Idaho Admin. Code r. 16.03.09.872

Current through September 2, 2024

Section 16.03.09.872 - NON-EMERGENCY MEDICAL TRANSPORTATION SERVICES: COVERAGE AND LIMITATIONS

01.Non-Emergency Medical Transportation Services. The transportation broker will reimburse contracted transportation providers for non-emergency medical transportation services under the following conditions:

a. The travel is essential to get to or from a medically necessary Medicaid covered service;

b. The mode of transportation is the least costly that is appropriate for the medical needs of the participant;

c. The transportation is to the nearest medical provider appropriate to perform the needed services, and transportation is by the most direct route practicable;

d. Other modes of transportation, including personal vehicle, assistance by family, friends, and charitable organizations, are unavailable or impractical under the circumstances;

e. The travel is authorized and scheduled by the transportation broker; and

f. The contracted transportation provider is in compliance with the terms of its contract with the transportation broker.

02.Travel-Related Services. The transportation broker will reimburse a contracted transportation provider for travel-related services under the following circumstances:

a. The reasonable cost of meals actually incurred in transit will be reimbursed for the participant when there is no other practical means of obtaining food.

b. The reasonable cost for lodging actually incurred for the participant will be reimbursed when:

i. The round trip and the needed medical service cannot be completed in the same day; and

ii. No less costly alternative is available.

c. The reasonable cost of wages for an attendant will be reimbursed when:

i. An attendant is medically necessary or when the vulnerability of the participant requires accompaniment for safety; and

ii. No family member or other unpaid attendant is available to accompany the participant.

d. The reasonable cost of meals actually incurred in transit will be reimbursed for one (1) family member or one (1) attendant, when:

i. Attendant care is medically necessary or when the vulnerability of the participant requires accompaniment for safety; and

ii. There is no other practical means of obtaining food.

e. The reasonable cost of lodging actually incurred will be reimbursed for one (1) family member or one (1) attendant when:

i. An overnight stay is required to receive the service;

ii. It is medically necessary or the vulnerability of the participant requires accompaniment for safety; and

iii. No less costly alternative is available.

Idaho Admin. Code r. 16.03.09.872

Effective March 17, 2022