Section 7 AAC 120.410 - Prior authorization for nonemergency transportation services(a) The department will pay for the least expensive mode of nonemergency transportation to and from an appointment with the closest appropriate provider for a recipient if the (1) services are medically necessary and covered under 7 AAC 105 - 7 AAC 160;(2) provider is enrolled under 7 AAC 105.210 at the time the travel occurs; and(3) recipient does not have transportation available on the recipient's own or through any voluntary source.(b) In determining the mode of nonemergency transportation authorized, the department will consider the (1) recipient's physical and mental condition;(2) distance to the appointment;(3) length of time that travelling to the appointment will take; and(4) availability of commercial transportation providers.(c) Payment for nonemergency transportation services, except for transportation services described under (i) of this section and services authorized under 7 AAC 110.210(c) and (d), requires prior authorization by the department.(d) The recipient's health care provider shall request prior authorization for nonemergency transportation and accommodation services on behalf of the recipient by submitting a request to the department or its designee. If accommodation services are necessary, the provider shall request prior authorization for accommodation services at the same time that the provider requests prior authorization for nonemergency transportation services.(e) The department will pay for changes to nonemergency transportation services authorized under this section if a recipient is forced to change authorized travel plans for reasons beyond the recipient's control, including the cancellation of an airline flight due to weather conditions or the closing of an airport for security reasons, or if the recipient's provider determines that the recipient must stay longer than previously approved because the medical service for which the recipient traveled reveals the need for additional services, screening, or treatment. The recipient's provider shall notify the department or its designee of the change in the recipient's travel plans immediately upon becoming aware that the change is necessary, but not later than the next business day.(f) Payment for rescheduled travel that occurs(1) not later than the month following the originally authorized travel dates does not require a new prior authorization from the department;(2) later than the month following the originally authorized travel dates requires a new prior authorization from the department.(g) If a recipient's travel plans change for a reason not described in (e) of this section, the department will not pay to change or rebook a flight unless, before the departure of the flight, the recipient, the recipient's escort, or the recipient's provider notifies the Medicaid travel office that originally arranged the travel.(h) The department will not pay for the following nonemergency transportation services: (1) the cost to change or reschedule a flight and the remainder of a cancelled itinerary when a flight is missed for reasons that are within the control of the recipient, including a recipient's failure to (A) arrange for timely transportation to the airport;(B) arrive at the airport early enough to meet airport, airline, and security check-in requirements;(C) take an identification card that meets the requirements of the United States Department of Homeland Security, Transportation Security Administration; and(D) behave in a manner that is consistent with airport, airline, and security requirements;(2) travel on a charter air service, unless the department, but not a department designee, determines that a delay of travel until a commercial flight is available will be detrimental to the health of the recipient.(i) A claim submitted to the department for the cost of nonemergency ground and air ambulance transportation service must be accompanied by written medical justification for the service.Eff. 2/1/2010, Register 193; am 5/1/2016, Register 218, July 2016; am 9/1/2017,Register 223, October 2017 ; am 7/1/2020,Register 234, July 2020Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040