Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-5550 - Nonemergency transportation-Exclusions and limitations

Current through Register Vol. 24-14, July 15, 2024
(1) The following
				  service categories listed in WAC
				  182-501-0060 are subject to the
				  following exclusions and limitations:
(a)
				  Adult day health (ADH) - Nonemergency transportation for ADH services is not
				  provided through the brokers. ADH providers are responsible for arranging or
				  providing transportation to ADH services.
(b) Against medical advice (AMA) discharges -
				  Nonemergency transportation is not provided through the brokers for clients
				  that elect to discharge from a facility or hospital AMA.
(c) Ambulance - Nonemergency ambulance
				  transportation is not provided through the brokers except as specified in WAC
				  182-546-5200(2)(e).
(d) Emergency department (ED) - When a client
				  is discharged from the ED, brokers may provide transportation only to another
				  medicaid-covered service or to the client's residence.
(e) Hospice services - Nonemergency
				  transportation is not provided through the brokers when the health care service
				  is related to a client's hospice diagnosis. See WAC
				  182-551-1210.
(f) Medical equipment, durable (DME) -
				  Nonemergency transportation is not provided through the brokers for DME
				  services, except for complex rehabilitation technology (CRT) and DME equipment
				  that needs to be fitted to the client (such as braces/crutches,
				  wheelchairs).
(g) Medical nutrition
				  services - Nonemergency transportation is not provided through the brokers to
				  pick up medical nutrition products.
(h) Medical supplies/equipment, nondurable
				  (MSE) - Nonemergency transportation is not provided through the brokers for MSE
				  services.
(i) The following mental
				  health and substance use disorder services:
(i) Nonemergency transportation brokers
				  generally provide one round trip per day. The broker must request agency
				  approval for additional trips for off-site activities.
(ii) Nonemergency transportation of an
				  involuntarily detained person under the Involuntary Treatment Act (ITA) is not
				  a service provided or authorized by transportation brokers. Involuntary
				  transportation is a service provided by an ambulance or a designated ITA
				  transportation provider.
(iii)
				  Nonemergency transportation is not provided through the brokers to or from
				  information and assistance services which include:
(A) Alcohol and drug information
				  school;
(B) Information and crisis
				  services; and
(C) Emergency service
				  patrol.
(j)
				  Program of all-inclusive care for the elderly (PACE)-nonemergency
				  transportation for clients in the PACE program is not provided through the
				  brokers. The PACE contractor is responsible for transportation to PACE
				  services.
(k) Standalone pharmacy
				  trips - Transportation that occurs solely for the purpose of picking up a
				  medication prescribed by a health care provider from a pharmacy.
(i) The broker may provide mileage
				  reimbursement to the client or coordinate a standalone pharmacy trip only when:
(A) The client cannot receive the medication
				  through the mail and such transportation assistance has been requested two
				  business days in advance; or
(B)
				  Documentation from a medical professional has been provided to the broker that
				  indicates medication was prescribed for a condition that requires urgent
				  treatment.
(ii) A
				  standalone pharmacy trip that meets the conditions of (k) of this subsection is
				  restricted to one trip per week per household, unless documentation from a
				  medical professional indicates the medication must be picked up
				  urgently.
(iii) Documentation of
				  medical necessity from the client's health care provider, pharmacy, or other
				  medical professional is required before the broker can authorize a standalone
				  pharmacy trip more frequently than once a week per household.
(iv) If the client has a scheduled trip to an
				  eligible medical appointment in the same week as a pharmacy pick up, the
				  prescription must be picked up when in route to or from the medical
				  appointment. See WAC
				  182-546-5600(3)(b).