Stat. Auth.:ORS413.042 Stats. Implemented:ORS414.065 Hist: Dmap 36-2013, F. 6-27-13, Cert. Ef. 7-1-13

Link to law: http://arcweb.sos.state.or.us/pages/rules/oars_400/oar_410/410_136.html
Published: 2015

The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

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OREGON HEALTH AUTHORITY, DIVISION OF MEDICAL ASSISTANCE PROGRAMS




 

DIVISION 136
MEDICAL TRANSPORTATION SERVICES
410-136-3000
Responsibility for Providing Non-emergent
Medical Transportation
(1) The Authority shall provide non-emergent
medical transportation (NEMT) for eligible clients who receive their OHP covered
medical services on a fee-for-service basis or are members enrolled in prepaid health
plans (PHP) or coordinated care organizations (CCO). The Authority shall cease providing
this service to CCO enrollees when CCOs provide the service to their enrollees pursuant
to section (2) of this rule.
(2) When a CCO begins providing
NEMT services for its enrollees, the Authority shall provide NEMT services in the
CCO’s service area only to clients not enrolled in a CCO for health care services:
(a) The Authority may not
pay for services covered by a CCO; reimbursement is a matter between the CCO and
its transportation subcontractor.
(b) For clients enrolled
in a CCO responsible for NEMT, the transportation provider must coordinate all transportation
services with the client’s transportation brokerage or CCO prior to providing
services.
(3) The requirements in OAR
410-136-3000–410-136-3360 apply to NEMT services for which the Authority is
responsible pursuant to this rule.
(4) A brokerage may request
that the Authority delay responsibility for reimbursement to clients pursuant to
OAR 410-136-3240, Client Reimbursed Mileage, Meals and Lodging, until a CCO in the
brokerage's service area assumes NEMT services for the CCO's enrollees. The delay
of the brokerage's responsibility also includes reimbursing clients in the fee-for-service
delivery system.
(5) OAR 410-136-3040,Vehicle
Equipment and Subcontractor Standards and 410-136-3120, Secured Transports do not
apply to ambulance providers, ambulance vehicles, or ambulance personnel that are
licensed and regulated by ORS Chapter 682 and OAR chapter 333, divisions 250, 255,
260 and 265, whether providing ambulance or stretcher transports.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13; DMAP 69-2013(Temp), f. 12-24-13, cert. ef. 1-1-14 thru 6-30-14;
DMAP 29-2014, f. & cert. ef. 5-20-14
410-136-3010
Coordinated Care Organizations
(1) The Authority contracts with Coordinated
Care Organizations (CCOs) to provide medical services for individuals receiving
Division of Medical Assistance Programs (Division), Title XIX and Title XXI services
for the purpose of providing integrated and coordinated care services across physical
health, dental health, and non-emergent medical transportation (NEMT). See also
OAR chapter 410, division 120 (General Rules) and division 141 (Oregon Health Plan
rules) for definitions and responsibilities and OAR 410-120-1210(4) (Division of
Medical Assistance Programs and Delivery Systems) for a description of how individuals
receive services through CCOs.
(2) When the Authority provides
a CCO with a global budget that includes funds to provide NEMT services for its
members, the CCO shall provide NEMT services to its members.
(3) The Authority may not
pay for services a CCO covers for its members. Reimbursement is a matter between
the CCO and its transportation providers.
(4) For members enrolled
in a CCO, all transportation services must be coordinated through the member’s
CCO or the CCO’s designated transportation provider, if any, prior to receiving
services.
Stat. Auth.: ORS 413.042 & 414.625
Stats. Implemented: ORS 414.625
Hist.: DMAP 39-2014, f. &
cert. ef. 7-1-14
410-136-3020
General Requirements for NEMT
(1) The Authority may enroll governmental
transportation brokerages (local units of government) or other entities to arrange
rides and pay subcontractors for NEMT services. The Authority may limit the enrollment
with brokerages to units of local government.
(2) For purposes of the rules
(OAR 410-136-3000 through 410-136-3360), “subcontractor” means the individual
or entity with which the brokerage subcontracts or employs to drive the client to
and from OHP covered medical services.
(3) The brokerage shall:
(a) Prior authorize and pay
subcontractors for the least costly but most appropriate mode of transport for the
client’s medical needs to and from an OHP covered medical service. The most
appropriate and least costly ride may include requiring the client to share the
ride with other clients;
(b) Verify that the client
is obtaining OHP covered medical services in the client’s local area. “Local
area” means an area within the accepted community standard and includes the
client’s metropolitan area, city, or town of residence;
(c) Verify the client’s
OHP eligibility and that the client’s benefit package includes NEMT services.
The brokerage shall verify this through electronic eligibility information;
(d) Assess the client’s
access to other means of transportation, such as driving their own car or getting
a ride from a family member or neighbor;
(e) Verify the client’s
attendance for continuing requests for rides if the medical provider could not affirm
an appointment for a previous ride;
(f) Schedule a ride with
an alternate subcontractor if the subcontractor originally assigned is unable to
provide the ride; and
(g) Assign rides based on
an evaluation of several factors including, but not limited to:
(A) Cost;
(B) The client’s need
for appropriate equipment and transportation;
(C) Any factors related to
a subcontractor’s capabilities, availability, and past performance; and
(D) Any factors related to
the brokerage’s need to maintain sufficient service capacity to meet client
needs.
(4) Pursuant to OAR 410-120-1210,
Medical Assistance Benefit Packages and Delivery System, clients receiving the following
benefit packages are not eligible for NEMT:
(a) Citizen Alien Waived
Emergency Medical (CWM); and
(b) Qualified Medicare Beneficiary
(QMB) only.
(5) The brokerage shall maintain
records of the reasons for authorizing a ride:
(a) That is not cost effective
or not based on the factors specified in section (3);
(b) With more than two attendants
for an ambulance or stretcher car; or
(c) With more than one attendant
for a wheelchair van.
(6) The brokerage shall provide
a ride to a client to fill prescription medication only in the following situation:
(a) The client needs to stop
on the way home to fill or pick up prescribed medication related to the medical
service for which the brokerage provided the ride;
(b) It is medically necessary
to fill or pick up the medication immediately; and
(c) The pharmacy is located
on the return route or is the closest pharmacy to the return route.
