Family and Children's Medicaid MA-3550 MEDICAID TRANSPORTATION

X. Reimbursement

DMA reimburses the county for the Federal and State share of certain transportation costs for direct services provided to beneficiaries. The FMAP rate is subject to change every year. Staff administrative costs are reimbursed at 50% of the administrative cost.

A. Reimbursement for Transportation Costs (Other than Travel Related Expenses)

1. Fares for public transportation (taxis, buses, rail or contracted service provided by Federal Transit Administration funded Community Transportation Systems;

a. Reimbursement for taxi fares, use billing code A0100 on the DMA-2055, Reimbursement Request Form.

b. Reimbursement for bus fares on intra or inter state carriers, use billing code A0110 on the DMA-2055, Reimbursement Request Form.

c. Reimbursement for mini-bus, mountain area transports or other transportation systems, use billing code A0120 on the DMA-2055, Reimbursement Request Form.

d. Reimbursement for wheel-chair vans, use billing code A0130 on the DMA-2055, Reimbursement Request Form.

2. Operating costs per passenger trip with agency owned vehicles or vehicles in the county's coordinated transportation system as described in the CTSP;

3. Reimbursement for mileage costs

a. Mileage costs incurred by non-financially responsible family members or friends shall not exceed the current IRS business rate (see Standard Mileage Rates) when payment is made directly to the friend, or relative. Use billing code A0090 on the DMA-2055, Reimbursement Request Form;

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(X.A.3.b.)

b. Mileage costs incurred by beneficiaries and FRPS shall not exceed half the current IRS business rate (see Standard Mileage Rates). Use billing code 0090 on the DMA-2055, Reimbursement Request Form.

c. Mileage costs incurred by DSS staff using private vehicles, or volunteers appointed by the county. The county may negotiate the reimbursement rate for its staff and volunteers.

(1) For DSS staff, use billing code A0160 on the DMA-2055, Reimbursement Request Form.

(2) For agency volunteers who provide their own vehicle, use billing code A0080 on the DMA-2055, Reimbursement Request Form.

5. Salary compensation for transportation aides employed by DSS (although the State and Federal share is reimbursed for this service, you must claim reimbursement on DSS-1571).

6. Attendants

a. All attendants, including family members, are entitled to reimbursement of expenses incurred during transportation at the least expensive rate that is appropriate to the beneficiary ’s circumstances, including reimbursement for return trips with or without the beneficiary ;

b. Attendants, other than family members, may charge for their time.

(1) Non-medical professionals

The county, at its discretion, may use the state or, if greater, the county per diem, but must not exceed the state minimum hourly wage (Minimum Wage in N.C.). The attendant may also be the driver if it’s the least expensive means;

(2) Medical professionals serving as attendants

(a) If the medical professional administers medical services during the trip, he can bill Medicaid for that service. Do not pay the attendant when he can bill Medicaid.

(b) If the medical professional does not perform a medical service during the trip, maximum reimbursement for the attendant cannot exceed the hourly minimum wage.

7. Vendor delivery charges for prescriptions as long as it meets least expensive criteria;

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(X.A.)

8. Reimbursement for travel for parents/guardians to care for, or be taught how to care for an in-patient child (necessity verified on DMA-5048);

9. Gas Vouchers

Vouchers are issued to eligible beneficiaries who can use their own car or a friend or relative’s car for transportation to a Medicaid covered service. Vouchers can be redeemed at local gas stations. Mileage reimbursement may not exceed half the current IRS business rate (see Standard Mileage Rates) unless the gas provider requires a minimum rate (see 3. above). Both mileage reimbursement and gas vouchers must be provided in an amount sufficient to cover the cost of gas. Because beneficiaries are unlikely to have fuel efficient vehicles, the amount of fuel required to complete the trip must be calculated using a conservative miles-per-gallon figure. Use billing code A0090 on the DMA-2055, Reimbursement Request Form.

B. Maximum Reimbursement for Travel Related Expenses

Reimbursement for related travel expenses may not exceed the state mileage, subsistence and lodging reimbursement rates. The rates can be found in section 5.1, Travel Policies for State Employees, of the linked document, http://www.osbm.state.nc.us/files/pdf_files/BudgetManual.pdf.

The county department has the option of providing money for travel related expenses to the beneficiary in advance or after the trip is completed. If the worker feels that verification of the appointment is necessary, he should request the appointment card or contact the provider.

1. Breakfast

Under State policy, reimbursement for breakfast may be claimed if the beneficiary must leave before 6:00 a.m.

2. Lunch

Reimbursement for lunch is only allowable on overnight stays. If a day trip will last from morning through afternoon the county department should counsel the beneficiary to make arrangements for lunch. At the county’s discretion, lunch may be provided for the beneficiary and attendant. However, reimbursement from DMA is not allowable.

