OAR 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 (Responsibility for Providing Non-emergent Medical Transportation)–410-136-3360 (Discontinuation of Brokerage as Enrolled Provider) 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), 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),Vehicle Equipment and Subcontractor Standards and 410-136-3120 (Secured Transports), Secured Transports do not apply to ambulance providers, ambulance vehicles, or ambulance personnel that are licensed and regulated by ORS Chapter 682 (Regulation of Ambulance Services and Emergency Medical Services Providers) and OAR chapter 333, divisions 250, 255, 260 and 265, whether providing ambulance or stretcher transports.
Source:
Rule 410-136-3000 — Responsibility for Providing Non-emergent Medical Transportation, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-136-3000.