(7) The brokerage may provide
a ride to a client to fill prescribed medication under the following situations:
(a) The brokerage asks the
client if the prescription service is available through the Authority’s contracted
postal prescription service, and the client responds that it is not available through
that source;
(b) The client has an urgent
need to fill or pick up prescribed medication because the postal prescription service
mailed the wrong medication, or the client has an unexpected problem caused by the
medication; or
(c) The client is transient
or without regular access to a mailbox. In this situation, the brokerage may evaluate
the need on a case-by-case basis.
(8) The brokerage shall provide
rides outside the brokerage’s service area, as described in Table 136-3380,
under the following circumstances:
(a) The client is receiving
an OHP covered medical service that is not available in the service or local area
but is available in another area of the state;
(b) The client is receiving
a covered service in California, Idaho, or Washington where the service location
is no more than 75 miles from the Oregon border; or
(c) No local medical provider
or facility will provide OHP covered medical services for the client.
(9) Brokerages may coordinate
to provide a return ride to a client who receives medical services outside the client's
local area.
(10) Brokerages shall retroactively
authorize and pay for NEMT services that have already occurred only when the brokerage
could not prior authorize the service because the brokerage was closed, and the
request for authorization is within 30 days of the date of service. The brokerage
also must confirm that one of the following circumstances supported the ride:
(a) The eligible client needed
urgent medical care;
(b) The eligible client required
secured transport pursuant to OAR 410-136-3120, Secured Transports; or
(c) The client was in a hospital,
and the hospital discharged or transferred the client.
(11) Notwithstanding section
(10), a brokerage shall retroactively authorize NEMT services for ambulance transports
when:
(a) An ambulance provider
responds to an emergency call, but the client’s medical condition does not
warrant an emergency transport;
(b) The ambulance provider
transports the client as a NEMT service; and
(c) The ambulance provider
requests retroactive authorization within 30 days of the NEMT service.
(12) Brokerages shall not
authorize or pay for rides outside their service areas based only on client preference
or convenience.
(13) Brokerages shall provide
toll-free call centers for clients to request rides. The following pertain to the
brokerage’s call center and scheduling of rides:
(a) The call center shall
operate at a minimum Monday through Friday from 9:00 a.m. to 5:00 p.m., but the
brokerage may close the call center on New Year’s Day, Memorial Day, July
4, Labor Day, Thanksgiving, and Christmas. The Authority may approve, in writing,
additional days of closure if the brokerage requests the closure at least 30 days
in advance.
(b) Brokerages shall make
all reasonable efforts for clients to have access to available NEMT services 24
hours a day. When the call center is closed, the brokerages shall provide a recording
or answering service to refer the client directly to a subcontractor. If no subcontractor
is available, the brokerage must provide clients with recorded information about
service hours and how to reach emergency services by calling 911;
(c) The brokerage shall allow
a client to schedule rides at least 30 days in advance of the medical service; and
(d) The brokerage shall allow
a client to request multiple ride requests at one time.
(e) The brokerage shall develop
procedures and make reasonable efforts to arrange a ride requested on the day of
the medical service when the medical service is:
(A) For an urgent medical
condition; and
(B) Due to the urgency of
the medical condition, the client scheduled an immediate medical appointment.
(14) The brokerage is not
responsible for providing emergency medical transportation services. However, brokerages
shall have procedures for referring clients requesting emergency medical transportation
services to the appropriate emergency transportation resources and procedures for
subcontractors per OAR 410-136-3040, Vehicle Equipment and Subcontractor Standards.
(15) The Authority shall
collaborate with brokerages and CCOs to develop and conduct a statewide client satisfaction
survey at least once every two years. The Authority may contract with one or more
brokerages to conduct the survey. The Authority shall use the results of the survey
to identify and address potential operational deficiencies and to identify and share
successes in the NEMT program.
(16) Brokerages shall establish
regional advisory groups consisting of representatives from the Authority, DHS,
Area Agencies on Aging, consumers, representatives of client advocacy groups from
within the service or local area, brokerage subcontractors, and providers of NEMT
ambulance services. The role of the group includes, but is not limited to:
(a) Assisting in monitoring
and evaluating the NEMT program; and
(b) Recommending potential
policy or procedure changes and program improvements to brokerages and the Authority
and assisting in prioritizing those changes and improvements.
(17) Brokerages shall have
the discretion to use or not use DHS-approved volunteers. DHS shall provide brokerages
with a list of approved and trained volunteers. DHS shall supervise the volunteers
and assumes all liability for each volunteer as provided by law.
(18) Brokerages or their
subcontractors shall not bill eligible clients for any transports to and from OHP
covered medical services or any transports where the Authority denied reimbursement.
(19) On a minimum of five
percent of the ride requests, brokerages shall contact medical providers to verify
appointments and that the appointments are for OHP covered medical services.
(20) Brokerages may purchase
tickets for common carrier transportation, such as inter- or intra-city bus, train,
or commercial airline when deemed cost effective and safe for the client.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13; DMAP 69-2013(Temp), f. 12-24-13, cert. ef. 1-1-14 thru 6-30-14;
DMAP 29-2014, f. & cert. ef. 5-20-14
410-136-3040
Vehicle Equipment and Subcontractor Standards
(1) Brokerages shall require subcontractors
to maintain their vehicles for the comfort and safety of the clients. The vehicles
shall meet the following requirements:
(a) The interior of the vehicle
shall be clean;
(b) The subcontractor shall
not smoke or permit smoking in the vehicle at any time; and
(c) The subcontractor shall
comply with appropriate local, state, and federal transportation safety standards
regarding passenger safety and comfort. The vehicle shall include, but is not limited
to, the following safety equipment:
(A) Safety belts for all
passengers if the vehicle is legally required to provide safety belts;
(B) A first aid kit;
(C) A fire extinguisher;
(D) Roadside reflective or
warning devices;
(E) A flashlight;
(F) Tire traction devices
when appropriate;
(G) Disposable gloves; and
(H) All equipment necessary
to transport clients using wheelchairs or stretchers if the subcontractor uses the
vehicle for these modes of transport.
(2) The subcontractor shall
follow a preventative maintenance schedule that incorporates at least all of the
maintenance recommended by the vehicle manufacturer. The vehicle must be in good
operating condition and shall include, but is not limited to:
(a) Side and rear view mirrors;
(b) A horn; and
(c) Working turn signals,
headlights, taillights and windshield wipers.
