471 NAC 27-002. DEFINITIONS

002. DEFINITIONS. The following definitions apply: 002.01 BASE RATES. Non-emergency medical transportation base rates include all services, equipment, and other costs, including: vehicle operating expenses, services of personnel, first five “loaded” miles of the trip, unloaded mileage, and usual waiting or standby time. 002.02 EXEMPT PROVIDER. Transportation carriers exempted from Nebraska Public Service Commission certification as defined in Neb. Rev. Stat. §§ 75-303 to 75-303.03. 002.03 FREE TRANSPORTATION. An appropriate mode of transportation that can be secured by the client without cost or charge, including the client’s personal vehicle or through access to a vehicle in the household that is owned by a legally responsible individual for the client. 002.04 INDIVIDUAL PROVIDER. An individual carrier who meets the requirements of Neb. Rev. Stat. § 75-303 (11), (12), or (13), has an approved service provider agreement with the Department and is chosen by the client. 002.05 LEGALLY RESPONSIBLE INDIVIDUAL. A parent or guardian of a minor child, or spouse. 002.06 LOADED MILEAGE. Miles traveled while the client is present in the vehicle. Loaded mileage is covered for non-emergency medical transports when travel exceeds six or more miles. The first five loaded miles are included in the payment for the base rate. 002.07 MODE. The method used to provide transportation services to clients. This includes personal vehicle owned by individual provider; fixed route public transportation; ambulatory sedan, van, and handi-bus; wheelchair-accessible van; and commercial airlines. 002.08 MOST APPROPRIATE. The least costly mode of transportation to meet a client’s medical needs that accommodates the client based on the client’s physical, cognitive, or developmental capabilities. 002.09 NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) BROKER. An entity under contract with a Heritage Health managed care organization provider to perform all administrative brokerage functions including, but not limited to establishing a transportation network; receiving non-emergency medical transportation (NEMT) service requests; verifying client program(s) eligibility; screening clients for mobility status and existing transportation resources; determining appropriateness and coverage of program services; approving and arranging for transport; notifying client of transportation arrangement; and facilitating provider payment for completed services. 002.10 NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) SERVICE PROVIDER. Non-emergency medical transportation (NEMT) services provided by an approved individual, exempt or public service commission (PSC) provider. 002.11 NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) SERVICE. Non-emergency medical transportation (NEMT) services are a ride, or mileage reimbursement for a ride, and escort or attendant services provided so that a Medicaid eligible client with no other transportation resources can receive Medicaid coverable services. By definition, non-emergency medical transportation (NEMT) services do not include transportation provided on an emergency basis, such as trips to the emergency room. 002.12 NO SHOW. A trip that is not cancelled where the client or non-emergency medical transportation (NEMT) provider does not arrive as scheduled; or a scheduled trip that is not cancelled prior to the service when either the client or the non-emergency medical transportation (NEMT) provider fails to arrive. 002.13 PUBLIC SERVICE COMMISSION (PSC) CERTIFIED CARRIER. Transportation providers requiring Nebraska Public Service Commission certification as defined in Neb. Rev. Stat. § 75-302 including the following carriers: 002.13(A) COMMON CARRIER. Any person who or which undertakes to transport passengers or household goods for the general public in intrastate commerce by motor vehicle for hire, whether over regular or irregular routes, upon the highways of this state. 002.13(B) CONTRACT CARRIER. Any motor carrier which transports passengers or household goods for hire other than as a common carrier designed to meet the distinct needs of each individual customer or a specifically designated class of customers without any limitation as to the number of customers it can serve within the class. 002.14 UNLOADED MILEAGE. Miles traveled when a client is not present in the vehicle. All unloaded mileage is included in the payment for the base rate. 002.15 URGENT. A serious, but not life threatening, illness or injury. Urgent care is determined by the client’s medical care provider. An appointment must be considered urgent if the medical service provider grants an appointment within 48 hours of the client’s request. An inpatient or outpatient hospital discharge must be considered an urgent trip. 002.16 WAIT TIME. Periods of time that a non-emergency medical transportation (NEMT) provider spends waiting for the client prior to or in between the provision of covered non-emergency medical transportation (NEMT) services.