Family and Children's Medicaid MA-3550 MEDICAID TRANSPORTATION

XI. REPORTING TRANSPORTATION COST

Direct payment to Medicaid recipients for transportation and travel-related expenses as well as transportation services purchased for Medicaid recipients are reported on the DMA-2055. Refer to A below for instructions on how to report such costs. All other costs, such as staff administrative cost and operating agency vehicles are reported on the DSS-1571. Please refer to chart below.

	Agency Costs	Direct Payment for Services
Forms	DSS-1571	DMA-2055
Reported Costs	Medically related transportation of Medicaid recipients. 1. Operation of agency owned vehicle. 2. Operation of DSS staff owned vehicle. 3. DSS staff time used in directly providing transportation. 4. Operation and Maintenance costs for agency vehicles. 5. Purchase price of a vehicle purchased by the agency for sole purpose of providing Medicaid transportation.	Medically related transportation of Medicaid recipients. 1. Direct payments to Medicaid recipients for Medical transportation. 2. Cost for medically related transportation services purchased for Medicaid recipients.

REVISED 01/01/12 – CHANGE NO. 01-12

(XI.)

A. Completing the DMA-2055, Reimbursement Request Form

When completing the DMA-2055, include only one month of transportation per form. The month should be the month in which the transportation occurred.

1. Purchased Medical Transportation Service Costs Include:

a. Fares for public transportation purchased for recipients.

b. Transportation services purchased for recipients, FRPs, friends, or volunteers to transport Medicaid recipients.

c. The purchase of gas vouchers as long as it meets the least expensive criteria. See VIII.C.

d. Attendant expenses.

e. Transportation of caretakers.

2. Unduplicated Recipients

Enter the total number of unduplicated Medicaid recipients. “Unduplicated recipients” means the number of distinct individuals provided transportation during the month. A recipient who has had multiple trips during the month counts as one unduplicated recipient.

3. Enter the total number of one way passenger trips. A one-way passenger trip consists of one passenger pick-up and drop-off. Count the total number of trips, not the number of distinct individuals transported.

4. Enter the appropriate billing code using the code list on the DMA-2055, Reimbursement Request Form.

5. Enter the total amount of reimbursement requested.

B. Time Limitation for County Reimbursement

Counties must submit claims for reimbursement to DMA within one year of the date of service.