Section 5160-15-22 - Transportation: services from an eligible provider: wheelchair van services(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:(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. Ohio Admin. Code 5160-15-22
Effective: 7/1/2021
Five Year Review (FYR) Dates: 4/16/2021 and 07/01/2026
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 04/07/1977, 05/09/1986, 07/05/1993, 03/01/2000, 12/27/2001, 10/01/2003, 12/30/2005 (Emer.), 01/01/2006, 03/27/2006, 04/01/2016