Instructions To Complete Enrollment Form For Transportation (Page 2 of 4) in pdf

Instructions To Complete Enrollment Form For Transportation Page 2

Additional Information for Enrollment as a TRANSPORTATION PROVIDER in New York Medicaid

CATEGORY OF

ENROLLMENT REQUIREMENTS

SERVICE (COS)

DESCRIPTION

nts)

(if required, submit proof with the enrollment form that Applicant meets these requireme

0602

Ambulette

1. Operating License for Transit Disabled from the NYS Department of Transportation

An entity which transports the infirm

2. NYS Department of Motor Vehicles Letter of Compliance with Article 19A dated

or disabled by ambulette to and from

on or after the most recent July 1

facilities which provide medical care

3. If transporting in the following areas, a Paratransit Base License is required

from that locale's Taxi & Limousine Commission**.

a) Westchester County

b) Nassau County

** For transportation in Nassau County, the NYC Taxi & Limousine Commission

Paratransmit Base License can substitute for the Nassau County license

0603

Taxi (Upstate Taxi Only - outside of NYC)

1. If transporting in the following areas, approval for Community Car Services (Livery)

is required from that locale's Taxi & Limousine Commission**:

(NOTE: if you enroll for Ambulette outside

of NYC, you do not need to enroll for

Westchester

ounty

b) Nassau County

Taxi-Upstate as well)

** For transportation in Nassau County, the NYC Taxi & Limousine Commission

Community Car Services (Livery) approval can substitute for the Nassau County approval

NOTE: Although not required to be submitted with the enrollment form,

applicant/provider must keep records which document that:

1) Drivers possess a valid commercial driver's license (Class E), and

2) Vehicles are registered with livery license plates

0605

NYC Taxi & Limousine Commission's Community Car Services (Livery) Approval

Livery (NYC Taxi only)

(NOTE: if you enroll for Ambulette in NYC,

you do not need to enroll for Livery as well)

EMEDNY-424402 (03/17)

Instructions To Complete Enrollment Form For Transportation Page 2