Or. Admin. Code § 411-016-0120

Current through Register Vol. 64, No. 1, January 1, 2025

Section 411-016-0120 - 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 (non-medical) 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. Community transportation may also be prior authorized to support the individual's well-being and for access to community-based services, activities, and resources if community integration is a goal in the individual's person-centered service plan.

(5) A maximum of 100 miles per pay period may be authorized for rides provided by homecare workers or in-home care agencies or 8 rides per pay period if provided by a contracted transportation provider may be authorized for transportation related to community-based services, activities, and resources.

(6) When available to an eligible individual, natural supports, volunteer transportation, and other transportation services are considered a prior resource and may not be replaced with transportation paid for by the Department. Unmet transportation needs may be part of an OPI-M Service plan.

(7) 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.

(8) Community transportation must be prior authorized by an individual's Services Case Manager (SCM) and documented in the individual's person centered 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 SCM 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 must be prior authorized to a homecare worker and 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.

(9) 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. Code § 411-016-0120

APD 22-2024, temporary adopt filed 05/20/2024, effective 5/31/2024 through 11/26/2024; APD 64-2024, adopt filed 11/20/2024, effective 11/22/2024

Statutory/Other Authority: ORS 410.070

Statutes/Other Implemented: ORS 410.060, 410.070 & 414.065