Reimbursement to Members for Transportation Expenses

(A) Reimbursable Expenses. Members may obtain direct reimbursement from the MassHealth agency in accordance with 130 CMR 407.431(B) for public transportation expenses that the member incurred when traveling to services covered by MassHealth. (B) Method and Amount of Reimbursement. (1) In order to obtain reimbursement for public transportation expenses, a member must obtain documentation from an authorized provider, a day habilitation program representative, an early intervention program representative, a managed-care representative, a registered nurse, a licensed practical nurse, a social worker, a case manager, or another medical professional who provided services for which the member seeks reimbursement of public transportation costs. The documentation must demonstrate that medical services covered by MassHealth were received, identify the date on which medical services were received, and identify the specific address where medical services were received. In cases where urgent care is needed, the documentation must also state the time medical services were received. Transportation receipts are also required when available. The member must submit documentation and receipts to the MassHealth agency and request reimbursement for public transportation expenses. (2) Transportation costs must total $5.00 or more in order for the member to request reimbursement. The member must submit a request for reimbursement no later than 90 days after the earliest date on which transportation costs in excess of $5.00 occurred. (3) If a member traveled outside his or her locality, the documentation must state the medical services that were needed and that could not be obtained locally. If a member traveled outside his or her locality when necessary medical services were available locally, transportation costs incurred are not reimbursable unless authorized by the MassHealth agency. (C) Exceptional Circumstances. The MassHealth agency may authorize reimbursement to a member for direct transportation expenses not described in 130 CMR 407.431(A) which the member incurred when traveling to services covered by MassHealth, when the MassHealth agency determines that transportation is not otherwise available through MassHealth-contracted providers or selective broker contracts, and public transportation is not available as determined in accordance with 130 CMR 407.411(E)(3). The MassHealth agency may require the member to submit such documentation as it determines necessary to support a request for reimbursement under 130 CMR 407.431(C).