Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 16 - OREGON PROJECT INDEPENDENCE - MEDICAID (OPI-M) › Section 411-016-0120 - Assisted and Community Transportation and Provider Qualifications

Current through Register Vol. 63, No. 7, July 1, 2024
(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 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.
(5)
			 Natural supports, volunteer transportation, and other transportation services
			 available to an eligible individual are considered a prior resource and may not
			 be replaced with transportation paid for by the Department.
(6) 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.
(7) Community
			 transportation must be prior authorized by an individual's Services Case
			 Manager and documented in the individual's 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 Services Case Manager 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 authorized to a homecare worker 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.