Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 05 - Developmental Disabilities Services › Rule 016.05.18-001 - Transportation 1-18 and State Plan Amendment #2018-009

Current through Register Vol. 49, No. 6, June, 2024
Section II
Transportation
260.000 EARLY 1NTERVATION DAY TREATMENT
			 (EIDT) AND ADULT DEVELOPMENTAL DAY TREATMENT (ADDT) TRANSPORTATION
261.000 Arkansas Medicaid Participation
			 Requirements for EIDT and ADDT Transportation Providers
Non-emergency medical transportation will be provided by the
				transportation broker for the region in which the beneficiary lives with the
				exception of transportation to and from an Early Intervention Day Treatment
				(EIDT) or an Adult Developmental Day Treatment (ADDT) center when the
				transportation is provided by the EIDT or ADDT facility.
272.000 Coverage of EIDT or ADDT
			 Transportation Services
Transportation provided by an EIDT or ADDT transportation
				providers is a covered service only for Medicaid eligible beneficiaries who are
				being transported to and from an EIDT or ADDT facility. Transportation by an
				EIDT or ADDT of Medicaid beneficiaries to and from other medical providers is
				not covered.
The Medicaid Program covers EIDT or ADDT transportation for
				"loaded miles" only. For purposes of this manual, "loaded miles" is that part
				of the trip in which a Medicaid beneficiary is a passenger in an EIDT or ADDT
				vehicle and is being transported either from the point of pickup to the
				facility or from the facility to the point of delivery. The exact address where
				the beneficiary is picked up and delivered must be documented in the EIDT or
				ADDT transportation provider's records.
272.100 Trips With Multiple Medicaid
			 Beneficiaries
If more than one Medicaid beneficiary is transported at the
				same time to the same location, Medicaid may be billed only for one
				beneficiary. If more than one Medicaid beneficiary is transported at the same
				time to different locations, the provider may bill only for the beneficiary
				traveling the farthest distance, (For purposes of this manual, the farthest
				distance means the beneficiary on the route who lives the farthest away from
				the facility.)
The provider must keep a record of all persons being
				transported. If the person is a Medicaid beneficiary, the beneficiary's
				Medicaid identification number must also be recorded in the provider's records.
				The provider must complete the EIDT/ADDT Transportation Log (Form DMS-638) each
				time a client is transported to or from the facility.
View or print
				EIDT/ADDT Transportation Log Form DMS-638.
272.200 Mileage Calculation
Mileage calculation is based on the odometer mileage for the
				Medicaid beneficiary traveling the farthest distance. The odometer mileage will
				be determined based on the following:
A. From the point of pickup of the first
			 Medicaid beneficiary to the facility.
B. From the facility to the last Medicaid
			 beneficiary's point of delivery.
The route taken when transporting the clients must be
				reasonable and must be planned to minimize the beneficiaries' time spent in
				route to and from the facility (i.e.. must pick up the beneficiary farthest
				from the facility first and drop him or her off last). The provider must not
				take unnecessary extended routes to increase the mileage.
See Section 290.000 of this manual for billing
				procedures.
273.000 Record Requirements for EIDT and ADDT
			 Transportation Providers DDTCS transportation providers are required to keep
			 written documentation of records to support the services actually furnished.
			 The following records must be maintained:
A.
			 EIDT and ADDT transportation providers must complete the EIDT/ADDT
			 Transportation Log {Form DMS-638) each time a client is transported to or from
			 the DDTCS facility. The following information must be recorded on the EIDT/ADDT
			 Transportation Log:
1. Provider's
			 name.
2. The date and time of each
			 pickup and delivery.
3. Provider's
			 identification number.
4. Vehicle
			 description, including the vehicle identification number and license plate
			 number.
5. Driver's name.
6. Attendants' name, if applicable.
7. Odometer reading and total
			 mileage,
8. The names of all
			 persons transported.
9. The exact
			 address of a pickup and/or delivery point must be recorded on the log when the
			 client is picked up or delivered to an address that is different from the
			 address listed in the client's file. {The provider must provide documentation
			 in the client's file of the reason(s) for a different address pickup and/or
			 delivery.)
B. The exact
			 address where the client is scheduled to be picked up and delivered according
			 to the client's file.
C. The
			 Medicaid identification number of each Medicaid beneficiary,
274.000 Retention of Records
			 7-1-1B
EIDT and ADDT transportation providers must maintain all
				required records for a period of five (5) years from the last date of service
				or until all audit questions, appeal hearings, investigations or court cases
				are resolved, whichever is longer. The records must be made available during
				normal business hours to authorized representatives of the Arkansas Department
				of Human Services, Arkansas Division of Medical Services, the State Medicaid
				Fraud Unit, and representatives of the Department of Human Services and its
				authorized agents or officials. Failure to furnish records upon request will
				result in sanctions being imposed.
All documentation must be made available to representatives of
				the Division of Medical Services at the time of an audit by the Medicaid Field
				Audit Unit. All documentation must be available at the provider's place of
				business. If an audit determines that recoupment is necessary, there will be no
				more than thirty (30) days after the date of the recoupment notice in which
				additional documentation will be accepted.
