Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.24 - Transportation Services
Rule 37.86.2402 - TRANSPORTATION AND PER DIEM, REQUIREMENTS
Current through Register Vol. 18, September 20, 2024
(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers.
(2) Coverage of transportation and per diem is limited to transportation and per diem necessary to obtain necessary medical services covered by the Medicaid program.
(3) Coverage for transportation and per diem is only available for transportation and per diem to the site of medical services at the provider closest to the locality of the recipient unless:
(4) Private vehicle transportation is limited to mileage reimbursement. Reimbursement is not available for any other private vehicle costs or fees.
(5) Coverage of per diem is not available when a round trip can reasonably be made in one day.
(6) Coverage of nonemergent transportation and per diem must be prior authorized by the department or its designee.
(7) Coverage of emergent transportation and per diem must be authorized by the department or its designee.
(8) Reimbursement for transportation is made to the common carrier unless otherwise authorized by the department or its designee.
(9) Coverage of transportation is limited to the least expensive available mode of transportation suitable to the recipient's medical needs plus any applicable per diem.
(10) Coverage of transportation and per diem are not available for transportation and per diem costs incurred during a retroactive eligibility period.
(11) Coverage of transportation and per diem for an attendant is only available for an attendant that is determined to be medically necessary.
(12) If a recipient dies enroute to or during treatment outside of the recipient's community, the cost of the recipient's transportation to the medical service is reimbursable. The cost of returning the body of a deceased recipient is not reimbursable.
(13) Mileage reimbursement is rounded to the nearest whole mile.
(14) Prior authorization is not a guarantee of payment as the department may subsequently deny payment based on factors other than medical necessity, including but not limited to ineligibility of the individual to whom services were provided or failure to comply with billing requirements set forth in ARM 37.85.406 or with any other Medicaid rule or requirement.
(15) Commercial providers are required to maintain and retain original dispatch records for services provided to a Montana Medicaid recipient that include:
AUTH: 53-6-113, MCA; IMP: 53-6-101, MCA