Or. Admin. Code § 410-136-3080

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

Section 410-136-3080 - Out-of-State Transportation

(1) "Out-of-state transportation" means transportation to or from any location outside Oregon, with the exception of contiguous areas up to 75 miles outside the Oregon border.

(2) The brokerage shall arrange rides and pay for out-of-state transportation, as defined in section (1) of this rule, to and from an out-of-state OHP or RHAF covered medical service when:

(a) The brokerage confirms that the Authority authorized the OHP client's out-of-state OHP covered medical service per OAR 410-120-1180, Medical Assistance Benefits: Out-of-State Services or the CCO authorized per OAR 410-141-3930 Transportation: Out-of-Service Area and Out-of-State Transportation; and

(b) The client is eligible for transportation services per OAR 410-136-3020, General Requirements for NEMT.

(3) The brokerage shall arrange for and pay for the most appropriate mode of transportation, and necessary travel to and from an airport or other departure location within Oregon, for out-of-state travel approved by the Authority.

(4) The brokerage may utilize any procurement method and criteria to purchase airline tickets, and any necessary travel to and from an airport or other departure location within Oregon, subject only to least expensive mode of transportation that meets the non-emergent medical needs of the client.

(5) Brokerages shall not arrange or pay for:

(a) A client's return from any foreign country to any location within the United States for the client to obtain medical care because the care is not available in the foreign country;

(b) A client's return to Oregon from another state when the client was not in the other state to obtain authorized medical services or treatments, unless the client is enrolled in RHAF, lives outside of Oregon, and is seeking RHAF covered services within Oregon.

(6) Brokerages may arrange emergency medical transportation services if authorized by the Authority, for a client traveling outside Oregon for a OHP covered medical service who experience an emergency medical condition needing emergency medical transportation as defined in OAR 410-120-0000.

Or. Admin. Code § 410-136-3080

DMAP 36-2013, f. 6-27-13, cert. ef. 7-1-13; DMAP 95-2023, amend filed 12/22/2023, effective 1/1/2024; DMAP 152-2024, amend filed 12/30/2024, effective 1/1/2025

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 414.065