periodic
renewal of each of the following:
1. Vehicle
registration
2. Commercial and/or
non-commercial driver's license(s) appropriate for the operation of any motor
vehicle(s) the driver will be operating/driving to transport DDTCS
beneficiaries
3. Required liability
insurance
