A.Purpose: The program provides reimbursements for medically necessary transportation for recipients of medical assistance, excluding the Medicare Cost Sharing programs.
B.Eligibility determinations:
1.Services for children under age 21 and adults who are eligble for medical assistance will be authorized by the DFS-CO using the HCF PC-T002.
2.The Public Health nurse will request transportatoin only for CSH/MCH clients and families who are not eligible for medical assistance. Using the HCF PC-T002 or HCF PC-T003. See Benefits Processing.
C.Selection of transportation for adults and children:
1.Authorize the least expensive appropriate type of transportation;
2.Utilize community Resources whenever possible considering the client's mental and physical condition.
3.The types of transportation that may be considered are:
a.Private vehicles -
(1)All travel is based on map miles;
(2)The DFS-CO may approve transportation services for Adults within town if the DFS-CO manager or designee determines it will avoid more costly emergency services;
(3)Payments may be made directly to the individual who furnishes transportation, i.e., the Recipient, family members, friends or neighbors, etc.
b.Public transit -
(1)The Wyoming Department of Transportation subsidizes public transportation carriers in Wyoming for intra-city and some limited inter-city service (see Table XXI);
(2)Advance reservations are required in some areas.
c.Taxi - Payments may be made for travel within town when it is the least costly mode of transportation for the recipient's medical condition.
d.Bus - Payments may be made for travel in state or out-of- state when it is the least costly mode of transportation for the recipient's medical condition and time and distance allows.
e.Airline -
(1)Air travel must be the last resort for transportation but may be allowed when time, distance or less cost makes air travel the most appropriate;
(2)Payments may be made when the recipient requires medical services not Available in the state and has been referred by a Wyoming physician.
4.Transportation restrictions:
a.Transportation within town is limited to emergency/ urgent cases (not requiring transportation by an ambulance) and Health Check (formerly EPSDT) appointments;
b.Services may be provided in border cities when:
(1)The service is not available locally; and
(2)The border city is closer than a major city in Wyoming;
(3)Referral has been made by a Wyoming physician.
c.Transportation within the Wyoming medical services area includes Wyoming and selected border cities in adjacent states as follows, questions regarding areas not listed below are to be directed to WDH:
(1)Colorado - Craig
(2)Idaho - Montpelier, Pocatello & Idaho Falls
(3)Montana - Billings & Bozeman
(4)Nebraska - Kimball & Scottsbluff
(5)South Dakota - Spearfish, Deadwood, Custer, Belle Fourche & Rapid City
(6)Utah - Salt Lake City & Ogden
d.Services must be provided in Wyoming if available within a Reasonable distance of the recipient's Home;
e.Questions regarding whether or not a service is available in Wyoming are to be directed to WDH.
D.Transportation reimbursement rates:
1.Transportation by private automobile will be reimbursed at the rate of:
a.Ten cents per mile for an adult in Need; or
b.Fifteen cents per mile for a child in need; or
c.Fifteen cents per mile if the parent is traveling to visit a child in need.
2.Transportation provided by taxi, bus or airplane will be reimbursed at the rate which is usual and customary to the general public.
E.Per diem:
1.This program will cover per diem (to be used for meals and lodging) for recipients under the age of 21 and attendant(s) at the rate of $25 per person per day;
2.A maximum of two attendants will be reimbursed, if medically necessary to ensure the safe transporting of a child;
3.For inpatient stays, per diem is not available for the child, but will cover the parent, Guardian, or attendant(s) who accompany the child.
4.The program will cover per diem when the child is receiving EqualityCare covered services and the trip cannot be completed in the same day;
5.Verification must be provided with the date, place, amount and nature of services performed. Failure to provide verification will cause a delay in Payment.
F.Benefit processing:
1.Process benefits according to the following guidelines:
a.Assure the transportation requested is appropriate;
b.DO NOT require prior authorization from the WDH for transportation services, unless there is an exception to the above policy;
c.Require a request for transportation assistance to be made at least one week in advance whenever possible;
d.Require any request for a retroactive service to be made within one Month of the date of service;
e.Process the travel expenses requested by the Public Health Nurse;
f.Authorize the request on the HCF PC-T-002, Travel Authorization Form;
g.Require the recipient receiving travel reimbursement to sign the Travel Authorization (HCF PC-T-002) Form upon receipt of the warrant:
(1)Require the form to be filled out by the Public Health Nurse and/or DFS-CO approving the travel;
(2)Allow the client to pick up the warrant at the DFS-CO and sign the form; or
(3)Allow the client to request the form be mailed with the warrant;
(4)Inform the recipient failure to return the signed form could affect future travel requests;
(5)File the form in the recipient’sCase record.
2.Authorize payments to vendors or private parties.
G.Transportation log:
1.Enter reimbursement information on the Transportation Log after each transaction;
2.Submit a correct copy of the Transportation Log to ACS/Consultec for reimbursement at the end of each month;
3.Understand reimbursements will be made by ACS/Consultec only when the request is received within one year from the service date on the Transportation Log.
H.Refunds:
1.Require the recipient to refund transportation funds given in advance to the authorizing DFS-CO if the recipient misses or cancels her/his appointment;
2.Allow the money to be used for travel to a rescheduled appointment if the recipient reschedules;
3.Delete the information from the Transportation Log prior to submitting to ACS/Consultec if the appointment has been missed or canceled within the same month as it was authorized;
4.Make a refund to ACS/Consultec if the Transportation Log has been submitted and reimbursement has been received by the local DFS-CO.
I.Benefit procedure: Examine the following flow chart for an outline of the above procedures.
