Current through Vol. 42, No. 1, September 16, 2024
(a) In addition to the exclusions listed in
Oklahoma Administrative Code (OAC)
317:30-5-327.1(f)
(1) - (4) of this Part, the SoonerRideNEMT broker may deny NEMT services if:
(1) The long-term care facility/member
refuses to cooperate in determining the member's eligibility;
(2) The long-term care facility/member
refuses to provide the documentation required to determine the medical
necessity for NEMT services;
(3)
The member, medical escort, attendant, or service animal exhibits uncooperative
behavior or misuses/abuses NEMT services;
(4) The member is not ready to board the NEMT
transport at the scheduled time or within fifteen (15) minutes after the
scheduled pick up time;
(5) The
member has not shown or cancelled previous appointments less than twenty-four
(24) hours prior to the appointment, or has cancelled three (3) times within a
ninety (90) day period, upon the SoonerRide NEMT transport's arrival at the
member's residence; or
(6) The
long-term care facility/member fails to request a reservation at least three(3)
days in advance of a health care appointment without good cause. Good cause is
created by factors such as, but not limited to, any of the following:
(A) Urgent care;
(B) Post-surgical and/or medical follow up
care specified by a health care provider to occur in fewer than three(3) days;
(C) Imminent availability of an
appointment with a specialist when the next available appointment would require
a delay of two(2) weeks or more; and
(D) The result of administrative or technical
delay caused by SoonerRide and requiring that an appointment be rescheduled.
(7) All requests,
provided with or without good cause, are subject to availability and resources.
(b) Pursuant to Federal
law, SoonerRide will provide notification in writing to long-term care
facilities/members when services have been denied . This notification must
include the specific reason for the denial and the member's right to appeal.
(1) An appeal must be filed with the Oklahoma
Health Care Authority (OHCA) in accordance with OAC
317:2-1-2.
(2) The appropriateness of
transportation may be appealed only to the extent that the transportation does
not meet the medical needs of the member. Dissatisfaction with the use of
public transportation, shared rides, type of vehicle, etc., is not appropriate
grounds for appeal.
(3) The OHCA's
decision is final. This decision may be appealed to the chief executive officer
of the OHCA pursuant to OAC
317:2-1-13.
(c) The agency
contracts directly with ambulance and air providers for all other
transportation needs for eligible members not approved by SoonerRide NEMT.
Please refer to Subchapter 5, Part 33, Transportation by Ambulance, of this
Chapter.
