Other Licensed Carriers

(A) Criteria for Use. The MassHealth agency pays for services provided by a licensed carrier in the following circumstances: (1) when there is no transportation provider in the member's locality or when it is less expensive to use a licensed carrier (for example, train) than a transportation provider; (2) when the member is traveling to specialized medical care that is a great distance from home and has obtained approval from the MassHealth agency; or (3) when the member lives on an island accessible only by boat or airplane. (B) Authorization Requirement. (1) All airplane transportation requires prior authorization from the MassHealth agency. (2) All train, boat, or private bus transportation requires prior authorization from the MassHealth agency. (3) If the member is traveling outside his or her locality, documentation from a physician is required to verify that the necessary medical services cannot be obtained locally. (C) Consultation with the Prior Authorization Unit. The following situations require consultation with the Prior Authorization Unit before granting prior authorization for private bus, train, or boat: (1) when the member is traveling outside his or her locality to obtain medical care; and (2) when a member is traveling out-of-state to obtain medical care, except when the destination is a town or city within the member's locality. (D) Rates of Payment. Rates of payment for licensed carriers shall not exceed the carrier’s usual fee for patients other than MassHealth members and shall not exceed established legal rates, if any. The service codes that must be used when billing are listed in Subchapter 6 of the Transportation Manual. (E) Billing Procedures. Billing procedures for other licensed carriers who have provided transportation in special circumstances for which they have received prior authorization requires consultation with the MassHealth agency.