Instructions To Complete Enrollment Form For Transportation (Page 3 of 4) in pdf

Instructions To Complete Enrollment Form For Transportation Page 3

OPWDD - An entity that transports enrollees to

Transporting via ambulette:

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OPWDD programs and facilities who have

NYSDOT Operating License for Transit Disabled or proof that this

transportation reimbursement included in the rate using

Requirement has been waived by NYSDOT.

ambulette or taxi level vehicles.

NYSDMV letter of compliance with Article 19A dated on or after the most recent July 1.

Providers registering for this category will not submit

Transporting via taxi/livery:

claims to the Medicaid program for their services.

Proof of OPWDD Provider/registration.

These services are included in the program rate received

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

by the OPWDD program/facility from the Medicaid

applicant/ provider must keep records which document:

program.

Drivers possess a valid commercial driver’s license (Class E).

Vehicles are to be registered with taxi or livery plates pursuant to

Vehicle and Traffic Law.

EMEDNY-424402 (03/17)

Instructions To Complete Enrollment Form For Transportation Page 3