016-06-06 Ark. Code R. § 18
ATTACHMENT 3.1-A
Effective for dates of service on or after December 1, 2001, public transportation services are available when provided by an enrolled Medicaid public transportation provider to an eligible Medicaid beneficiary being transported to or from a medical facility to receive medical care services covered by the Arkansas Medicaid Program. Transportation will be covered from the point of pick-up to the medical facility or from the medical facility to the point of delivery. The following benefit limits are established. One unit of service = 1 mile. The benefit limits do not apply to EPSDT beneficiaries.
Effective for dates of service on or after January 1,2006, public transportation services are available when provided by an enrolled Medicaid public transportation provider to a full benefit dual eligible being transported to or from a pharmacy to receive prescriptions covered under the Medicare Prescription Drug Benefit- Part D.
X Public Transportation, Taxi, Intra-City, One Way - may be billed once per day, per beneficiary for a maximum of 15 units. Extensions of the established benefit limits will be considered if medically necessary. The provider must request an extension.
X Public Transportation, Taxi, Intra-City, Round Trip - may be billed once per day, per beneficiary for a maximum of 30 units. Extensions of the established benefit limits will be considered if medically necessary. The provider must request an extension.
X Public Transportation, City-to-City - may be billed once per day, per
beneficiary for a maximum of 50 units. Extensions of the established benefit limits will be considered if medically necessary. The provider must request an extension.
X Public Transportation, ADA Accessible Van, Intra-City, One Way - may be billed once per day, per beneficiary for a maximum of 15 units. The provider may request an extension of the benefit limit if medically necessary by submitting documentation including the purpose of the trip and the provider=s name and address.
X Public Transportation, ADA Accessible Van, Intra-City, Round Trip - may be billed once per day, per beneficiary for a maximum of 30 units. The provider may request an extension of the benefit limit if medically necessary by submitting documentation including the purpose of the trip and the provider=s name and address.
X Public Transportation, ADA Accessible Van, Intrastate Authority - may be billed once per day, per beneficiary for a maximum of 50 units. The provider may request an extension of the benefit limit if medically necessary by submitting documentation including the purpose of the trip and the provider=s name and address.
Effective for dates of service on or after December 1, 2001, non-public transportation services are available when provided by an enrolled Medicaid transportation provider to an eligible Medicaid beneficiary transported to or from a medical provider to receive medical services covered by the Arkansas Medicaid Program. Transportation will be covered from the point of pick-up to the medical service delivery site and from the medical service delivery site to the beneficiary=s return destination.
Effective for dates of service on or after January 1, 2006, non-public transportation services are available when provided by an enrolled Medicaid non-public transportation provider to a full benefit dual eligible being transported to or from a pharmacy to receive prescriptions covered under the Medicare Prescription Drug Benefit- Part D.
The following benefit limits are established. The benefit limits do not apply to EPSDT beneficiaries.
This service may be billed once per day, per beneficiary for a maximum of 300 miles per date of service.
Effective for dates of service on or after December 1, 2001, public transportation services are available when provided by an enrolled Medicaid public transportation provider to an eligible Medicaid beneficiary being transported to or from a medical facility to receive medical care services covered by the Arkansas Medicaid Program. Transportation will be covered from the point of pick-up to the medical facility or from the medical facility to the point of delivery. The following benefit limits are established. One unit of service = 1 mile. The benefit limits do not apply to EPSDT beneficiaries.
Effective for dates of service on or after January 1,2006, public transportation services are available when provided by an enrolled Medicaid public transportation provider to a full benefit dual eligible being transported to or from a pharmacy to receive prescriptions covered under the Medicare Prescription Drug Benefit- Part D.
X Public Transportation, Taxi, Intra-City, One Way - may be billed once per day, per beneficiary for a maximum of 15 units. Extensions of the established benefit limits will be considered if medically necessary. The provider must request an extension.
X Public Transportation, Taxi, Intra-City, Round Trip - may be billed once per day, per beneficiary for a maximum of 30 units. Extensions of the established benefit limits will be considered if medically necessary. The provider must request an extension.
X Public Transportation, City-to-City - may be billed once per day, per
beneficiary for a maximum of 50 units. Extensions of the established benefit limits will be considered if medically necessary. The provider must request an extension.
X Public Transportation, ADA Accessible Van, Intra-City, One Way - may be billed once per day, per beneficiary for a maximum of 15 units. The provider may request an Extension of the benefit limit if medically necessary by submitting documentation including the purpose of the trip and the provider=s name and address.
X Public Transportation, ADA Accessible Van, Intra-City, Round Trip - may be billed once per day, per beneficiary for a maximum of 30 units. The provider may request an Extension of the benefit limit if medically necessary by submitting documentation including the purpose of the trip and the provider=s name and address.
X Public Transportation, ADA Accessible Van, Intrastate Authority - may be billed once per day, per beneficiary for a maximum of 50 units. The provider may request an extension of the benefit limit if medically necessary by submitting documentation including the purpose of the trip and the provider=s name and address.
Effective for dates of service on or after December 1, 2001, non-public transportation services are available when provided by an enrolled Medicaid transportation provider to an eligible Medicaid beneficiary transported to or from a medical provider to receive medical services covered by the Arkansas Medicaid Program. Transportation will be covered from the point of pick-up to the medical service delivery site and from the medical service delivery site to the recipient=s return destination.
Effective for dates of service on or after January 1, 2006, non-public transportation services are available when provided by an enrolled Medicaid non-public transportation provider to a full benefit dual eligible being transported to or from a pharmacy to receive prescriptions covered under the Medicare Prescription Drug Benefit- Part D.
The following benefit limits are established. The benefit limits do not apply to EPSDT beneficiaries.
This service may be billed once per day, per beneficiary for a maximum of 300 miles per date of service.
016.06.06 Ark. Code R. § 018