Section 405 IAC 1-1.4-3 - Provider enrollmentAuthority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15-10-2; IC 12-15-11; IC 12-15-12-21; IC 16-31-2-1; IC 20-27
Sec. 3.
(a) In order to receive reimbursement under Medicaid, a provider shall be enrolled to participate as a provider. A provider is enrolled to participate in Medicaid when all of the following conditions have been met: (1) The provider is duly licensed, registered, or certified by the appropriate professional regulatory agency pursuant to state or federal law, or otherwise authorized by the office.(2) The provider has submitted an application to participate in Medicaid and completed such forms as may be required.(3) The provider has signed and returned a Medicaid provider agreement.(4) The provider has received a provider number.(5) For an institutional or individual provider located out-of-state, such entity shall, in addition to meeting subdivisions (2) through (4), be either: (D) authorized; as required by the state in which the entity is located.
(6) The provider maintains state licensure and abides by the office's provider agreement.(7) The provider meets credentialing standards as required in order for the MCO to receive accreditation through the National Committee for Quality Assurance pursuant to IC 12-15-12-21.(b) In addition to subsection (a), a provider seeking to enroll transportation services shall:(1) make transportation services available to the general public; and(2) demonstrate that its primary business function is the provision of transportation services. This requirement does not apply to transportation providers who provide only ambulance, family member transportation services, or school corporations.
(c) With respect to ambulance service, vehicles and staff that provide emergency services must be certified by the Indiana emergency medical services commission established under IC 16-31-2-1 to be eligible for Medicaid reimbursement for transports involving either advanced life support or basic life support services that are emergent in nature. Failure to maintain the Indiana emergency medical services commission certification on all vehicles involved in transporting Medicaid members will result in termination of the Medicaid provider agreement.(d) All transportation provider types shall continuously comply with all state statutes, rules, and local ordinances governing public transportation. The following requirements also apply as follows:(1) A common transportation carrier shall submit proof of, and maintain throughout its period of participation, the following:(A) Certification by the Indiana motor carrier authority.(B) Insurance coverage as required by the Indiana motor carrier authority.(C) Appropriate and valid drivers' licenses for all drivers.(2) A taxicab transportation entity shall submit proof of and maintain throughout its period of participation the following:(A) Written acknowledgment by local or county officials of whether there are existing ordinances governing taxi services and written verification from local or county officials that taxicab services operating in the local vicinity are in compliance with those ordinances.(B) Livery insurance as indicated by existing local ordinances, or in the absence of such ordinances, a minimum of twenty-five thousand dollars/fifty thousand dollars ($25,000/$50,000) public livery insurance covering all vehicles used in the business.(C) Appropriate and valid drivers' licenses for all drivers.(3) A not-for-profit transportation entity shall submit proof of, and maintain throughout its period of participation, the following: (A) An acknowledgment from state or federal officials of its status as a not-for-profit entity.(B) A minimum of five hundred thousand dollars ($500,000) of combined single limit commercial automobile liability insurance.(C) Appropriate and valid drivers' licenses for all drivers.(e) IEP transportation services provided in accordance with 405 IAC 5-30-11 must conform to the requirements set out in IC 20-27 and are exempt from the transportation provider agreement requirements set out in this section.(f) The office may enroll the family member of a member only when the member must make frequent trips to medical services and that travel creates undue financial hardship for the family. In order to enroll as a transportation provider, a family member shall do the following: (1) Comply with and maintain compliance with all enrollment requirements under any federal or state law or rule.(2) Possess a valid driver's license as required by state law.(3) Possess coverage of the minimum amount of automobile insurance as required by state law.(4) Utilize as the vehicle for transporting family members, only a vehicle that has been duly licensed and registered.(5) Include, at a minimum, the following information in an enrollment request: (A) The member's name and Medicaid number.(B) The name, address, and relationship of the family member provider.(C) A description of the circumstances surrounding the request.(D) A statement of the financial impact on the family as a result of providing transportation services to the recipient.(E) The desired effective date for the enrollment of the family member as a transportation provider.(g) A close associate or able-bodied member may enroll to provide transportation services when no family member is available to provide this service. When a family member is enrolled as a transportation provider, that individual may provide services only to the designated recipient, and those services are subject to prior authorization.Office of the Secretary of Family and Social Services; 405 IAC 1-1.4-3; filed 12/21/2018, 3:17 p.m.: 20190116-IR-405180251FRAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA