Wisconsin In-Network Transportation Provider Checklist

the Participant is eligible for transportation if he/she has a batteryoperatedventilator and an adult escort trained to provide ventilatorcare will travel with the Participant, and if no other medicalequipment or care is required.d) to transport a passenger who requires close observation or medicalmonitoring;e) to transport more than one (1) stretcher passenger at a time.f) Non Emergency Ambulance Vehicle Requirements. All vehicles used totransport Participants that require covered non-emergency BLS or ALS servicemust meet the General Vehicle Requirements set forth above as well as thefollowing additional requirements. State or local laws or regulations establishingminimum operational standards for Ambulances shall supersede the followingprovisions.i) Ambulance vehicle must have at least one (1) gurney that is capable ofsupporting 400 pounds or more.ii) Each gurney must have the capability to be lowered and raised from aheight of 18” to a height necessary to load the gurney into the vehiclewithout requiring the gurney to be manually lifted from the ground.iii)iv)Each gurney must be equipped with no less than one safety belt.Ambulance vehicle must have the necessary equipment to “lock” thegurney securely in place while in the vehicle.g) Driver and Attendant Qualifications. All drivers and attendants used to performservices under this Agreement shall, at a minimum, meet the applicablequalifications listed below. Each driver’s and attendant’s records andqualifications are subject to an initial and annual inspection by LGTC as well asinterim inspections as required by LGTC in its sole discretion. Any driver orattendant failing, at any time, to meet all of the applicable qualifications, or anyrequirements imposed by state or local law, shall be prohibited from providingservice under this Agreement. LGTC and the Client reserve the right to disallowany driver or attendant from performing services under this Agreement.i) All drivers and attendants must be at least twenty-one (21) years of ageand have an appropriate and unrestricted (with the exception of correctivelenses) current valid Wisconsin driver's license issued by the WisconsinDepartment of Transportation.ii) Drivers who receive citations and are convicted of two (2) movingviolations and/or accidents related to transportation provided under thisRFP, where the driver was at fault during the full term of the contract,must be removed from service. Provider must report any Driver citationsto the LGTC.iii) Drivers who currently have a suspended or revoked driver's license,commercial or other, are prohibited from driving for any purpose underthis contract. Drivers shall not have had their driver’s license suspendedor revoked due to moving violations in the previous three (3) years.iv) Provider shall verify that all drivers and attendants have been subject toWisconsin NET ProgramVersion: March 25 2011Page 12