Current through Vol. 42, No. 1, September 16, 2024
(a)
SoonerRide NEMT coverage.
SoonerRide NEMT is available for SoonerCare compensable services under the
following conditions:
(1)
Nearest
appropriate facility.
(A)
Transportation is to the nearest appropriate facility or medical provider that
is capable of providing the necessary services.
(B) SoonerRide NEMT services to a more
distant hospital, clinic, practitioner or physicians' office solely to avail a
member of the service of a specific physician or physician assistant does not
make the institution in which the physician has staff privileges the nearest
institution with appropriate facilities.
(C) The nearest facility is not considered
appropriate if:
(i) The member's condition
requires a higher level of care or specialized services available at a more
distant facility; or
(ii) There
are no beds or providers available. Medical records must be properly documented
in this circumstance.
(2)
Radius. Primary care and
specialty SoonerCare compensable services should be available within forty-five
(45) miles of the member's residence. The Oklahoma Health Care Authority (OHCA)
has the final authority to approve or deny travel greater than forty-five (45)
miles to access these services.
(A)
Residency change. Should a member change residence then care will
be established within forty-five (45) miles of the new residence.
(B)
American Indians/Alaska Natives
(AI/AN). AI/AN members that are seeking services at a Tribal or Indian
Health Services (I.H.S.) facility may be transported to any Tribal or I.H.S.
facility equipped for their medical needs. All trips to out-of-state facilities
require prior authorization and approval.
(3)
Services requiring prior
authorization.
(A) Travel that exceeds
the forty-five (45) mile radius, as mentioned in Oklahoma Administrative Code
(OAC) 317:30-5-327.1(a) (2), must be authorized and approved; and
(B) Out-of-state travel for prior authorized
out-of-state medically necessary services, must also be authorized and
approved.
(b)
Discharge coverage. SoonerRide NEMT is available if a member is
being discharged from a facility to their home. The facility is responsible for
scheduling the transportation. SoonerRide NEMT is only responsible for
transporting the member.
(1) Personal
belongings and/or durable medical equipment (with the exception of portable
oxygen or a wheelchair that is medically necessary for transportation) will not
be transported through SoonerRide NEMT.
(2) Wheelchairs must be provided by the
medical escort/member. This item is not provided by the SoonerRide NEMT
transport.
(c)
Medical escorts/service animals/additional passengers. In
instances where there is documented medical necessity, a medical escort or
service animal may accompany the member.
(1)
Medical escort. A medical escort is not eligible for direct
compensation by the SoonerRide NEMT broker or SoonerCare.
(2)
Service animal. The
SoonerRide NEMT broker may request additional information regarding the service
animal, including but not limited to, if the animal is required because of a
disability and what work or task the animal has been trained to
perform.
(3)
Removal of the
service animal. The SoonerRide NEMT broker may ask for the service
animal to be removed if it is not under the control of the handler or if it is
not housebroken/trained. Additionally, the SoonerRide NEMT broker and the OHCA
are not responsible for the care and supervision of the service
animal.
(4)
Additional
passengers. SoonerRide NEMT is not required to transport any additional
individuals other than the one (1) approved individual providing the escort
services.
(A)
Additional passengers
request. In the event that additional individuals request
transportation, it is the responsibility of the member to contact the
transportation provider directly to request allotment of additional passengers.
The SoonerRide NEMT broker will not facilitate this request.
(B)
Exceptions for urgent
appointments. Exceptions may be granted if the medical appointment is
urgent in nature and meets the criteria outlined in Oklahoma Administrative
Code (OAC) 317:30-5-327.1(d) (1)- (3).
(d)
Urgent appointments and additional
passengers. An urgent appointment can be for either a sick child or sick
parent/guardian. The member must make the request for additional child
passengers when making the trip reservation. A maximum of three (3) children
can ride with the parent/guardian. The total number of passengers, including
the driver, cannot exceed more than five (5) persons for any vehicle. In
addition, the following conditions must be met:
(1)
Urgent medical appointment.
The medical appointment must be urgent (for a sick child or sick parent) as
determined by the member's doctor. The SoonerRide NEMT broker will confirm that
the medical appointment is urgent with the member's doctor;
(2)
Children. All children must
be the member's by birth, marriage, legal adoption, foster child, or legal
guardianship. Further, the additional children passengers must be younger than
thirteen (13) years of age. Exception will be granted if a child has complex,
medical, intellectual, or physical disabilities that requires constant care and
supervision; and
(3)
Car
seats for children. Each child must have his or her own car seat,
provided by the member, if required by Oklahoma state law.
(e)
Forms of transportation.
SoonerRide NEMT can include one (1) of the following forms of transportation:
(1)
Authorization for transportation by
private vehicle or bus. Transportation by private vehicle or bus is
administered through the broker when it is necessary for an eligible member to
receive medical services.
(2)
Authorization for transportation by taxi. Taxi service may be
authorized at the discretion of the broker.
(3)
Transportation by ambulance.
Transportation by ambulance is only provided for non-emergency scheduled
stretcher service.
(4)
Transportation by airplane. When an individual's medical condition
is such that transportation out-of-state by a commercial airline is required,
approval for airfare must be secured by telephoning the OHCA who will make the
necessary flight arrangements.
(f)
Exclusions for SoonerRide
NEMT. SoonerRide NEMT coverage excludes the following:
(1)
Emergency services.
Transportation of members to access emergency services;
(2)
Ambulance. Transportation of
members by ambulance for any reason, except for non-emergency scheduled
stretcher service per OAC 317:30-5-327.1(e) (3);
(3)
Non-compensable services.
Transportation of members to services that are not covered by SoonerCare; and
(4)
Non-medically necessary
services. Transportation of members to services that are not medically
necessary.
Added at 24 Ok Reg
2095, eff 6-25-07; Amended at 29 Ok Reg 1104, eff
6-25-12