(3) Brokerages shall require
the subcontractors’ drivers to receive training on their job duties and responsibilities,
including:
(a) Understanding NEMT services
in general, reporting forms, vehicle operation, requirements for fraud and abuse
reporting and the geographic area in which subcontractors will provide service;
(b) Requiring the subcontractors’
drivers to complete the National Safety Council Defensive Driving course or an equivalent
course within six months of the date of hire and at least every three years thereafter;
(c) Requiring the subcontractors’
drivers to complete Red Cross-approved First Aid, Cardiopulmonary Resuscitation
and blood spill procedures courses or equivalent courses within six months of the
date of hire and to maintain the certification as a condition of employment;
(d) Requiring the subcontractors’
drivers to complete the Passenger Service and Safety course or an equivalent course
within six months of the date of hire and at least every three years thereafter;
(e) Understanding established
procedures for subcontractors and the subcontractors’ drivers in the event
that the client needs emergency care during the ride; and
(f) If providing ground or
air ambulance services, verifying that the Authority has licensed the subcontractor
to operate ground or air ambulance. If the subcontractor is located in a contiguous
state and regularly provides rides to OHP eligible clients, the brokerage must ensure
that both the Authority and the contiguous state have licensed the subcontractor.
(4) Brokerages shall require
the following when hiring a subcontractor:
(a) The subcontractor’s
driver must have valid driver license. The license must be the class of license,
with any required endorsements, that permits the subcontractor’s driver to
legally operate the vehicle for which they are hired to drive per ORS Chapter 807
and OAR chapter 735, division 062, or the applicable statutes of other states; and
(b) The subcontractor’s
drivers must pass a criminal background check in accordance with ORS 181.534 and
181.537 and OAR chapter 257, division 10, or if the brokerage is a mass transit
district formed under ORS Chapter 267, the subcontractor’s drivers must pass
a criminal background check in accordance with ORS 267.237 and the mass transit
district’s background check policies. The brokerage may request an exception
to this requirement in writing to the Authority, but only the Authority may grant
the exception. Approval of the exception is dependent upon when the crime occurred,
the nature of the offense, and any other circumstances to ensure that the client
is not at risk of harm from the subcontractor. If approved, the Authority shall
document the approval within 30 days of the request.
(5) For authorized out-of-state
NEMT services in which the subcontractor solely performs work in the other state
and for which the brokerage has no oversight authority, the brokerage is not responsible
for requiring that the subcontractor’s vehicle and the subcontractor’s
standards meet the requirements set forth in this rule.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13
410-136-3060
Insurance Requirements
(1) Brokerages must obtain and maintain
general and automobile liability coverage for personal injury and death in accordance
with ORS 30.271, Limitations on Liability of State for Personal Injury and Death.
(2) Brokerages must obtain
and maintain general and automobile liability coverage for property damage and destruction
in accordance with ORS 30.273, Limitations on Liability of Public Bodies for Property
Damage or Destruction.
(3) The liability coverage
required by sections (1) and (2) of this rule shall include the State of Oregon,
Oregon Health Authority and its divisions, officers, employees, and agents as additional
insureds but only as related to the brokerages’ NEMT services.
(4) In lieu of purchasing
liability coverage under sections (1) and (2) of this rule, the Authority may authorize
a brokerage to establish and maintain a Self-Insurance Reserve Fund. The following
apply to requirements of the fund:
(a) The Authority shall establish
the fund at $1 million through the fixed rate for rides established in OAR 410-136-3200,
Reimbursement and Accounting for all Modes of Transport;
(b) The fund shall comply
with OMB Circular 87;
(c) If the brokerage subsequently
terminates its enrollment with the state as a Medicaid provider, the brokerage shall
refund the Authority the balance of any monies in the fund within two years from
the termination of its enrollment or at the conclusion of any claim or litigation
related to the brokerage’s NEMT services for eligible clients;
(d) Once funded, the fund
shall be maintained at an amount not less than $1 million through the fixed rate
for rides established in OAR 410-136-3200, Reimbursement and Accounting for all
Modes of Transport;
(e) The Authority shall reconcile
the fund amount during the annual cost settlement process pursuant to OAR 410-136-3200,
Reimbursement and Accounting for all Modes of Transport, and shall increase or decrease
the fixed rate for rides to maintain the $1 million fund amount; and
(f) The brokerage shall maintain
a separate account for the fund.
(5) Brokerages and their
subcontractors that employ workers as defined in ORS 656.027 shall comply with 656.017
and shall provide workers’ compensation insurance coverage for those workers,
unless they meet the requirement for an exemption under 656.126(2). Brokerages shall
require each of their subcontractors to comply with this requirement.
(6) In lieu of purchasing
workers’ compensation insurance coverage as required by section (5), a brokerage
may self-insure for all of its subject workers. The Authority shall not fund this
reserve and shall only reimburse the brokerage for costs of self-insurance in the
event of a claim arising from the brokerage’s NEMT services to eligible clients.
(7) Brokerages and their
subcontractors shall furnish proof of liability coverage and insurance to the Authority
upon request.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13; DMAP 69-2013(Temp), f. 12-24-13, cert. ef. 1-1-14 thru 6-30-14;
DMAP 29-2014, f. & cert. ef. 5-20-14
410-136-3080
Out-of-State Transportation
(1) “Out-of-state transportation”
means transportation to or from any location outside Oregon, with the exception
of contiguous areas up to 75 miles outside the Oregon border.
(2) The brokerage shall arrange
rides and pay for out-of-state transportation, as defined in section (1) of this
rule, to and from an out-of-state OHP covered medical service when:
(a) The brokerage confirms
that the Authority, the Prepaid Health Plan (PHP) or CCO authorized the out-of-state
OHP covered medical service per OAR 410-120-1180, Medical Assistance Benefits: Out-of-State
Services; and
(b) The client is eligible
for transportation services per OAR 410-136-3020, General Requirements for NEMT.
(3) Brokerages shall not
arrange or pay for:
(a) A client’s return
from any foreign country to any location within the United States for the client
to obtain medical care because the care is not available in the foreign country;
(b) A client’s return
to Oregon from another state when the client was not in the other state to obtain
authorized medical services or treatments.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13
410-136-3100
Attendants for Child Transports
(1) This rule applies to NEMT for children
under 12 years of age who are eligible for NEMT services to and from OHP covered
medical services. The rule also applies to children and young adults with special
physical or developmental needs, regardless of age, hereafter referred to as “child”
or “children.”
