MEDICAID INFORMATION RELEASE MA04-60

TO:                 Individual Transportation Providers and Service Coordinators

 

FROM:           Randy May, Deputy Administrator

 

SUBJECT:      Change in Medical Transportation Prior Authorization Requirements

 

FOR Individual transportation providers billing S0215 (Medical Transportation):

 

• Medicaid is initiating a six month pilot program to eliminate the requirement for prior authorization when Medicaid clients are transported less than 200 miles one-way, or 400 miles round trip, in the same day. This pilot program only applies to Individual Transportation Providers, and is effective for medical transportation provided between January 1 and June 30, 2005.
• Medical transportation over 200 miles one-way or 400 miles round trip in the same day will still require prior authorization. The process to request prior authorization has not changed. For information about obtaining prior authorization, please refer to the Medicaid Transportation Provider Manual, which is available online at:

            http://www.healthandwelfare.idaho.gov/_Rainbow/Documents/medical/s3_010_transportation.pdf

      Section 3.1.6.1, page 3-9.

 

Medical Transportation Guidelines:

 

• Travel must be necessary for a Medicaid client to get to or from a Medicaid-covered service.
• Client must not have any other available transportation, such as a client’s personal vehicle, or a ride from family, friends, or charitable organizations.
• The mileage billed to Medicaid must be to the nearest available Medicaid provider to perform the needed services, and by the shortest practical route.
• Client must be in vehicle and transported for the entire distance billed.
• The provider must maintain the following documentation for a minimum of 5 years:

1.       Client name and Medicaid ID number for each trip.

2.       Date, time, geographical point, and odometer reading at point of client’s pick-up and drop off.

3.       Total mileage each client was transported for each trip billed.

4.       Identification of the vehicle and driver transporting each client on each trip.

 

Please note:  The Department will monitor this pilot program for over-utilization or abuse.  Providers are subject to recoupments and additional actions by the Department as outlined in Idaho Administrative Code, Rules Governing the Medical Assistance Program, (IDAPA 16.03.09), Sections 200 through 223. These rules can be accessed online at: http://www2.state.id.us/adm/adminrules/rules/idapa16/0309.pdf.

 

 

If you have questions about this information, please contact the Medicaid Transportation Unit locally at 334-4990 or toll-free 1-800-296-0509.  Thank you for your continued participation in the Idaho Medicaid Program.

 

IDAHO MEDICAID PROVIDER HANDBOOK:

This Information Release does not replace information in your Idaho Medicaid Provider Handbook.

 

RM/af