(A)
Reimbursable
Expenses. Members may obtain direct reimbursement from the
MassHealth agency in accordance with 130 CMR 407.431(B) for public
transportation expenses that the member incurred when traveling to services
covered by MassHealth.
(B)
Method and Amount of Reimbursement.
(1) In order to obtain reimbursement for
public transportation expenses, a member must obtain documentation from an
authorized provider, a day habilitation program representative, an early
intervention program representative, a managed-care representative, a
registered nurse, a licensed practical nurse, a social worker, a case manager,
or another medical professional who provided services for which the member
seeks reimbursement of public transportation costs. The documentation must
demonstrate that medical services covered by MassHealth were received, identify
the date on which medical services were received, and identify the specific
address where medical services were received. In cases where urgent care is
needed, the documentation must also state the time medical services were
received. Transportation receipts are also required when available. The member
must submit documentation and receipts to the MassHealth agency and request
reimbursement for public transportation expenses.
(2) Transportation costs must total $5.00 or
more in order for the member to request reimbursement. The member must submit a
request for reimbursement no later than 90 days after the earliest date on
which transportation costs in excess of $5.00 occurred.
(3) If a member traveled outside his or her
locality, the documentation must state the medical services that were needed
and that could not be obtained locally. If a member traveled outside his or her
locality when necessary medical services were available locally, transportation
costs incurred are not reimbursable unless authorized by the MassHealth
agency.
(C)
Exceptional Circumstances. The MassHealth agency may
authorize reimbursement to a member for direct transportation expenses not
described in 130 CMR 407.431(A) which the member incurred when traveling to
services covered by MassHealth, when the MassHealth agency determines that
transportation is not otherwise available through MassHealth-contracted
providers or selective broker contracts, and public transportation is not
available as determined in accordance with 130 CMR 407.411(E)(3). The
MassHealth agency may require the member to submit such documentation as it
determines necessary to support a request for reimbursement under 130 CMR
407.431(C).