(2) Parents or legal guardians
must provide an attendant to accompany the children while traveling to and from
medical appointments except when:
(a) The driver is a DHS volunteer,
DHS employee or an Authority employee;
(b) The child requires secured
transport per OAR 410-136-3120, Secured Transports; or
(c) An ambulance subcontractor
transports the child for NEMT services, and the brokerage reimburses the ambulance
subcontractor at the ambulance transport rate.
(3) Attendants are required
for NEMT ambulance transports when the brokerage uses an ambulance to provide wheelchair
or stretcher car or van rides.
(4) DHS shall establish and
administer written guidelines for children in the department’s custody, including
written guidelines for volunteer drivers. If DHS’s requirements or administrative
rules differ from this rule, DHS’s requirements or administrative rules take
precedence.
(5) An attendant may be the
mother, father, stepmother, stepfather, grandparent or legal guardian of the child.
The attendant also may be any adult the parent or legal guardian authorizes to be
an attendant. An attendant also may be a brother, sister, stepbrother or stepsister
of the child, as long as the attendant is at least 18 years of age, and the parent
or legal guardian authorizes it.
(6) Brokerages or their subcontractors
may require the child’s parent or legal guardian to provide written authorization
for an attendant other than themselves to accompany the child.
(7) Brokerages or their subcontractors
shall not bill additional charges for a child’s attendant.
(8) The attendant must accompany
the child from the pick-up location to the destination and on the return trip. The
attendant must also remain with the child during their appointment. Another person
shall not accompany the attendant unless the parent or legal guardian authorizes
it or unless the other person is an eligible child traveling to the same location
for a medical appointment.
(9) The parent, guardian
or adult caregiver for the child shall provide and install child safety seats as
required by state law. The subcontractor shall not transport a child if a parent
or legal guardian fails to provide a child safety seat that complies with state
law.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13
410-136-3120
Secured Transports
(1) “Secured transport”
means NEMT services for the involuntary transport of clients who are in danger of
harming themselves or others. Secured transports are allowable when:
(a) The brokerage verified
that the subcontractor has met the requirements of the secured transport protocol
pursuant to OAR 309-033-0200 through 309-033-0970, and, therefore, the subcontractor
is able to transport the client who is in crisis or at immediate risk of harming
themselves or others due to mental or emotional problems or substance abuse; and
(b) The transport is to a
Medicaid enrolled facility that the Authority recognizes as being able to treat
the immediate medical or behavioral health care needs of the client in crisis.
(2) One additional attendant
may accompany the client at no additional charge when medically appropriate, such
as to administer medications, etc. in-route, or to satisfy legal requirements, including,
but not limited to when a parent, legal guardian or escort is required during transport.
(3) The brokerage shall authorize
transports to and from OHP covered medical services for an eligible client when
the court orders the medical service with the following exceptions:
(a) The client is in the
custody of or under the legal jurisdiction of any law enforcement agency;
(b) The client is an inmate
of a public institution as defined in OAR 461-135-0950, Eligibility for Inmates;
or
(c) The Authority has suspended
the client’s OHP eligibility pursuant to ORS 414.420 or 414.424.
(4) The brokerage shall assume
that a client returning to their place of residence is no longer in crisis or at
immediate risk of harming themselves or others, and is, therefore, able to use non-secured
transportation. In the event that a secured transport is medically appropriate to
return a client to their place of residence, the brokerage shall obtain written
documentation, signed by the treating medical professional, stating the circumstances
that required secured transport. The brokerage shall retain the documentation and
a copy of the order in their record for the Authority to review.
(5) The brokerage shall not
approve or pay for secured medical transport provided to a person going to or from
a court hearing or to or from a commitment hearing.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13
410-136-3140
Transports of Clients Changing Hospitals
or Other Facilities
(1) Brokerages shall arrange and pay
for transporting an eligible client who has had a change in condition, noted in
the client’s DHS care plan, resulting in a need for a new service setting
with a lower or higher level of care. This includes clients who are changing levels
of care between their community-based care settings or between institutional and
community-based settings. The client’s DHS worker must request the ride.
(2) Brokerages shall not
arrange or pay for:
(a) The transport or return
of an inpatient client from an admitting hospital to another hospital (or facility)
for diagnostic or other short-term services when the patient will return to the
admitting hospital within the first 24-hours of admission. The subcontractor shall
bill the admitting hospital directly for these transports;
(b) The transport of a client
receiving long-term care service in their home or residing in a long-term care facility
for the sole purpose of shopping for another long-term care facility, even if the
client is looking for a new facility to receive a lower or higher level of care;
(c) The transport of a client
moving from one type of facility to a facility of the same type, such as from an
adult foster home to another adult foster home; and
(d) The transport of a client
who is relocating to another state, unless the transport is to receive an OHP covered
medical service pursuant to OAR 410-136-3080, Out-of-State Transportation.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13; DMAP 69-2013(Temp), f. 12-24-13, cert. ef. 1-1-14 thru 6-30-14;
DMAP 29-2014, f. & cert. ef. 5-20-14
410-136-3160
Ground and Air Ambulance Transports
(1) Transporting a client via ambulance
is required when a medical facility or provider states the client’s medical
condition requires the presence of a health care professional during the emergency
or non-emergency transport. This includes neonatal transports.
(2) For NEMT services, the
brokerage shall authorize the transport.
(3) Brokerages shall provide
ambulance transports with a medical technician when:
(a) A client’s medical
condition requires a stretcher;
(b) The length of transport
would require a personal care attendant; and
(c) The client does not have
an attendant who can assist with personal care during the ride.
(4) Emergency ambulance transportation
is required when a client’s medical condition is an emergency pursuant to
OAR 410-120-0000, Acronyms and Definitions. The ambulance must transport the client
to the nearest appropriate facility able to meet the client's medical needs. Brokerages
do not arrange emergency transportation.
(5) The following apply to
air-ambulance NEMT services:
(a) The brokerage shall approve
air-ambulance NEMT only when another mode of transportation would further jeopardize
or compromise the client's medical condition due to:
(A) The length of time required
to transport the client by ground-ambulance;
(B) Current road conditions
preclude the use of ground transportation; or
(C) Ground-ambulance is not
available.
