isi IDEC specified by the Secretary. Virgin Islands Transportation Provided: No limitations With limitations Description provided TN No.
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From this document you will learn the answers to the following questions:
What type of air ambulance services are provided?
What is provided only when the recipient has a life threatening condition?
What is one type of non emergency travel that the Medicaid Agency provides?
Transcription
1 State/Territory: Virgin Islands Attachment 3.1 -A y; Page 9 isi AMOUNT, DURATION AND SCOPE OF MEDICAL AND REMEDIAL CARE AND SERVICES PROVIDED TO THE CATEGORICALLY NEEDY 24. Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary. a. Transportation b. Services of Christian Science Nurses c. Care and services provided in Christian Science sanitoria d. Nursing facility services for patients under 21 years of age e. Emergency hospital services f. Personal care services in recipient's home, prescribed in accordance with a plan oftreatment and provided by a qualified person under supervision of a registered nurse. Description provided TN No c on attachment. TN No IDEC 1009 Date Effective Date 04/01/ 2009
2 State/Territory: Attachment 3.1 Ḇ pcpcv l Page tait 9 Virgin Islands AMOUNT, DURATION AND SCOPE OF MEDICAL AND REMEDIAL CARE AND SERVICES PROVIDED TO THE CATEGORICALLY NEEDY 24. Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary. a. Transportation b. Services of Christian Science Nurses c. Care and services provided in Christian Science sanitoria d. Nursing facility services for patients under 21 years of age e. Emergency hospital services f. Personal care services in recipient's home, prescribed in accordance with a plan of treatment and provided by a qualified person under supervision of a registered nurse. Description provided on attachment. TN No c TN No IDEC O , Date Effective Date 04/01/ 2009
3 State: Territory of the Virgin Islands Attachment 3.1 -D Page 1 e EctplIk Y Methods of Providing Transportation to Medical Assistance Recipients t 1. Transportation and other related travel services incident to securing medically necessary care and/or treatment are provided when prior authorization is obtained from the Medicaid Agency and when transportation is not otherwise available. 2. Transportation is paid as an expense of administration. 3. Kinds of travel covered: a. Same island travel: emergency and non emergency; b. Inter- island travel: emergency and non emergency; and c. Off island - travel to Puerto Rico or to the contiguous United States: emergency and nonemergency. 4. Methods of travel: a. Same island non emergency travel, when transportation is not otherwise available through the recipient's family, friends or community resources who will provide the service free, will include bus, taxi, automobile, ground ambulance, and common carriers. Non- emergency travel to receive pharmacy services will be provided only when transportation is not otherwise available through the recipient's family, friends or community resources who will provide the service free and the pharmacy home delivery service. Emergency ambulance services shall be provided only when it is a medical emergency and when the recipient has a life threatening condition and requires immediate travel to the nearest medical facility able to provide required services. does not have a b. Inter island non emergency travel will include airplanes, seaplanes, boat and air ambulance services. The Medicaid Agency will provide for transportation via bus, taxi, automobile, ground ambulance or common carrier for travel from airports or lodging establishments to the medical care or facility where the recipient is receiving medically necessary services when it is not otherwise available through the recipient's family, friends or community resources who will provide the service free. Emergency air ambulance services shall be provided only when it is a medical emergency and when the recipient has a life threatening condition and requires facility able to provide required services. c. Off - immediate travel to nearest medical United States will island non emergency travel to Puerto Rico and the contiguous include commercial airplanes and air ambulances. Emergency shall be provided only when it is a medical emergency and when the recipient air ambulance services has a life flee NS Date 106to TN No. New New Effective Date 4/1/ 09
4 State: Territory of the Virgin Islands ti 1. Attachment 3.1 -D Page2 threatening condition and requires immediate travel to nearest medical facility able to provide required services. Once in Puerto Rico or the contiguous United States the Medicaid Agency will provide for transportation via bus, taxi, automobile, ambulance or establishments to the medical care or common carrier for travel from airports or lodging facility where the recipient is receiving through the recipient's family, friends or community resources who will provide the service free. needed services when it is not otherwise available 5. Arrangements for travel: The Medicaid Agency is responsible for making the necessary arrangements for travel. Medicaid Agency staff shall coordinate such arrangements with family, responsible referring agencies, social service or nursing staff, and/or staff at the medical facility where the recipient is receiving needed services as appropriate. 6. Factors considered in selecting means of travel: a. The Medicaid Agency shall consider the recipient's medical needs, as well as least expensive available transportation that will serve the medical needs of the recipient when determining the type oftravel to be provided. b. The Medicaid Agency is not obliged to provide transportation when it is not medically necessary or it is provided in a manner which is beyond reasonable measures. Non emergency medical transportation will only be provided to eligible recipients when it is necessary for them to access medically necessary services covered under the State Plan. Transportation will be provided to the closest available provider of the services required to treat the patient's medical condition. 7. Coverage for Attendant/Escort: In addition to providing same island, inter island and off island transportation to the recipient, the Medicaid Agency will cover same island, interisland and off island - transportation for one parent or attendant/escort for all minor children and individuals with a legal guardian assigned to them. The Medicaid Agency will provide meals and lodging for the attendant/escort when accompanying a minor child or adult with a legal guardian assigned to them receiving medically necessary health care at a facility not on their home island (includes inter island - and off island). All transportation, meals and lodging for attendants /escorts shall be prior authorized by the Medicaid Agency. 8. Administrative Controls a. Prior authorization is required for all transportation except for: 1) ( same- island emergency ambulance service; (2) inter - and (3) off island - emergency air ambulance. Although prior authorization is not required, the Medicaid Agency requires written notification within 24 hours of any off island emergency air ambulance service utilization and this service is subject to posttreatment review by the Medicaid Agency. island emergency air or boat ambulance services; The evaluation of referrals for off island - care TN No. New a ew Q Q Date Effective Date 4/1/ 09
5 State: Territory of the Virgin Islands OFF! d Attachment 3.1 Ḏ Page 3 involves also the medical and /or social need of escort and type of escort whether relative, nurse or doctor. a. The Medicaid Agency assures that the most appropriate plan for recipient implemented. travel is b. The Medicaid Agency prepares official documents and provides proper travel related instructions to the recipient and attendant/escort if ( applicable). 9. Reimbursement Emergency services provided by the Department of Health will be reimbursed according to the Medicare fee schedule. For all other transportation providers, according to 42 CFR , the Medicaid Agency will pay customary charges of transportation providers, but not more than the prevailing charges for comparable services under comparable circumstances. The Medicaid Agency will conduct annual surveys of transportation providers to ascertain the prevailing charges. Date i DEC Effective Date 4/1/ 09 TN No New
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