Travel expenses for medical purposes - Limitations

1. For purposes of this section, "travel expenses" means fares, mileage, meals, lodging, and driver and attendant care. 2. General requirements. a. A transportation service provider shall be enrolled as a provider in the Medicaid program and children's health insurance program and may be an individual, a taxi, a bus, a food service provider, a lodging provider, an airline service provider, a travel agency, or another commercial form of transportation. b. The department or human service zone may determine and authorize the most efficient, economical, and appropriate means of travel to meet the medical needs of the recipient. c. The cost of travel provided by a parent, spouse, or any other member of the recipient's Medicaid unit, as defined in section 75-02-02.1-08, may be allowed as an expense of necessary medical or remedial care for recipient liability purposes, unless the parent, spouse, or any other member of the recipient's Medicaid unit is enrolled as a transportation provider. A parent, spouse, friend, household member, or family member of the recipient may be paid as an enrolled provider for transportation for that recipient. An individual who provides foster care, kinship, or guardianship may enroll as a transportation provider and is eligible for reimbursement to transport a Medicaid-eligible child to and from Medicaid-eligible medical appointments in situations in which the Medicaid-eligible child's medical needs exceed ordinary, typical, and routine levels. A guardian of a vulnerable adult may enroll as a transportation provider and is eligible for reimbursement to transport a Medicaid-eligible adult, for whom the guardian has been court-ordered to provide guardianship services, to and from Medicaid-covered medical appointments. d. Emergency transport by ambulance is a covered service when provided in response to a medical emergency. e. Nonemergency transportation by ambulance is a covered service only when medically necessary and ordered by the attending licensed provider. f. A recipient may choose to obtain medical services outside the recipient's community. If similar medical services are available within the community and the recipient chooses to seek medical services elsewhere, travel expenses are not covered services and are the responsibility of the recipient. g. If a provider refers a recipient to a facility or provider that is not located at the closest medical center, travel expenses may not be covered services and are the responsibility of the recipient, unless special circumstances apply and prior authorization is secured. 3. Out-of-state travel expenses. Travel expenses for nonemergency out-of-state medical services, including follow-up visits, may be authorized if the out-of-state medical services are first approved by the department under section 75-02-02-13 or if prior approval is not required under that section. 4. Limitations. a. Private or noncommercial vehicle mileage compensation is limited to the amount on the department fee schedule. This limit applies even if more than one recipient is transported at the same time. Mileage is determined by map miles from the residence or community of the recipient to the medical facility. When necessary to ensure volunteer drivers continue to provide transportation services to a recipient, the department may authorize payment for additional mileage. Transportation services may be billed to the Medicaid program or children's health insurance program only upon completion of the service. b. Meals compensation is allowed only when medical services or travel arrangements require a recipient to stay overnight. Compensation is limited to the amount on the department fee schedule. The entity providing meals must be an enrolled Medicaid provider and must submit the proper requests for payment. c. Lodging expense is allowed only when medical services or travel arrangements require a recipient to stay overnight. Lodging compensation is limited to the amount on the department fee schedule. Lodging providers must be enrolled in Medicaid and shall submit the proper requests for payment. d. Travel expenses may not be authorized for both a driver and an attendant unless the referring licensed practitioner determines that one individual cannot function both as driver and attendant. Travel expenses may not be allowed for a noncommercial driver or an attendant while the recipient is a patient in a medical facility unless it is more economical for the driver or attendant to remain in the service area, as determined by the department. e. Travel expenses may be authorized for one parent to travel with a child who is under eighteen years of age. No additional travel expenses may be authorized for another driver, attendant, or parent unless the referring licensed practitioner determines that individual's presence is necessary for the physical, psychological, or medical needs of the child. f. Compensation for attendant services, provided by an attendant who is not a family member, may be allowed at a rate determined by the department if the department determines attendant services are medically necessary. Attendant services must be approved by the department or human service zone.