Current through Register Vol. 24-18, September 15, 2024
(1) To be
reimbursed for trips, meals, or lodging, the requestor must receive prior
authorization from the broker at least two business days in advance of the
client's travel.
(2) A client must
request reimbursement of preauthorized expenditures for trips, meals, or
lodging within 30 calendar days after their medical appointment. The broker may
consider reimbursement requests beyond 30 calendar days if a client shows good
cause as defined in WAC
388-02-0020 for having not
requested reimbursement within 30 calendar days.
(3) To be reimbursed for
transportation-related services, the requestor must provide the broker with
legible copies of:
(a) Itemized
receipt(s);
(b) The operator's
valid driver's license;
(c) Valid
vehicle registration; and
(d) Proof
of insurance for the vehicle/operator at the time of the trip.
(4) The agency or the broker may
retroactively authorize and reimburse for transportation costs, including meals
and lodging when:
(a) A client is approved for
a delayed certification period as defined in WAC
182-500-0025, or for a
retroactive eligibility period as defined in WAC
182-500-0095, or is retroactively
eligible for a medically needy program which requires a spenddown as defined in
WAC 182-500-0100;
(b) The transportation costs were not used to
meet a client spenddown liability in accordance with WAC
182-519-0110;
(c) The transportation costs for which
retroactive reimbursement is requested falls within the period of retroactive
eligibility or delayed certification;
(d) The client received medically necessary
services that were covered by the client's medical program for the date(s) of
service for which retroactive reimbursement is requested; and
(e) The request for retroactive reimbursement
is made within 60 calendar days from the date of eligibility notification
(award letter), not to exceed eight months from the date(s) of service for
which reimbursement is requested.
(5) When transportation cost(s) are
retroactively authorized, the reimbursement amount must not exceed the
reimbursement amount that would have been authorized prior to the date(s) of
service.
(6) To be paid by the
broker for nonemergency transportation services:
(a) Ambulance providers must be subcontracted
with the broker in accordance with WAC
182-546-5200.
(b) Nonambulance providers must be
subcontracted with the broker in accordance with WAC
182-546-5200.
(7) The agency, through its
contracted brokers, does not pay for nonemergency transportation when:
(a) The health care service the client is
requesting transportation to or from is not a service covered by the client's
medical program;
(b) The covered
health care service is within three-quarters of a mile from the pick-up point,
except when:
(i) The client's documented and
verifiable medical condition and personal capabilities demonstrates that the
client is not able to walk three-quarters mile distance;
(ii) The trip involves an area that the
broker determines is not physically accessible to the client; or
(iii) The trip involves an area that the
agency's broker considers to be unsafe for the client, other riders, or the
driver.
(c) The client
has personal or informal transportation resources that are available and
appropriate to the clients' needs;
(d) Fixed-route public transportation service
is available to the client within three-quarters of a mile walking distance.
Exceptions to this rule may be granted by the transportation broker when the
need for more specialized transportation is documented. Examples of such a need
may be the client's use of a portable ventilator, a walker, or a quad cane;
or
(e) The mode of transport that
the client requests is not necessary, suitable, or appropriate to the client's
medical condition.
11-17-032, recodified as WAC 182-546-6200, filed 8/9/11,
effective 8/9/11. Statutory Authority:
RCW
74.04.057,
74.08.090, and
74.09.500. 11-15-029, §
388-546-6200, filed 7/12/11, effective
8/12/11.