(b) Notwithstanding section
(4) (a), the brokerage may grant air-ambulance transportation if it determines the
transportation is cost effective. The brokerage shall document how air-ambulance
is more cost effective than ground transportation.
(c) The brokerage must obtain
a written recommendation from the client’s medical provider indicating medical
appropriateness before authorizing air-ambulance transportation.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13
410-136-3180
Reimbursement for Ground and Air Ambulance
Transports
(1) The following applies to how the
Authority shall reimburse providers of NEMT ground and air ambulance services that
brokerages arrange for eligible clients. This applies to clients receiving services
through the fee-for-service delivery system, a PHP or a CCO.
(2) Brokerages shall submit
documentation to the Authority stating the brokerage authorized the transportation.
The documentation also shall inform the Authority to reimburse at the Authority’s
base rate or another amount the brokerage specifies. Ambulance providers shall bill
the Authority for payment of authorized rides.
(3) If brokerage does not
specify another amount, the Authority’s reimbursement shall include:
(a) The base rate established
in the Authority’s fee schedule posted on the OHP Web page at www.oregon.gov/OHA/healthplan/pages/feeschedule.aspx.
The base rate for NEMT ground and air ambulances includes:
(A) Any procedures or services
provided, all medications, non-reusable supplies or oxygen and all direct or indirect
costs. “Indirect costs” include general operating costs, personnel costs,
neonatal intensive care teams employed by the ambulance subcontractor, use of reusable
equipment and any other miscellaneous medical items or special handling that may
be required in the course of transport;
(B) The first ten miles for
ground ambulance transports; and
(C) Mileage for air ambulance
transports.
(b) A modified base rate
for each additional client, according to OAR 410-136-3220, Brokerage Reimbursements
to Subcontractors, if applicable;
(c) Payment for an extra
attendant, if applicable; and
(d) Compensation for service
or care provided at the scene when the client did not require transport, if applicable.
(4) Reimbursement outlined
in section (3) also applies to the Authority’s reimbursements to providers
of emergency ground or air ambulance services for clients who receive services through
the fee-for-service delivery system.
(5) A PHP is responsible
for reimbursement to providers of emergency ground or air ambulance for clients
who are PHP members.
(6) A CCO is responsible
for reimbursement to providers of emergency ground or air ambulance for clients
who are CCO enrollees.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13
410-136-3200
Reimbursement and Accounting for all Modes
of Transports
(1) The following applies to the rate
the Authority pays brokerages:
(a) The Authority shall calculate
and pay a brokerage a fixed rate for rides based on the following formula: Direct
costs plus indirect costs divided by the number of projected monthly rides. “Direct
costs” are transportation costs plus administrative costs;
(b) The Authority shall notify
the brokerages of their specific ride rates; and
(c) The Authority and the
brokerages shall assess any needed modifications to this rate:
(A) Quarterly;
(B) When the Authority changes
any program affecting eligibility or scope; or
(C) If other factors impact
the cost of delivering service.
(2) Brokerages shall account
for NEMT services separate from any other services the brokerage provides.
(3) The Authority shall reimburse
brokerages after they submit claims data files to the Authority, using the standardized
electronic billing format prescribed by the Authority.
(4) The Authority and brokerages
shall conduct an annual cost settlement to determine any overpayment or underpayment
for costs the brokerage incurred for NEMT services for eligible clients. The following
applies to the cost settlement process:
(a) The Authority shall request
cost settlement information from the brokerages 6 months after the end of the fiscal
year. The request shall include a file detailing the brokerages claims, a template
for the brokerages to submit their cost settlement information and instructions
for completing the template;
(b) Brokerages shall submit
the requested information, certified by a Certified Public Accountant, within 90
days of receiving the Authority’s request;
(c) The Authority shall verify
the reported expenses and notify the brokerages in writing of the Authority’s
determination;
(d) If the Authority’s
determination results in an adjustment to the cost settlement information the brokerages
submitted, the brokerages may request an appeal pursuant to OAR 410-120-1560 through
410-120-1700, pertaining to provider appeals.
(5) The Authority shall pay
for services the brokerage authorized and provided in good faith, including mailing
transit passes to clients. The Authority shall use the rate in effect on the day
of the transport or the mailing date of the transit passes. “Good faith”
means:
(a) The brokerage verified
client eligibility on the date of service or the date of mailing the transit passes,
using the Authority’s eligibility information; or
(b) The client eligibility
information was inconsistent or not available, and the brokerage used the most recent
client information available immediately before the time of service or mailing of
transit passes.
(6) Each brokerage may establish
a working capital reserve with funds the Authority provides. The following applies
to any established working capital reserve:
(a) The working capital reserve
shall represent 30 days of cash expenses for normal operating purposes. The Authority
may base the reserve on a time other than 30 days if circumstances warrant the change;
(b) The Authority shall calculate
the reserve amount as part of the annual cost settlement for the most recent past
fiscal year;
(c) The Authority shall base
the reserve amount on an average of six months of operating expenses that the brokerage
reports in its monthly NEMT financial reports. However, the Authority may base the
reserve amount on more or less than six months of expenses when a six-month average
does not reflect an accurate accounting of expenses;
(d) Brokerages shall maintain
a separate account for the reserve funds; and
(e) The Authority may require
the brokerage to return any funds in excess of the amount the Authority calculated,
or the Authority may decrease the ride rate to reduce the reserves. If the Authority
requires the brokerage to return the excess funds, the brokerage shall do so within
45 days of receipt of the Authority notification.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13
410-136-3220
Brokerage Reimbursements to Subcontractors
(1) Brokerages shall reimburse their
NEMT subcontractors for the most cost-effective route from point of origin to point
of destination that most benefits the client’s condition.
(2) Brokerages shall establish
a base rate with its subcontractors. “Base rate” for all modes of transportation
except ground and air ambulance means the rate the brokerage and its subcontractors
agree on for each mode of transportation.
(3) If a subcontractor uses
an ambulance as a stretcher car or van, the brokerage shall reimburse the subcontractor
using the base rate for stretcher cars or vans.
(4) Notwithstanding section
(3), brokerages shall pay ambulance subcontractors at the ambulance rate instead
of the stretcher car or van rate when the transport exceeds two hours, necessitating
a health care professional to care for the client during the ride.
