7 AAC 43.502. Transportation and accommodation services; general requirements

(a) The department will pay for only those transportation and accommodation services that are

(1) medically necessary;

(2) authorized by the department; and

(3) performed by an Alaska provider or an out-of-state provider that is enrolled as a Medicaid provider in Alaska at the time the services are performed.

(b) A Medicaid recipient's health care provider shall request authorization for medically necessary transportation and accommodations for the recipient. The health care provider shall request authorization for accommodation services at the same time it requests authorization for transportation services.

(c) The department may pay for the least expensive means of transportation for a recipient and an authorized escort. In determining how much the department will pay in accordance with State and federal law, the department may consider the recipient's medical condition, distance to the place of treatment, and availability of transportation providers.

(d) The department may approve costs for transportation and accommodations outside the recipient's community of residence to obtain medically necessary services for the recipient if

(1) the total cost for those services with transportation and accommodation costs included is less than the cost of the services at a facility within the recipient's community of residence; or

(2) the recipient is an American Indian or Alaska Native who has requested services at a tribal health facility outside the recipient's community of residence.

(e) The department will not pay for the following:

(1) transportation or accommodations that the department determines to be excessive or inappropriate for the distance traveled or inconsistent with the medical needs of the recipient;

(2) transportation for a recipient two years of age or younger if the department pays the cost for an escort to accompany the child, unless the condition of the child prevents the child from riding in the same seat as the escort;

(3) transportation for a recipient who is an inpatient in an acute care hospital to be transported to another location to receive medical services if the recipient remains a patient in the acute care hospital while absent and is to be returned to the acute care hospital;

(4) transportation and accommodations for a recipient or an authorized escort to travel to a health care provider, other than a military or veterans facility, that is not enrolled as a Medicaid provider by the department at the time the travel occurs;

(5) transportation and accommodations on weekends if travel on a weekday would shorten the length of the trip and the weekend travel is not medically necessary;

(6) ground transportation, including travel by automobile, taxi, and bus, for a recipient to travel to a health care provider within the recipient's community of residence, unless the recipient's medical condition justifies the need for the transportation or an undue hardship would result from a denial of the claim;

(7) separate accommodations for a recipient and escort, unless justified by special circumstances.

History: Eff. 6/24/2004, Register 170

Authority: AS 47.05.010

AS 47.07.030

AS 47.07.040

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