Section 405IAC5-30-3. Noncovered transportation services

   Medicaid reimbursement is not available for the following transportation services:

(1) One-way trips exceeding twenty (20) per member, per rolling twelve (12) month period of time, except when additional trips are medically necessary and the same is demonstrated and documented through the prior authorization process. The services identified in section 1(1) of this rule are exempt from the numeric cap and do not require prior authorization, except as specified in section 1(2) of this rule.

(2) Trips of fifty (50) miles or more one (1) way unless prior authorization is obtained.

(3) The first thirty (30) minutes of waiting time for any type of Medicaid covered conveyance, including ambulance.

(4) Nonemergency transportation provided by any of the following:

(A) A volunteer with no vested or personal interest in the member.

(B) An interested individual or neighbor of the member.

(C) A case worker or social worker.

(5) Ancillary nonemergency transportation charges, including, but not limited to, the following:

(A) Parking fees.

(B) Tolls.

(C) Member meals or lodging.

(D) Escort meals or lodging.

(6) Disposable medical supplies, other than oxygen, when provided by a transportation provider.

(7) Transfer of durable medical equipment, either from the member's residence to place of storage, or from the place of storage to the member's residence.

(8) Charges for use of red lights and siren in emergency ambulance call.

(9) All interhospital transportation services, except when the member has been discharged from one (1) hospital for the purpose of admission to another hospital.

(10) Delivery services for prescribed drugs, including transportation of a member to or from a pharmacy to pick up a prescribed drug.

(Office of the Secretary of Family and Social Services; 405 IAC 5-30-3; filed Jul 25, 1997, 4:00 p.m.: 20 IR 3358; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA; filed Aug 1, 2016, 3:44 p.m.: 20160831-IR-405150418FRA; errata filed Nov 1, 2016, 9:36 a.m.: 20161109-IR-405160493ACA)