Nemt Services: Coverage And Limitations

01. NEMT Services. The transportation broker will reimburse contracted transportation providers for NEMT services under the following conditions: (7-1-26) a. The travel is essential to get to or from a covered service; (7-1-26) b. The mode of transportation is the least costly that is appropriate for the medical needs of the participant; (7-1-26) c. The transportation is to the nearest medical provider appropriate to perform the needed services, and transportation is by the most direct route practicable; (7-1-26) d. Other modes of transportation, including personal vehicle, assistance by family, friends, and charitable organizations, are unavailable or impractical under the circumstances; (7-1-26) e. The travel is authorized and scheduled by the transportation broker; and (7-1-26) f. The contracted transportation provider follows the terms of its contract with the transportation broker. (7-1-26) 02. Travel-Related Services. The transportation broker will reimburse a contracted transportation provider for travel-related services under the following circumstances: (7-1-26) 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. (7-1-26) b. The reasonable cost for lodging actually incurred for the participant will be reimbursed when: (7-1-26) i. The round trip and the needed medical service cannot be completed in the same day; and (7-1-26) ii. No less costly alternative is available. (7-1-26) c. The reasonable cost of wages for a non-family member attendant will be reimbursed when: (7-1-26) i. An attendant is medically necessary or when the vulnerability of the participant requires accompaniment for safety; and (7-1-26) ii. No other unpaid attendant is available to accompany the participant. (7-1-26) d. The reasonable cost of meals actually incurred in transit will be reimbursed for one (1) family member or one (1) attendant, when: (7-1-26) i. Attendant care is medically necessary or when the vulnerability of the participant requires accompaniment for safety; and (7-1-26) ii. There is no other practical means of obtaining food. (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 343 Page 96 e. The reasonable cost of lodging actually incurred will be reimbursed for one (1) family member or one (1) attendant when: (7-1-26) i. An overnight stay is required to receive the service; (7-1-26) ii. It is medically necessary, or the vulnerability of the participant requires accompaniment for safety; and (7-1-26) iii. No less costly alternative is available. (7-1-26)