(5) Brokerages shall not
reimburse their subcontractors for waiting for clients to get to the vehicle or
for assisting clients to get in or out of a vehicle.
(6) Brokerages may reimburse
their subcontractors for waiting time:
(a) In special situations,
such as when the subcontractor has to wait for a client who is using the subcontractor’s
gurney and cannot transfer to a gurney at a medical facility; or
(b) Because of a medical
issue during the ride, such as:
(A) The client is nauseous
or is vomiting after dialysis or chemotherapy; or
(B) The client needs to stop
to get prescription medication or medical supplies related to the medical service.
(7) Brokerages shall reimburse
their subcontractors at the base rate for ambulatory vehicles if the subcontractor
provides a ride to an ambulatory client in a non-ambulatory vehicle.
(8) Brokerages may authorize
a subcontractor to transport a non-ambulatory client in an ambulatory vehicle if
the vehicle can accommodate and transport the client and if allowed by local ordinance.
The brokerage shall reimburse its subcontractor at the non-ambulatory vehicle rate.
(9) The wheelchair base rate
applies to the transport of a client with a reclining wheelchair; wheelchairs do
not qualify as stretchers or gurneys.
(10) The following applies
to reimbursement for deceased clients:
(a) If a client dies before
the subcontractor arrives at the scene, the brokerage shall not reimburse its subcontractors;
or
(b) If a client dies after
the transport begins but before reaching the destination, the brokerage’s
payment is limited to the base rate for the mode of transportation and mileage.
For ambulance transports, the payment also would include costs for an extra attendant,
if applicable.
(11) Brokerages may authorize
shared-ride transports of two or more clients at the same time when the shared-ride
transports are allowable under the Health Insurance Portability and Accountability
Act of 1996 (HIPAA).
(12) Brokerages shall reimburse
subcontractors:
(a) At the full base rate
for the first client and one-half the base rate for each additional client when
all of these clients need the same mode of transportation, such as by wheelchair
van; or
(b) At the full base rate
for the client with the need for the highest mode of transportation and one-half
the base rate of the appropriate mode of transportation for each additional client.
This applies when the additional client needs a less costly mode of transportation
than the first client. For example, the first client needs an ambulance, but the
additional client needs a less costly wheelchair van.
(13) When transporting two
or more clients at the same time, brokerages shall pay subcontractors only from
the first pickup point to the final destination under the following circumstances:
(a) The clients have a single
pick up point but different destinations;
(b) The clients have different
pick up points but a single destination; or
(c) The clients have different
pick up points and different destinations.
(14) Brokerages shall reimburse
subcontractors only for actual miles traveled, regardless of the number of clients
transported.
(15) A brokerage shall not
reimburse a subcontractor if:
(a) A county or city ordinance
prohibits any charging for services identified in the medical transportation services
administrative rules; or
(b) The subcontractor does
not charge the public for such services.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13; DMAP 69-2013(Temp), f. 12-24-13, cert. ef. 1-1-14 thru 6-30-14;
DMAP 29-2014, f. & cert. ef. 5-20-14
410-136-3240
Client Reimbursed Mileage, Meals and Lodging
(1) The brokerage must prior authorize
a client’s mileage, meals, and lodging to an OHP covered medical service in
order for the client to qualify for reimbursement. If the brokerage prior authorized
the travel costs, a client may request reimbursement up to 45 days after the travel.
(2) The client must return
any documentation the brokerage requires before receiving reimbursement. Documentation
required shall include a receipt for lodging.
(3) The brokerage may hold
reimbursements under the amount of $10 until the client’s reimbursement reaches
$10.
(4) Brokerages shall reimburse
clients for meals when a client, with or without an attendant, travels a minimum
of four hours round-trip out of their local area. The travel, however, must span
the following meal times:
(a) For a breakfast allowance,
the travel must begin before 6 a.m.;
(b) For a lunch allowance,
the travel must span the entire period from 11:30 a.m. through 1:30 p.m.; and
(c) For a dinner allowance,
the travel must end after 6:30 p.m.
(5) Brokerages shall reimburse
for meals at the Authority’s allowable rate.
(6) Brokerages shall not
reimburse clients for meals that a hospital or other medical facility provides.
(7) Brokerages shall reimburse
clients for lodging when:
(a) A client would otherwise
be required to begin travel before 5 a.m. in order to reach a scheduled appointment;
(b) Travel from a scheduled
appointment would end after 9 p.m.; or
(c) The client’s health
care provider documents a medical need.
(8) Brokerages shall reimburse
for lodging at the Authority’s allowable rate or the actual cost of the lodging,
whichever is less.
(9) Brokerages shall reimburse
for meals or lodging for only one attendant, which may be a parent, to accompany
the client if medically necessary but only if:
(a) The client is a minor
child and unable to travel without an attendant;
(b) The client's attending
physician provides a signed statement indicating the reason an attendant must travel
with the client;
(c) The client is mentally
or physically unable to reach his or her medical appointment without assistance;
or
(d) The client is or would
be unable to return home without assistance after the treatment or service.
(10) The brokerage shall
not reimburse for the attendant's time or services.
(11) If a client’s
health care provider admits the client for inpatient care, an attendant is no longer
medically necessary because the facility provides all necessary services for the
client. Therefore, the attendant is no longer eligible for lodging and travel expenses.
The brokerage shall reimburse for meals and lodging for the attendant’s transportation
home. However, the brokerage may pay for the attendant’s meals and lodging
if it is more cost effective for the attendant to remain near the client to accompany
the client on the return trip as allowed by section (12).
(12) Upon the client’s
release from inpatient care, if the attendant is medically necessary based on one
of the conditions or circumstances listed in section (9), the brokerage shall reimburse
for the attendant to return to the inpatient facility to accompany the client on
the return trip. This only applies if the brokerage prior authorizes the attendant’s
travel.
(13) Brokerages shall not
reimburse for mileage, meals, and lodging for an attendant visiting an inpatient
client unless the physician provides a signed statement of the medical need. This
exclusion includes, but is not limited to, parents of minors, breastfeeding mothers,
and spouses.
