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November 16, 2006
 
 
MEDICAID INFORMATION RELEASE #MA06-40
 
TO:               Commercial Transportation Providers;
                 Service Coordination Agencies;
                 Waiver Adult Day Care Providers; and
                 Waiver Community Supported Employment Providers
 
FROM:           Leslie M. Clement, Administrator
 
SUBJECT:     WAIVER COMMERCIAL TRANSPORTATION REIMBURSEMENT
 
Beginning January 1, 2007, commercial transportation providers may request prior authorization (PA) at the commercial rate for non-medical, waiver transportation.  Agency and individual transportation providers will continue to be reimbursed at the agency or individual rate, respectively.
 
Commercial transportation providers with existing PA who want to be paid at the commercial rate must submit a written request for a PA change to their local Regional Medicaid Services (RMS) office.  Providers that do not request a change will continue to be paid according to their existing PA.  No retroactive PA changes will be made.  Additional information about provider reimbursement for all non-emergency transportation services, including non-medical transportation under waiver programs, is described at IDAPA 16.03.09.875.
 
Providers must use the prior authorization number and the appropriate procedure code and modifiers to be reimbursed for services:
 
Service
Code
PA Required
Description
Non-emergency transportation, per mile – vehicle provided by volunteer (individual or organization) with no vested interest
 
(A&D non-medical transportation)
A0080
 
U2
AND
SE
Modifiers Required
Yes
A&D non-medical transportation, per mile as authorized by the RMS.
 
One unit = 1 mile
 
The maximum allowable units per year are 1800.
 
• Requires modifier U2 to report services for the A&D waiver
 
Non-emergency transportation, per mile – vehicle provided by volunteer (individual or organization) with no vested interest
 
(DD non-medical transportation)
A0080
 
U8
AND
SE Modifiers Required
Yes
DD non-medical transportation, per mile as authorized by the RMS.
 
One unit = 1 mile
 
The maximum allowable units per year are 1800.
 
• Requires modifier U8 to report services for the DD waiver
 
Specific requirements, qualifications, and limitations for non-medical, waiver transportation are described in IDAPA 16.03.10, “Medicaid Enhanced Plan Benefits.”  Non-medical, waiver transportation is described in Subsection 326.04 for A&D waiver participants and Subsection 703.05 for DD/ISSH waiver participants.
 
If you have questions regarding this information, please contact David Simnitt in the Bureau of Behavioral Health at (208) 364-1992.  Thank you for your continued participation in the Idaho Medicaid program.
 
IDAHO MEDICAID PROVIDER HANDBOOK
This Information Release replaces information in your Idaho Medicaid Provider Handbook.