HAR §17-1737-83. Out-of-state transportation

(a) Out-of-state transportation may be provided to eligible recipients for covered medical services which are unavailable in Hawaii and with prior authorization by the department's medical consultant. (b) Transportation shall be by the most economical means which would not be hazardous or injurious to the recipient's health. (c) Transportation shall be limited to a United States medical facility which is licensed to provide such services and certified as a medicaid provider by the state where the facility is located. (d) Request for out-of-state transportation shall be made by the attending physician or a medical facility and shall include: (1) All information requested in the department designated forms; and (2) A comprehensive clinical summary of the patient's condition, need for out-of-state medical facility service, the name and address of the out-of-state facility and the name and telephone number of the authorized representative of that medical facility. (e) Out-of-state transportation may be provided in the form of a round trip ticket issued to: (1) The recipient when the recipient is expected to return home in thirty days or less as determined by the attending physician or medical facility. A one-way ticket may be issued when the recipient is expected to remain out-of-state for more than thirty days. (2) Any person accompanying the recipient without regard to the person's relationship to the UNOFFICIAL 1737-100 recipient, if an attendant is required by the transportation carrier or recommended by the attending physician or the medical facility and authorized by the department's medical consultant. (f) Other related travel expenses may be allowed with prior authorization by the department's medical consultant and may include but not be limited to: (1) Cost of meals and lodging for the recipient and one attendant; (2) Taxi or other non-emergency ground transportation when such transportation is related to the provision of authorized medical coverage; and (3) Services of an attendant provided the attendant is unrelated to the recipient. (g) Transportation services shall be available for those individuals eligible for medical assistance, provided all the provisions in this section are met. An individual who utilizes benefits for other than their intended purpose, may be referred for potential prosecution of fraud. A provider who knowingly and willfully falsifies, misrepresents, conceals, or fails to disclose material facts to obtain transportation services for an individual, may be referred by the department to the Medicaid fraud control unit for investigation and potential prosecution of fraud. The department may seek the recovery of monies associated with the fraudulent act. [Eff 08/01/94; am 02/07/05] (Auth: HRS §346-14) (Imp: 42 C.F.R. §§431.53, 440.170)