Current through March 20, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15-10-2; IC 12-15-11; IC
12-15-12-21; IC 16-31-2-1; IC 20-27
Sec. 3.
(a) In order
to receive reimbursement under Medicaid, a provider shall be enrolled to
participate as a provider. A provider is enrolled to participate in Medicaid
when all of the following conditions have been met:
(1) The provider is duly licensed,
registered, or certified by the appropriate professional regulatory agency
pursuant to state or federal law, or otherwise authorized by the
office.
(2) The provider has
submitted an application to participate in Medicaid and completed such forms as
may be required.
(3) The provider
has signed and returned a Medicaid provider agreement.
(4) The provider has received a provider
number.
(5) For an institutional or
individual provider located out-of-state, such entity shall, in addition to
meeting subdivisions (2) through (4), be either:
(A) certified;
(B) licensed;
(C) registered; or
(D) authorized;
as required by the state in which the entity is
located.
(6) The
provider maintains state licensure and abides by the office's provider
agreement.
(7) The provider meets
credentialing standards as required in order for the MCO to receive
accreditation through the National Committee for Quality Assurance pursuant to
IC 12-15-12-21.
(b) In
addition to subsection (a), a provider seeking to enroll transportation
services shall:
(1) make transportation
services available to the general public; and
(2) demonstrate that its primary business
function is the provision of transportation services.
This requirement does not apply to transportation providers
who provide only ambulance, family member transportation services, or school
corporations.
(c) With respect to ambulance service,
vehicles and staff that provide emergency services must be certified by the
Indiana emergency medical services commission established under IC 16-31-2-1 to
be eligible for Medicaid reimbursement for transports involving either advanced
life support or basic life support services that are emergent in nature.
Failure to maintain the Indiana emergency medical services commission
certification on all vehicles involved in transporting Medicaid members will
result in termination of the Medicaid provider agreement.
(d) All transportation provider types shall
continuously comply with all state statutes, rules, and local ordinances
governing public transportation. The following requirements also apply as
follows:
(1) A common transportation carrier
shall submit proof of, and maintain throughout its period of participation, the
following:
(A) Certification by the Indiana
motor carrier authority.
(B)
Insurance coverage as required by the Indiana motor carrier
authority.
(C) Appropriate and
valid drivers' licenses for all drivers.
(2) A taxicab transportation entity shall
submit proof of and maintain throughout its period of participation the
following:
(A) Written acknowledgment by local
or county officials of whether there are existing ordinances governing taxi
services and written verification from local or county officials that taxicab
services operating in the local vicinity are in compliance with those
ordinances.
(B) Livery insurance as
indicated by existing local ordinances, or in the absence of such ordinances, a
minimum of twenty-five thousand dollars/fifty thousand dollars
($25,000/$50,000) public livery insurance covering all vehicles used in the
business.
(C) Appropriate and valid
drivers' licenses for all drivers.
(3) A not-for-profit transportation entity
shall submit proof of, and maintain throughout its period of participation, the
following:
(A) An acknowledgment from state
or federal officials of its status as a not-for-profit entity.
(B) A minimum of five hundred thousand
dollars ($500,000) of combined single limit commercial automobile liability
insurance.
(C) Appropriate and
valid drivers' licenses for all drivers.
(e) IEP transportation services provided in
accordance with
405 IAC 5-30-11 must conform to
the requirements set out in IC 20-27 and are exempt from the transportation
provider agreement requirements set out in this section.
(f) The office may enroll the family member
of a member only when the member must make frequent trips to medical services
and that travel creates undue financial hardship for the family. In order to
enroll as a transportation provider, a family member shall do the following:
(1) Comply with and maintain compliance with
all enrollment requirements under any federal or state law or rule.
(2) Possess a valid driver's license as
required by state law.
(3) Possess
coverage of the minimum amount of automobile insurance as required by state
law.
(4) Utilize as the vehicle for
transporting family members, only a vehicle that has been duly licensed and
registered.
(5) Include, at a
minimum, the following information in an enrollment request:
(A) The member's name and Medicaid
number.
(B) The name, address, and
relationship of the family member provider.
(C) A description of the circumstances
surrounding the request.
(D) A
statement of the financial impact on the family as a result of providing
transportation services to the recipient.
(E) The desired effective date for the
enrollment of the family member as a transportation provider.
(g) A close associate
or able-bodied member may enroll to provide transportation services when no
family member is available to provide this service. When a family member is
enrolled as a transportation provider, that individual may provide services
only to the designated recipient, and those services are subject to prior
authorization.