(14) The state shall recover
overpayments made to a client. Overpayments occur when the brokerage paid the client:
(a) For mileage, meals, and
lodging, and another resource also paid:
(A) The client or;
(B) The ride, meal, or lodging
provider directly;
(b) Directly to travel to
medical appointments, and the client did not use the money for that purpose, did
not attend the appointment, or shared the ride with another client whom the brokerage
also directly paid;
(c) For common carrier or
public transportation tickets or passes, and the client sold or otherwise transferred
the tickets or passes to another person.
(15) If a person or entity
other than the client or the minor client’s parent or legal guardian provides
the ride, the brokerage may reimburse the person or entity that provided the ride.
However, the client or the minor client’s parent or legal guardian must approve
in writing of the reimbursement.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13; DMAP 69-2013(Temp), f. 12-24-13, cert. ef. 1-1-14 thru 6-30-14;
DMAP 29-2014, f. & cert. ef. 5-20-14
410-136-3260
Modifications Based on Client Circumstances
(1) Brokerages may impose reasonable
modifications on NEMT services when the client:
(a) Is threatening harm to
the driver or others in the vehicle;
(b) Has a health condition
that creates health or safety concerns to the driver or others in the vehicle;
(c) Has other behaviors or
circumstances that place the driver or others in the vehicle at risk of harm;
(d) Frequently does not show
up for scheduled rides;
(e) Frequently cancels the
ride on the day of the scheduled ride time;
(f) Has behaviors that cause
local medical providers or facilities to refuse to provide further services without
imposing modifications; or
(g) Has special needs that
require special accommodations.
(2) 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.
(3) 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, PHP or CCO in the discussion. The
client may include other individuals in the discussion.
(4) Brokerages may not make
a reasonable modification based on the criteria in section (1)(a)-(g) above 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.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 413.042,
414.065   
Hist: 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
410-136-3280
Client Rights and Confidentiality
(1) Brokerages shall treat all information
gathered on the client as privileged and confidential communications. The brokerage
shall apply confidentiality policies to all requests for information from outside
sources. Nothing prohibits the disclosure of information in summaries, statistical
reports or other forms as long as the document does not identify particular individuals
and cannot lead to the identification of individuals. Brokerages and any subcontractors
may share information as necessary to serve the client effectively. The brokerage
shall not divulge the information without the written consent of the client, the
responsible parent of a minor child or the client’s legal guardian. The use
or disclosure of information is limited to persons directly connected to the administration
of NEMT services.
(2) Brokerages or their subcontractors
shall comply with OAR 943-014-0300 through 943-014-0320 pertaining to access control
if the Authority grants them access to any secure computer system or information
asset.
(3) The brokerage shall not
deny or allow subcontractors to deny any client NEMT services based on race, color,
sex, sexual orientation, religion, national origin, creed, marital status, age,
health status or the presence of any sensory, mental or physical disability.
(4) Brokerages must treat
clients and require subcontractors to treat clients in accordance with OAR 410-120-1855,
Client Rights and Responsibilities.
(5) The brokerages shall
have educational materials available for clients on its NEMT services. The Authority
must first approve the materials and document the approval in writing.
(6) As required by 42 CFR
431, a brokerage shall follow OAR 410-120-1860 and 410-120-1865 pertaining to contested
case hearings when it denies a ride, with the following exceptions:
(a) The brokerage must immediately
provide a secondary review by another employee when the initial screener denies
a ride; and
(b) The brokerage must mail
a notice of action to a client denied a ride within 72 hours of denying a ride.
(7) Upon the Authority’s
request, brokerages shall provide documentation pertaining to discovery for or investigation
of contested case hearings pursuant to OAR 410-120-1360.
(8) Brokerages shall provide
documentation pertaining to discovery for or investigation of contested case hearings
when the client, the responsible parent of a minor child or the client’s legal
guardian requests the documentation. The brokerage shall provide the documentation
to the client’s legal representative upon written consent from the client,
the responsible parent of a minor child or the client’s legal guardian.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13
410-136-3300
Reports and Documentation
(1) Brokerages shall maintain documentation
of rides denied and rides provided to clients. This documentation shall include,
but is not limited, to:
(a) The name of the client
and the person requesting the ride on behalf of the client, if applicable;
(b) The client's OHP medical
care identification number;
(c) The date and time of
the request for transportation;
(d) The mode of transport
authorized for the client and a justification for authorizing a mode of transport
that is not reasonably understandable;
(e) The location for picking-up
the client and the destination;
(f) The medical reason for
the appointment;
(g) The availability of other
transportation resources and the justification for authorizing a ride when the client
has other resources;
(h) The subcontractor assigned
to give the ride and the date and time the brokerage notified the subcontractor
of the assignment;
(i) The name of the employee
who approved a ride; and
(j) In the case of a denial
of a ride:
(A) The name of the employee
who denied a ride;
(B) The name of the employee
who performed the secondary review before denying the ride;
(C) The reason for the denial
and the applicable Oregon administrative rule that supports the denial;
(D) The date on the notice
of action the brokerage mailed to the client;
(E) Documentation on the
brokerage’s review, resolution, or disposition of the matter, if applicable,
including the reason for the decision and the date of the resolution or disposition;
and
(F) Notations of oral and
written communications with the client.
(2) The brokerage shall retain
the documentation on denials of rides for three calendar years, even if the brokerage
is no longer a Medicaid enrolled provider before the end of the three years. The
Authority may request this information at any time during the three year retention
period.
(3) The brokerage shall maintain
billing files organized by subcontractor that justify the number of transports and
with cross references to actual rides and specific clients.
(4) The brokerages shall
report monthly on estimated revenue and expenses that affect the balance of the
working capital reserve amount. The report must contain the following costs as they
pertain to providing NEMT services:
(a) Sub-totals of administrative
expenses, including:
(A) Salaries and wages of
the brokerage’s employees;
(B) Payroll related expenses
for the brokerage’s employees;
(C) Other employee related
expenses, such as recruitment and advertising;
(D) Computer hardware and
software purchased, leased or licensed;
(E) Office supplies such
as stamps, paper or printing;
(F) Non-computer related
equipment purchased, leased or licensed;
(G) Telephone;
(H) Administrative support
and other indirect charges;
(I) Education and training;
(J) Building expenses such
as leases, rents, security, janitorial services and repairs that retain the property’s
operating condition but do not add to the permanent value of the property;
(K) Subcontractor identification
and drug testing, such as fingerprinting and drug analysis;
(L) Legal expense not related
to the Authority, such as attorney fees; fines or penalties;
(M) Indirect expenses, such
as accounting, human resources, risk management or insurance;
(N) Sub-contracts for operations
or temporary employees;
(O) Required driver training,
if applicable;
(P) The client satisfaction
survey, if applicable;
(Q) Software maintenance,
if applicable; and
(R) Details of other administrative
expenses not specified above.
