Payment to Providers for Transportation Services

(A) Amount of Payment. Payment for transportation is made directly to providers of services except in the circumstances specified in 130 CMR 407.431 or 407.432(B). Payment for brokered transportation is made in accordance with the terms of the selective contract. In all other cases, payment is made in accordance with 101 CMR 327.00: Rates of Payment for Ambulance and Wheelchair Van Services. When a member and an individual who is not a member or an escort are transported together, the member is considered the “additional person” for billing purposes. (B) Payment Limitations. The MassHealth agency does not pay a provider of transportation services other than a transportation broker for services other than those identified in 130 CMR 407.471(A)(2), 407.481(A), and 407.491(A), when provided to MassHealth members who reside in an area of the state where a selective contract with a transportation broker is in effect, unless the MassHealth agency determines that (1) the transportation service is not available through the selective contract; or (2) the transportation service available through the provider is more appropriate for the particular member than the transportation service available through the transportation broker. (130 CMR 407.433 through 407.470 Reserved)