Nonemergency Medical Transportation (NEMT) Services

PURPOSE: This rule establishes the criteria by which the MO HealthNet Division (MHD) reimburses expenses for nonemergency, medically necessary transportation if a participant does not have access to transportation services that are available free of charge. (1) The MO HealthNet Division (MHD) or its contractor shall reimburse eligible participants or nonemergency medical transportation (NEMT) providers for medically necessary transportation only if a participant does not have access to transportation services that are available free of charge. (A) The participant must have an appointment for any medical treatment that is approved by MHD. (B) MHD will not reimburse eligible participants or NEMT providers for nonemergency medical transportation to a pharmacy or to any location where the purpose of the nonemergency transportation is to fill a pharmaceutical prescription. MHD will reimburse eligible participants or NEMT providers for nonemergency medical transportation to a pharmacy for an MHD participant to receive a scheduled vaccination. (C) Alternative transportation services that may be provided free of charge include but are not limited to private vehicles, volunteers, relatives, a designated legal representative, an individual involved in the resident’s care, or transportation services provided by nursing facilities or other residential centers. Participants must not have access to free transportation in order to be eligible for reimbursement under this section. (2) MHD shall reimburse the most appropriate and least costly transportation alternative suitable for the participant’s medical condition. If a participant has access to private vehicles or less costly public transportation, those alternatives must be used in lieu of more expensive transportation alternatives. (A) The alternative transportation services provided include: 1. Bus passes/tickets; 2. Taxi/sedans; 3. Wheelchair van; 4. Multi-passenger vans; 5. Stretcher van; 6. Ambulance; 7. Gas reimbursement; or 8. Volunteer driver program, if approved by the state agency. (B) Transports are limited to medical treatment within the distance standards set forth in 20 CSR 400-7.095. Exceptions to these standards include: 1. The participant has a previous history of other than routine medical care with the qualified, enrolled medical service provider for a special condition or illness; 2. The participant has been referred by a Primary Care Provider (PCP) to a qualified, enrolled medical service provider for a special condition or illness; and 3. There is not a routine or specialty care appointment available within thirty (30) calendar days to a qualified, enrolled medical service provider within the travel standards. (3) MHD shall reimburse for the least expensive and most appropriate ancillary services when the medical treatment requires an overnight stay. Ancillary services include meals and lodging. AUTHORITY: sections 208.201 and 660.017, RSMo 2016.* Original rule filed May 16, 2005, effective Oct. 30, 2005. Amended: Filed Feb. 1, 2008, effective Aug. 30, 2008. Amended: Filed Aug. 27, 2020, effective March 30, 2021. Amended: Filed May 23, 2022, effective Nov. 30, 2022. *Original authority: 208.201, RSMo 1987, amended 2007, and 660.017, RSMo 1993, amended 1995.