“Assurance of Transportation” 42 CFR Section 431.53 states that; “a state plan must specify that the medical agency will ensure necessary transportation for recipients to and from providers; and describe the methods that the agency will use to meet this requirement.” The word “transportation” encompasses the expenses of transportation and other related travel costs deemed imperative by the Medicaid agency to book medical examinations as well as treatment for the beneficiary.
An emergency transport is essential in all events that put the health and life of a Medicaid beneficiary at any critical risk if treatment is postponed. The occurrences of real emergencies happen when the medical requirements of a beneficiary are instantaneous because of acute symptoms. Symptoms may arise because of an event that is life-threatening such as a heart attack, car accident etc. Medicaid will reimburse the providers of emergency transportation when they provide services to qualified beneficiaries conforming to the guidelines.
Non-emergency medical transport or NEMT is for those eligible medical beneficiaries that need a ride to and from appointments and services. Non-emergency medical transports are for those who are in need of medical support but are medically solid. The rules of individual states are different; the providers hold the culpability of knowing the program rules of their state. States are entrusted in ensuring that services are proper and provided following Medicaid rules; that the need of a beneficiary are met and the providers are paid correctly.
The cost for non-emergency medical transportation is pointedly lower than emergency transportation. This happens because the crew of the long distance medical transport isn’t employing medical interference to protect the patient’s life during the trip as well as the fact that the trip is much safer because the driver/pilot doesn’t need to rush to a medical facility. The capability to plan the trip also decreases costs, since it can be planned for a normal working shift, without the need to solicit overtime or add working hours from transportation costs.
The code of Federal Regulations commands that states; “specify that the Medicaid agency will ensure necessary transportation for beneficiaries to and from providers; and describe the methods that the agency will use to meet the requirement.” For most acceptability is figured by weighing an individual’s income and assets (sometimes) against resource standard income. Those who have income/resources under the standard are declared qualified. Those that are qualified for Medical benefits may or may not be eligible for transportation services. In order to be eligible states may necessitate that there’s a transportation requirement that is unfulfilled. This may include; not having a valid driver’s license, no working vehicle in the household, ineptitude to travel or wait for services alone or physical, cognitive, mental or developmental limitation(s).