275.000
PRIOR
			 AUTHORIZATION
Prior Authorization is not applicable to Transportation
				Services provided by EIDT or ADDT providers in Arkansas.
281.000 Method of Reimbursement for EIDT and
			 ADDT Transportation
Providers
The Medicaid Program reimburses the lesser of the billed
				charges or the Title XIX maximum allowable. EIDT and ADDT Transportation
				providers are reimbursed on the basis of a rate times loaded miles traveled for
				the eligible Medicaid beneficiary transported the longest distance for each
				trip.
281.100 EIDT/ADDT
			 Transportation Survey
EIDT and ADDT transportation providers are required to prepare
				and submit an annual EIDT/ADDT Survey
(View or print EIDT/ADDT
				Transportation Survey DMS-632)
and other applicable information
				concerning the survey to the Arkansas Department of Human Services Division of
				Medical Services, Provider Reimbursement Unit.
View or print the
				Arkansas Department of Human Services Division of Medical Services. Provider
				Reimbursement Unit contact information.
The survey information will be reported for the provider's
				fiscal period. The survey must be submitted within five {5) months after the
				close of the provider's fiscal year end. Providers with financial reporting
				periods of less than six (6) months are not required to submit a survey.
				However, if no survey is required, the provider must notify the Division of
				Medical Services (DMS) in writing why the survey is not being submitted.
				Failure to submit the completed survey or failure to submit a written
				explanation of a reporting period of less than six (6) months within the
				prescribed period, except as expressly extended by the State Medicaid agency,
				may result in the suspension of reimbursement until DMS receives this
				information.
Survey information requested includes direct and
				indirect/overhead costs, revenues and client mileage information associated
				with and applicable to the EIDT or ADDT Transportation Program. No other
				program costs, revenues or mileage information is to be included on the survey.
				If the provider provides transportation services for programs other than EIDT
				or ADDT programs, please remove the other program costs, revenues and mileage
				information before completing the survey and submit a narrative describing how
				these other transportation program amounts were calculated and removed. All
				cost and revenue amounts are to be reported using the accrual method of
				accounting and will be reported in whole dollar amounts, no cents.
Providers must also submit with the survey a written general
				description of what costs are included with indirect/overhead costs and how
				these costs were identified, calculated and allocated to the EIDT or ADDT
				transportation program.
Providers are required to maintain adequate financial records,
				mileage data and rider data for proper documentation and support of the cost
				and statistical information reported on the annual survey. These records must
				be retained for a period of five years after submission of the survey. The
				surveys, supporting documentation and provider narratives are subject to
				on-site review and inspection by DHS/DMS personnel.
EIDT and ADDT providers may order copies of Form DMS-632 on the
				Medicaid Form Request. Requests may be forwarded to the Hewlett Packard
				Enterprise Provider Assistance Center.
View or print the DXC
				Provider Assistance Center contact Information.
290.000
EIDT/ADDT BILLING
			 PROCEDURES
291.000
			 Introduction to Billing
EIDT and ADDT transportation providers use the CMS-1500 claim
				form to bill the Arkansas Medicaid Program on paper for services provided to
				eligible Medicaid beneficiaries. Each claim should contain charges for only one
				beneficiary.
Section III of this manual contains information about Provider
				Electronic Solutions (PES) and other available options for electronic claim
				submission.
292.100
			 EIDT/ADDT Procedure Codes
Early Intervention Day Treatment (EIDT) providers and Adult
				Developmental Day Treatment (ADDT) providers may choose to provide
				transportation services for their clients as a fee-for-service provider for
				transportation to and from an EIDT or ADDT facility only. EIDT or ADDT
				transportation cannot be claimed for transporting beneficiaries to and from
				other medical providers.
The procedure code A0120 must be used when billing the Medicaid
				Program for EIDT or ADDT transportation services. The Medicaid Program
				reimburses for "loaded miles" only, e.g., from the point of pickup to the EIDT
				or ADDT facility and from the EIDT or ADDT facility to the point of delivery.
				The route must be planned to minimize each beneficiary's time in route (i.e.,
				the facility must pick up the beneficiary who lives farthest away first and
				drop him or her off last). One unit equals one mile. The overall allowable
				one-way mileage for each pickup and delivery trip should be totaled and rounded
				to a whole mile. Mileage will be rounded up if 0.5 or greater and rounded down
				if 0.4 or less.
292.300
			 EIDT and ADDT Transportation Billing Instructions-Paper Only
Bill Medicaid for professional services with form CMS-1500. The
				numbered items in the following instructions correspond to the numbered fields
				on the claim form.
View a sample form CMS-1500.
Carefully follow these instructions to help the Arkansas
				Medicaid fiscal agent efficiently process claims. Accuracy, completeness, and
				clarity are essential. Claims cannot be processed if necessary information is
				omitted.
Forward completed claim forms to the Claims Department.
View or print the Claims Department contact
				information.