Or. Admin. R. 411-016-0120

Current through Register Vol. 63, No. 8, August 1, 2024

Section 411-016-0120 - [Effective until 11/26/2024] Assisted and Community Transportation and Provider Qualifications

(1) Assisted transportation is offered through homecare workers or in-home care agencies who have a valid Medicaid provider number. Hours authorized for assisted transportation are included in the 40-hour maximum per pay period.

(2) Assisted transportation may be provided during medically related transportation if related to an ADL or IADL needs and part of the prior authorized service plan.

(3) Community transportation is offered through contracted transportation providers, public transportation, homecare workers or in-home care agencies who have a valid Medicaid provider number.

(4) Community transportation may be prior authorized for reasons related to an eligible individual's ADL and IADL needs and safety or health, in accordance with the individual's service plan.

(5) Natural supports, volunteer transportation, and other transportation services available to an eligible individual are considered a prior resource and may not be replaced with transportation paid for by the Department.

(6) Medical transportation costs are not reimbursed through community transportation. Community transportation is not provided by the Department to obtain medical or non-medical items that may be delivered by a supplier or sent by mail order without extra cost to the eligible individual.

(7) Community transportation must be prior authorized by an individual's Services Case Manager and documented in the individual's service plan. The Department does not pay any provider under any circumstances for more than the total number of hours, miles, or rides prior authorized by the Department or AAA and as documented in the individual's service plan.

(a) Contracted transportation providers are reimbursed according to the terms of their contract with the Department. Community transportation services provided through contracted transportation providers must be prior authorized by a Services Case Manager based on an estimate of a total count of one-way rides per month.

(b) Homecare workers who use their own personal vehicle for community transportation are reimbursed according to the terms defined in their Collective Bargaining Agreement between the Home Care Commission and Service Employees International Union, Local 503, OPEU. Any mileage reimbursement authorized to a homecare worker must be based on an estimate of the maximum miles required to drive to and from the destination authorized in an individual's service plan.

(c) The AAA may not authorize reimbursement for travel to or from the residence of a homecare worker. The AAA only authorizes community transportation and mileage from the home of an eligible individual to the destination authorized in the individual's service plan and back to the individual's home.

(8) The Department is not responsible for any vehicle damage or personal injury sustained or other liability incurred while using a personal motor vehicle for community transportation.

Or. Admin. R. 411-016-0120

APD 22-2024, temporary adopt filed 05/20/2024, effective 5/31/2024 through 11/26/2024

Statutory/Other Authority: ORS 410.070

Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065