La. Admin. Code tit. 50 § XXVII-505

Current through Register Vol. 50, No. 11, November 20, 2024

Section XXVII-505 - Requirements for Coverage

A. Payment shall only be authorized for the least costly means of transportation available. The least costly means of transportation shall be determined by the department or its designee and considered the beneficiary's choice of transportation, the level of service required to safely transport the beneficiary (e.g., ambulatory, wheelchair, transfer), and the following hierarchy:

1. public providers;

2. gas reimbursement providers who are enrolled in the Medicaid Program;

3. non-profit providers who are enrolled in the Medicaid Program; and

4. for-profit providers who are enrolled in the Medicaid Program.

B. Beneficiaries shall be allowed a choice of transportation for-profit providers as long as it remains the least costly means of transportation.

C. Beneficiaries may request NEMT elevated level of care services to and/or from a Medicaid covered service if medically eligible.

1. - 2. Repealed.

D. Beneficiaries are encouraged to utilize healthcare providers of their choice in the community in which they reside when the beneficiary requires Medicaid reimbursed transportation services.

1. Beneficiaries may seek medically necessary services in another state when it is the nearest option available.

2. In the managed care program, transportation will only be approved to and/or from a healthcare provider within the department's geographic access standards, unless granted an exception by the department or its designee.

E. Beneficiaries and healthcare providers should give advance notice when requesting transportation.

La. Admin. Code tit. 50, § XXVII-505

Promulgated by the Department of Health, Bureau of Health Services Financing, LR 471639 (11/1/2021), Amended LR 49, Amended LR 49877 (5/1/2023), Amended LR 501471 (10/1/2024).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.