3. Dinner

Reimbursement for dinner is allowable if the beneficiary does not return until after 8:00 p.m.

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(X.B.)

4. Billing Codes for Meals

a. For beneficiary meals, use billing code 0190 on the DMA-2055, Reimbursement Request Form.

b. For attendant meals, use billing code 0210 on the DMA-2055, Reimbursement Request Form.

6. Parking Fees, Tolls

Reimbursement for parking fees and tolls is allowable if reimbursement is based only on mileage. If transportation is reimbursed on a per-trip basis, parking fees and tolls are already included in the payment for the trip. Use billing code A0170 for parking fees and tolls on the DMA-2055, Reimbursement Request Form.

7. Overnight Lodging

When the medical service is available only in another county, city, or state, medical condition, travel time and distance may warrant staying overnight. Allowable expenses include overnight lodging and meals for eligible beneficiaries while in transit to and from the medical resource. Lodging and transportation to and from the lodging must be determined to be less expensive than daily travel from home (unless deemed medically necessary).

Overnight lodging, not to exceed the state rate or, at the county’s discretion, the county reimbursement rate if higher, can be reimbursed. If the county per diem is higher than the state per diem, the DSS may choose, but is not required to use the higher reimbursement rate.

a. For beneficiary’s lodging, use billing code A0180 on the DMA-2055, Reimbursement Request Form.

b. For attendant’s lodging, use billing code A0200 on the DMA-2055, Reimbursement Request Form.

C. Transportation Costs Reimbursed at 50% Administrative Rate

Staff Administrative Costs - Reimbursed by DSS, as reported on the DSS-1571.

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(X.D)

D. Reimbursement to Nursing Facilities

1. Direct Reimbursement

DMA directly reimburses long term care facilities for non-ambulance transportation of Medicaid eligible patients to receive medical care that cannot be provided in the facility. This reimbursement is included in the total cost of care paid to the facility. Family members are encouraged to provide transportation when they can as a means of providing critical family and social support to the patient. Costs for routine transportation may not be charged to the family or to the patient's funds. It is not necessary for DSS to have the DMA-5046, Notice of Rights/Responsibilities signed for applications and redeterminations since nursing homes provide their own transportation.

2. Arranging Transportation

The facility will be responsible for arranging and/or providing non-ambulance transportation for all Medicaid beneficiaries (even if DSS has guardianship) who do not have family assistance. The facility may contract with providers (including local county services) to provide transportation or may provide transportation services using its own vehicles, whichever is more cost effective.

3. Ambulance Transportation

Ambulance transportation for nursing home residents is permitted only by medical necessity as specified in Section VIII.C.4. above.

If a nursing facility schedules non-emergency ambulance transportation for a Medicaid beneficiary and the claim is denied due to lack of justification for medical necessity (the beneficiary’s medical/physical condition did not warrant stretcher transport), the nursing facility is responsible for payment. The facility cannot bill the patient or his family for non-covered services.

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(X.E)

E. Reimbursement to Adult Care Homes

1. Arranging Transportation

The county DSS is responsible for arranging and/or providing non-ambulance transportation for Adult Care Home (ACH) beneficiaries with no other appropriate means of transportation available.

The facility may contract local county social services to provide transportation assistance on behalf of Mediciad beneficiaries residing in an adult care home.

If the facility possesses an appropriate mode of transportation, they must enter into contract with the county DSS before they can be utilized as a non-emergency medical transportation vendor. Please refer to IX for Safety and Risk Management procedures.

2. Ambulance Transportation

Ambulance transportation for adult care home residents is permitted only by medical necessity as specified in Section VIII.C.4. above.

If an adult care home schedules non-emergency ambulance transportation for a Medicaid beneficiary and the claim is denied due to lack of justification for medical necessity (the beneficiary’s medical/physical condition did not warrant stretcher transport), the adult care home facility is responsible for payment. The facility cannot bill the patient or his family for non-covered services.

F. The County may not request reimbursement for the following:

1. Expenses of an attendant to sit and wait following beneficiary admission to a medical facility.

2. Transportation provided when free or lower cost suitable transportation was available.

3. Purchase price of a vehicle for transportation. The purchase of a vehicle may be recovered over the life of the vehicle through trip reimbursement.

4. Private or public vendor costs which are higher than appropriate when less expensive means of transportation are available.

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(X.F.)

5. Routine transportation to school on a school day even though health services may be provided in the school during normal school hours.

6. Travel to visit a hospitalized patient (except to provide or learn to provide care for the patient).

7. Transportation of a beneficiary in deductible status.

8. Empty trips.

Miles to or from a transportation vendor’s office/home/garage to or from the Medicaid beneficiary’s residence are not compensated by Medicaid. Medicaid only pays from point of pickup to the point of drop off. The cost of empty trips should be factored in the total cost in setting mileage rates.

9. Ambulance transportation of a deceased person.