(b) The number and costs
of the following:
(A) Stretcher car rides;
(B) Wheelchair rides;
(C) Ambulatory rides;
(D) Secured transports;
(E) Bus tickets;
(F) Bus passes;
(G) NEMT ambulance transports;
(H) Reimbursements to clients;
and
(I) Commercial transports.
(c) The amount of credits
to subcontractors.
(d) Information on the brokerage’s
working capital reserve, including:
(A) The Authority-calculated
working capital reserve;
(B) The estimated working
capital reserve as of the beginning of the fiscal year;
(C) The estimated working
capital reserve as of this report; and
(D) The difference between
sub-sections (B) and (C).
(5) The financial reports
must show the number of rides that volunteer drivers provide.
(6) Brokerages must submit
the financial report required in Section (4) of this rule within 45 days of the
end of the reporting month.
(7) Brokerages shall submit
a cost allocation plan that includes anticipated expenses, certified by the brokerage’s
Chief Financial Officer, to the Authority no later than April 1 of each year for
the upcoming fiscal year.
(8) The Authority may request,
and the brokerage shall provide, other reports or information not specified in sections
(1), (3), (4) and (6) of this rule.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13
410-136-3320
Audits
(1) The Authority, the Oregon Secretary
of State Audits Division, the Oregon Department of Justice and the federal government
may audit the brokerage’s or its subcontractor’s records at least annually.
The audit shall include, but is not limited to, the following areas:
(a) Financial status;
(b) Performance and quality
of the service;
(c) Efficiency and effectiveness
of the program’s operation; and
(d) The relationship between
the funds provided by the Authority and the amounts expended by brokerages or billed
by subcontractors and that the use of funds is reasonable and necessary to provide
quality service.
(2) The Authority, the Oregon
Secretary of State Audits Division, the Oregon Department of Justice, and the federal
government may review the brokerage’s or subcontractor’s records whenever
necessary to verify delivery of service, financial and operational status, and compliance
with Oregon administrative rules or to investigate unresolved questions of fact.
(3) As specified by 42 CFR
455.17, brokerages and subcontractors shall report to the Authority any suspected
fraud or abuse of NEMT services. If the suspected fraud or abuse is subcontractor-related,
and the brokerage or the Authority determines the subcontractor has committed fraud,
the brokerage shall immediately terminate its subcontract.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13
410-136-3340
Brokerage Service Areas
(1) Brokerages enrolled with the Authority
shall arrange and pay for NEMT services to all eligible clients in the counties
shown in Table 136-3340.
(2) OHP clients shall use
only the brokerages available in their county of residence unless they have permission
from their local brokerage to use another brokerage.
(3) Nothing in this rule
precludes brokerages from coordinating to provide rides to clients in another brokerage
if it would be more cost effective or provide better service for the client.
[ED. NOTE: Tables referenced are available
from the agency.]
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13
410-136-3360
Discontinuation of Brokerage as Enrolled
Provider
(1) A brokerage may discontinue being
an enrolled provider for NEMT services only with notice to the Authority. The following
establishes the requirements for notice:
(a) If the reason is for
the brokerage’s convenience: The effective date must be at least 90 days after
the brokerage sends written notice; and (ii) the effective date must be on the first
calendar date of the month ;
(b) The brokerage must provide
45 days advance written notice if the brokerage does not obtain funding, appropriations
and other expenditure authorizations from its governing body, federal, state or
other sources sufficient to permit the brokerage to satisfy its requirements pursuant
to these rules (OAR 410-136-3000 through 410-136-3360);
(c) Immediately upon written
notice if the Oregon Legislative Assembly, the federal government or a court interprets,
modifies or changes Oregon statutes or federal laws, regulations or guidelines in
such a way that the brokerage immediately has no authority to satisfy the requirements
of these rules.
(2) The Authority may discontinue
allowing a brokerage to provide NEMT services as an enrolled provider only with
notice to the brokerage. The following establishes the requirements for notice:
(a) If the reason is for
the Authority’s convenience:
(A) The effective date must
be at least 90 days after the Authority sends written notice; and
(B) the effective date must
be on the first calendar date of a month.
(b) The Authority must provide
45 days advance written notice if the Authority does not obtain funding, appropriations
and other expenditure authorizations from its governing body, federal, state or
other sources sufficient to meet its payment obligations pursuant to OAR 410-136-3200,
Reimbursement and Accounting for all Modes of Transportation.
(c) Immediately upon written
notice if the Oregon Legislative Assembly, the federal government or a court interprets,
modifies or changes Oregon statutes or federal laws, regulations or guidelines in
such a way that the Authority immediately has no authority to provide NEMT services
pursuant to these rules.
(d) Immediately upon written
notice to the brokerage if the Oregon Legislative Assembly or Emergency Board reduces
the Authority’s expenditure authorization, resulting in the following:
(A) The Authority cannot
meet its payment obligations pursuant to OAR 410-136-3200, Reimbursement and Accounting
for all Modes of Transportation; and
(B) The effective date for
the reduction in expenditure authorization is less than 45 days from the date the
Legislative Assembly or Emergency Board takes the action.
(e) Immediately upon written
notice to the brokerage if a law or regulation requires a brokerage to have any
license or certificate, and the license or certificate is denied, revoked, suspended,
not renewed or changed in such a way that brokerage no longer meets requirements
to deliver NEMT services. The Authority may only exercise this right with respect
to the particular service impacted by the loss of the licensure or certification.
(f) Immediately upon written
notice to the brokerage, if the Authority determines the brokerage any of its subcontractors
have endangered or are endangering the health or safety of a client or others.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
Hist: DMAP 36-2013, f. 6-27-13,
cert. ef. 7-1-13

The official copy of an Oregon Administrative Rule is
contained in the Administrative Order filed at the Archives Division,
800 Summer St. NE, Salem, Oregon 97310. Any discrepancies with the
published version are satisfied in favor of the Administrative Order.
The Oregon Administrative Rules and the Oregon Bulletin are
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