Or. Admin. Code § 410-136-3260

Current through Register Vol. 63, No. 10, October 1, 2024

Section 410-136-3260 - Modifications Based on Client Circumstances

(1) A client may request modification of non-emergent medical transportation (NEMT) services when the NEMT driver:

(a) Threatens to harm the client or others in the vehicle;

(b) Drives or engages in other behavior that places the client or others in the vehicle at risk of harm; or

(c) Presents a perceived or direct threat to the client or others in the vehicle.

(2) A brokerage may modify NEMT services when the client:

(a) Is threatening harm to the driver or others in the vehicle;

(b) Presents a direct threat to the driver or others in the vehicle;

(c) Has a health condition that creates health or safety concerns to the driver or others in the vehicle;

(d) Engages in behaviors or circumstances that place the driver or others in the vehicle at risk of harm;

(e) Frequently does not show up for scheduled rides;

(f) Frequently cancels the ride on the day of the scheduled ride time;

(g) Engages in behaviors that cause local medical providers or facilities to refuse to provide further services without modifying NEMT services; or

(h) Has special needs that require special accommodations.

(2) For the purposes of this rule, "direct threat" means a significant risk to the health or safety of others and which:

(a) Cannot be eliminated or reduced to an acceptable level through the provision of auxiliary aids and services or through reasonably modifying policies, practices, or processes; and

(b) Is identified through an individual assessment that relies on current medical evidence or the best available objective evidence which shows:

(A) The nature, duration, and severity of the risk;

(B) The probability that a potential injury shall actually occur; and

(C) Whether reasonable modification of policies, practices, or processes shall lower or eliminate the risk.

(3) Reasonable modifications include, but are not limited to requiring the client to:

(a) Use a specific transportation subcontractor;

(b) Travel with an attendant;

(c) Use public transportation where available;

(d) Drive themselves or locate someone to drive them and receive mileage reimbursement; or

(e) Confirm the ride with the brokerage on the day of or the day before the scheduled ride.

(4) Before requiring any modifications, the brokerage shall talk with the client about the reason for imposing a modification, explore modifications that are appropriate to the needs of the client and that address the health and safety concerns of the brokerages. The brokerage or client may include the client's worker, or CCO in the discussion. The client may include other individuals in the discussion.

(5) Responses to requests for modification or auxiliary aids based on disability or other protected class status under state or federal rule or law must comply with the Americans with Disabilities Act and all other applicable state and federal laws and rules.

(6) Brokerages may not modify NEMT services under this rule unless the modification is permitted under this rule or required in order to accommodate a disability requiring modification or auxiliary aid.

(7) Brokerages may not make a reasonable modification based on the criteria in section (1)(a)-(g) in this rule that results in a denial of NEMT services to a client and must make all reasonable efforts to offer an appropriate alternative to meet the client's needs under the circumstances.

(8) Brokerages shall draft policies and procedures that ensure the safety of all passengers in NEMT vehicles which shall include, without limitation, policies and procedures that comply with this rule and in accordance with OAR 410-136-3020 (13)(e). Brokerages shall include passenger safety policy and procedures in a OHP Open Card Member Handbook or in a stand-alone document, and ensure the information is available on the Brokerages' website for passengers. Brokerages shall also provide passenger safety policy and procedures information to their NEMT subcontractors and require the NEMT subcontractors to follow the policies and procedures.

Or. Admin. Code § 410-136-3260

DMAP 36-2013, f. 6-27-13, cert. ef. 7-1-13; DMAP 58-2013(Temp), f. & cert. ef. 10-30-13 thru 4-28-14; DMAP 11-2014, f. & cert. ef. 3-11-14; DMAP 95-2023, amend filed 12/22/2023, effective 1/1/2024

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 414.065