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Issue Alert - Medical Transportation Reimbursement

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Date:

Jul 11, 2006

Program Area:

Medicaid

Issue Summary:

Medical transportation is ensured for transportation to and from medical services providers for Medicaid-covered services.In some instances, clients can be reimbursed for expenses incurred for transporation. A time limit in which to request prior authorization has been added.

Persons Affected:

Individuals seeking reimbursement for transportation costs that require prior authorization from the Department of Human Services (DHS).

For More Information:

Center for Civil Justice
320 S. Washington, 2nd Floor
Saginaw, MI 48607
Phone: (989) 755-3120, (800)724-7441
Fax: (989) 755-3558
E-mail: info@ccj-mi.org

Michigan Poverty Law Program
611 Church Street, Suite 4A
Ann Arbor, MI 48104-3000
Phone: (734) 998-6100
Fax: (734) 998-9125


Background

Medical transportation is available to obtain medical evidence or receive any Medicaid-covered service from any Medicaid -enrolled provider, including:
• Chronic and ongoing treatment
• Prescriptions
• Medical supplies
• Onetime, occasional and ongoing visits for medical care.

Local offices may authorize and pay for the following (prior authorization may be required):
• Travel for clients to receive any Medicaid-covered service from any Medicaid -enrolled provider.
-Travel for methadone treatment for up to 18 months.
• Travel and a fee for an attendant/travel aide needed to accompany a recipient needing special assistance during transport.
• Travel for a parent, relative, guardian or attendant who is accompanying a client who is a minor child.
• Travel for family members of clients who are children in an inpatient hospital treatment program, if the family members are part of
a structured treatment or therapy program.
• Travel for one trip for examination and one trip per Medical Review Team (MRT) recommendation for clients claiming disability or blindness.
• Travel within or outside the normal service delivery area including borderland outstate travel

Meals and Lodging
• Overnight stays (including meals and lodging) for up to 5 consecutive nights for:
•• One parent or guardian of a child for any inpatient stay.
•• One client and, in addition, one parent of a child, spouse, guardian or attendant for outpatient treatment at U of M Hospital.
• Overnight stays if travel is 50 miles (one-way) or more from the client's home. DCH must prior authorize overnight stays when the
distance is less than 50 miles.
• Meal allowance associated with long-term recovery housing for bone marrow transplant operations at U of M or Harper Hospital
(amount determined by DCH) and prior authorized through the transplant coordinator. Lodging necessary prior to bone marrow
transplant operation is to be paid.

What's Happening?

A time limit for requesting prior authorization has been added. All prior authorization requests must be submitted before the service is provided and payment is made. Exceptions will only be granted for emergency situations or when extenuating circumstances exist and are clearly documented. No exceptions will be made for requests submitted one month or more after the service is provided.

The following transportation expenses require prior authorization from the Department of Community Health (DCH):
  • All outstate travel that is non-borderland (see PAM 402).
  •  Overnight stays if within 50 miles from recipient's home (one way).
  •  Overnight stays beyond 5 days (14 days for U of M MOTT Children's Pediatric Hospital).
  • Overnight stays or travel outside the normal service delivery area if expenses for two or more family members are included.
  • Special allowance when two or more attendants are medically necessary.
  • Mileage and food costs for daily long-distance trips.
  • Methadone treatment that extends beyond 18 months.

What Should Advocates Do?

Encourage clients to apply for medical transportation if they appear eligible. If denied, investigate whether to request a hearing.

What Should Clients Do?

Apply for necessary medical transportation expenses. Document expense by keeping receipts and other evidence that indicates how much money is being paid and to whom.

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee.

You can locate various sources of legal and related services, including the free legal aid office that serves your county, at <a href="http://michiganLegalaid.org">MichiganLegalAid.org</a>.

You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.

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