Current through Register Vol. 24-18, September 15, 2024
(1) The medicaid agency covers nonemergency
transportation for a Washington apple health client to and from health care
services if all of the following apply:
(a)
The health care services are:
(i) Within the
scope of coverage of the eligible client's benefit services package;
(ii) Covered as defined in WAC
182-501-0050 through
182-501-0065 and the specific
program rules; and
(iii)
Authorized, as required under specific program rules.
(b) The health care service is medically
necessary as defined in WAC
182-500-0070;
(c) The health care service is being provided
:
(i) Under fee-for-service, by an
agency-contracted provider;
(ii)
Through an agency-contracted managed care organization (MCO), by an MCO
provider;
(iii) Through a
behavioral health organization (BHO), by a BHO contractor; or
(iv) Through one of the following providers,
as long as the provider is eligible for enrollment as a medicaid provider (see
WAC 182-502-0012) :
(A) A medicare enrolled provider;
(B) A provider in the network covered by the
client's primary insurance where there is third-party insurance;
(C) A provider performing services paid for
by the Veteran's Administration, charitable program, or other voluntary program
(Shriners, etc.).
(d) The trip is to a local provider as
defined in WAC
182-546-5100 (see WAC
182-546-5700(3)
for local provider exceptions);
(e)
The transportation is the lowest cost available mode or alternative that is
both accessible to the client and appropriate to the client's medical condition
and personal capabilities;
(f) The
trip is authorized by the broker before a client's travel; and
(g) The trip is a minimum of three-quarters
of a mile from pick-up point to the drop-off point (see WAC
182-546-6200(7)
for exceptions to the minimum distance requirement).
(2) Coverage for nonemergency medical
transportation is limited to one roundtrip per day, with the exception of
multiple medical appointments which cannot be accessed in one
roundtrip.
11-17-032, recodified as WAC 182-546-5500, filed 8/9/11,
effective 8/9/11. Statutory Authority:
RCW
74.04.057,
74.08.090, and
74.09.500. 11-15-029, §
388-546-5500, filed 7/12/11, effective 8/12/11. Statutory Authority:
RCW
74.08.090 and 42 C.F.R. Part 440. 10-05-079,
§ 388-546-5500, filed 2/15/10, effective 3/18/10. Statutory Authority:
RCW
74.08.090,
74.09.500,
74.04.050,
74.04.055, and
74.04.057. 01-06-029, §
388-546-5500, filed 3/2/01, effective
4/2/01.
