(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers.
(2) Coverage of transportation and per diem is limited to transportation and per diem necessary to obtain necessary medical services covered by the Medicaid program.
(3) Coverage for transportation and per diem is only available for transportation and per diem to the site of medical services at the provider closest to the locality of the recipient.
(a) The closest provider is determined based on equivalent licensure or certification from the appropriate national or state licensing board without consideration of continuing education credits or units.
(b) The closest provider is determined using providers who are currently accepting Medicaid recipients regardless of any individual client's:
(i) noncompliance with medical treatment plans;
(ii) financial or legal actions pending or filed against the provider; or
(iii) behavior (including but not limited to aggressive, inappropriate communication, failure to keep appointments or to arrive for appointments on time) that may have caused an individual not to be accepted as a patient in a particular practice.
(c) Transportation and per diem to a site, other than the one nearest to the locality of the recipient, is available if the combined total cost to the Medicaid program of medical services and transportation and per diem at the more distant site is less than the total cost to the Medicaid program for the provision of the services in the closest location, or to a Center of Excellence, as defined in ARM 37.86.2901, if prior authorization requirements have been met.
(4) Private vehicle transportation is limited to mileage reimbursement. Reimbursement is not available for any other private vehicle costs or fees.
(5) Coverage of per diem is not available when a round trip can reasonably be made in one day.
(6) Coverage of nonemergent transportation and per diem must be prior authorized by the department or its designee.
(a) If a medical appointment has been rescheduled, any prior authorization of the original appointment does not apply to the rescheduled appointment. Prior authorization must be obtained for the rescheduled appointment.
(7) Coverage of emergent transportation and per diem must be authorized by the department or its designee.
(a) Notification of emergent transportation must be received by the department or its designee within 30 days of the initial emergency treatment.
(8) Reimbursement for transportation is made to the common carrier unless otherwise authorized by the department or its designee.
(9) Coverage of transportation is limited to the least expensive available mode of transportation suitable to the recipient's medical needs plus any applicable per diem.
(10) Coverage of transportation and per diem are not available for transportation and per diem costs incurred during a retroactive eligibility period.
(11) Coverage of transportation and per diem for an attendant is only available for an attendant that is determined to be medically necessary.
(a) Use of an attendant must be prior authorized by the department or its designee.
(b) Coverage of transportation and per diem for an attendant is limited to the same standards and fees as for a recipient.
(c) An attendant must return home after accompanying the recipient to the destination for provision of medical services unless the department or its designee determine that the cost of the attendant's stay for the recipient's course of treatment will be less than the cost of additional transportation costs resulting from the return to home.
(d) Coverage of per diem and transportation is available for a responsible adult to accompany a minor.
(12) If a recipient dies enroute to or during treatment outside of the recipient's community, the cost of the recipient's transportation to the medical service is reimbursable. The cost of returning the body of a deceased recipient is not reimbursable.
(13) Mileage reimbursement is rounded to the nearest whole mile.
(14) Prior authorization is not a guarantee of payment as the department may subsequently deny payment based on factors other than medical necessity, including but not limited to ineligibility of the individual to whom services were provided or failure to comply with billing requirements set forth in ARM 37.85.406 or with any other Medicaid rule or requirement.
(15) Commercial providers are required to maintain and retain original dispatch records for services provided to a Montana Medicaid recipient that include:
(a) name of recipient;
(b) originating address;
(c) destination address;
(f) authorized units;
(g) charges; and
(h) the authorization number.