Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-15 - Medical Transportation Services
Section 5160-15-22 - Transportation: services from an eligible provider: wheelchair van services
Universal Citation: OH Admin Code 5160-15-22
Current through all regulations passed and filed through September 16, 2024
(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 conditions 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
needs to be accompanied by a mobility-related
assistive device from the point of pick-up to the point of drop-off.
This need is demonstrated by the following
indicators:
(a)
The mobility device is dropped off or picked up along with
the medicaid-eligible individual at the location where the medicaid-coverable
service is obtained; and
(b)
The medicaid-eligible individual rides in or on the
mobility device when moving between the wheelchair van and the location where
the medicaid-coverable service is obtained.
(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,
and the transportation provider
maintains documentation of such necessity.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
