Under 42 CFR SS447.10(d) and 18 NYCRR SS504.1(b)(1), OPWDD day and residential programs (hereinafter “programs”) that include transportation in their Medicaid rates are now required to use transportation providers enrolled with Medicaid. This enrollment obligation affects those transportation providers that are compensated with funds included in OPWDD program rates, (rates that are incorporated to fund the costs connected with the transportation of Medicaid enrollees).

Transportation providers contracted with the OPWDD programs must be enrolled as “Medicaid transportation providers” by April 1, 2016. Enrollment is also necessary for programs that offer their own transportation through their vehicles (owned or leased).

OPWDD program providers have through the date of the specified deadline to ensure that transportation services are provided by enrolled Medicaid transportation providers. If transportation continues to be provided by un-enrolled providers beyond the allotted deadline, OPWDD program providers will be subjected to administration action by the Medicaid program. Such involvement may result in the recoupment of Medicaid payments.

Transportation providers seeking enrollment must complete an application under service category 0606 (previously called Day Treatment). The application instructions will aid in the correct completion of the form. Such applicants must also provide a document that confirms that they are a registered provider under OPWDD, such as the approved “Registered Provider Approval Request Form” (OPWDD Form 108 and 108a). Confirmation on OPWDD letterhead from an authorized official confirming the provider’s status as a registered provider with OPWDD is also an acceptable form of validation.

Transportation providers serving the OPWDD programs will continue to be paid by these programs. On new applications, where the provider enrolls for the sole purpose of continuing transportation services to OPWDD program participants, the Medicaid program will enroll them with a “21” status code, which indicates that, while the provider meets the Medicaid enrollment conditions, they cannot bill the fee-for-service.

If Medicaid transportation providers are already enrolled as such, an email should be sent to the Medicaid Transportation Unit at medtrans@health.ny.gov. This email should include the company’s name, contact information, and the eight digit Medicaid identification number.

Questions related to the enrollment application process or Medicaid transportation can be directed to the Medicaid Transportation Unit at (518) 473-2160 / medtrans@health.ny.gov.

Questions related to OPWDD provider confirmation can be emailed to OPWDD at regprovider.approvals@opwdd.ny.gov.

If you would like to learn more about this topic, please contact:

Kenneth R. Cerini, CPA, CFP, FABFA

Kenneth R. Cerini, CPA, CFP, FABFA

Managing Partner

Ken is the Managing Partner of Cerini & Associates, LLP and is the executive responsible for the administration of our not-for-profit and educational provider practice groups. In addition to his extensive audit experience, Ken has been directly involved in providing consulting services for nonprofits and educational facilities of all sizes throughout New York State in such areas as cost reporting, financial analysis, Medicaid compliance, government audit representation, rate maximization, board training, budgeting and forecasting, and more.