Section 5160-15-25 - Transportation: services from an eligible provider: points of transport(A) For purposes of this chapter, medicaid recognizes the following twelve points of transport, which represent the origin or destination of a discrete one-way trip: (1) Ten points of transport recognized by the centers for medicare and medicaid services (CMS): (a) A diagnostic or therapeutic site other than a practitioner's office or a hospital, such as an alcohol and drug rehabilitation center, an ambulatory surgery center, an independent diagnostic testing facility, or a medical equipment supplier;(b) A residential, domiciliary, or custodial facility that is not a skilled nursing facility ;(c) A dialysis facility located in a hospital;(e) A site of transfer between modes of transport, such as an airstrip or a helipad;(f) A dialysis facility not located in a hospital;(g) A skilled nursing facility;(h) A practitioner's office, which includes but is not limited to the office of an individual health professional, the office of a group of health professionals, or a clinic;(i) A residence other than a residential, domiciliary, or custodial facility; and(j) The scene of an accident or an acute event;(B) On each claim for a transportation service provided by wheelchair van or by ambulance, the origin and the destination are specified in accordance with current claimsubmission instructions.(1) A claim submitted for a wheelchair van service or an ambulance service is subject to manual review unless the combination of origin and destination has been exempted. A list of the exempted combinations for each service is shown in the appendix to rule 5160-15-28 of the Administrative Code.(2) Transportation providers may request manual review of claims for services involving non-exempted combinations of origins and destinations. Transportation providers may also request manual review of a claim for a service involving an origin or destination not listed in paragraph (A) of this rule if they indicate that fact explicitly on the claim.(3) A request for manual review of a claim for a transportation service includes the following information:(a) A completed practitioner certification form when the claim does not concern emergency ambulance service;(b) A complete description of the service requested, the date of service, the trip origin and destination, a description of any special services involved, and a justification for the use of an attendant (when applicable); and(c) Details of any related circumstances that should be considered in the evaluation of the request for manual review.Ohio Admin. Code 5160-15-25
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.), 03/27/2006, 04/01/2016