Section 210-RICR-20-00-2.5 - Covered ServicesCovered Services - The Medicaid Program covers emergency and NEMT. Ground transportation is covered and provided for when the individual is a Medicaid beneficiary and is receiving a Medicaid-covered service.
2.5.1Emergency TransportationA. When medical services are obtained at a hospital participating in the Medicaid program, it is the responsibility of the hospital or emergency department staff to provide and pay for appropriate transportation home if needed.B. For Medicaid managed care beneficiaries, emergency transportation is provided by the managed care organization. Billing for this service is through the managed care organization.C. For Medicaid fee-for-service beneficiaries, emergency transportation is provided by the Medicaid fee-for-service program. Billing for this service is through the Medicaid fee-for-service program.2.5.2Non-Emergency Medical Transportation (NEMT)A. NEMT is provided when the Medicaid beneficiary has no other means of transportation, no other community resource exists, such as family and friends, and transportation by any other means would endanger the individual's health or safety. NEMT may be provided by ambulance if this mode is medically necessary. A physician/clinician written statement or attestation will be required.B. To be eligible for NEMT services, Medicaid beneficiaries must be unable to find alternative transportation and require transportation services for medical/health visits that are part of a total patient plan of care supervised and ordered by a health care professional. 1. Escorts a. If medically justified and communicated during the reservation to the State's transportation management authority, an additional person can be permitted to accompany a beneficiary.b. An escort must accompany all children under the age of 18 years.c. Adult beneficiaries who need transportation to their own medical appointments may have a child accompany them.2. More than one beneficiary may be transported by the same vehicle on the same trip, provided: a. Adequate seating and safety restraints are available for all passengers.b. The health and safety of any of the passengers is not compromised.c. Passengers must not have their trip lengthened by more than 30 minutes due to increasing the number of passengers in the same vehicle.2.5.3Out-of-State Non-Emergency Medical TransportationA. Transportation to communities that closely border Rhode Island may be provided for Medicaid-covered services and as pre-authorized by the transportation management authority subject to review and approval of the State, as needed. See § 2.20 of this Part for a list of border communities.B. With the exception of transportation to communities that closely border Rhode Island, NEMT for out-of-state trips will only be considered for payment when the service is medically necessary and the Medicaid-covered service is either not available in Rhode Island or there are other extenuating medical circumstances.C. All out-of-state NEMT, with the exception of NEMT to border communities, requires prior authorization from the State's transportation management authority.2.5.4Nursing Facility ResidentsA. NEMT: An individual residing in a nursing facility whose condition precludes transportation by the facility vehicle to and from a physician's office, medical laboratory, hospitals, etc., may be transported for non-emergency medical services when: 1. Patient cannot be transported by any other means through the facility; and2. Required medical service cannot be provided within the facility, such as portable x-ray services provided in a facility setting; and3. Facility has exhausted all other alternative means (including transportation by family or friends) whenever possible.B. Emergency medical transportation: services can only be provided when a patient is severely ill or injured and transportation by any other means would endanger the individual's health or safety.210 R.I. Code R. 210-RICR-20-00-2.5
Amended effective 1/1/2019
Amended effective 7/22/2020