Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This proposed amendment will allow MO
HealthNet participants to receive transportation services to a pharmacy to
receive vaccinations during a scheduled appointment.
(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.
*Original authority: 208.201, RSMo 1987, amended
2007.
