Haw. Code R. § 17-1737-82

Current through September, 2024

Section 17-1737-82 - Intra-state transportation

(a) Transportation may be provided in order to enable a recipient to secure needed medical care and related services.

(b) Transportation shall be by the most economical means which would not be hazardous or injurious to the recipient's health.

(c) Air transportation may be allowable where the attending physician or a hospital refers a recipient to a specialist or medical facility for diagnostic and treatment services not available or not accessible on the recipient's island of residence. Air transportation requests may be initiated by the department's social worker when a physician is not available to refer an individual for medical care in Honolulu.

(d) In emergency situations, air transportation:

(1) Shall be by regularly scheduled commercial flight when:

(A) Available;

(B) Medical care will not be affected if travel is delayed until the next scheduled flight; and

(C) The patient can sit in a standard seat and requires no oxygen or other life support mechanisms enroute; or

(D) If the patient is unable to sit and a stretcher is required, the airline may accommodate the patient in lieu of four passenger seats;

(2) Shall be by air ambulance service when:

(A) Regularly scheduled commercial flights are inappropriate because of problems with the recipient's condition, which include:

(i) Head injuries with evidence of increasing intracranial pressure;

(ii) Multiple system injuries;

(iii) Complications of labor or prematurity of newborn children with respiratory distress; or

(iv) Other acute injuries or illnesses beyond local capabilities; and do not allow for service or time delays; or

(B) Recipients to be transported on an arranged basis cannot travel by regularly scheduled commercial flights because the recipients are:

(i) In spica casts returning home to another island; or

(ii) Long-term care patients who are bed-bound and going to another island;

(3) If by air ambulance:

(A) Shall be authorized for a one-way trip only; and

(B) Shall have life support services and at least one attendant on the flight;

(4) Shall be arranged by the recipient's attending physician or hospital who shall complete and sign the appropriate form justifying the use of an air ambulance and give the original and all copies of the form to the air ambulance crew chief; and

(5) May be coordinated with surface ambulance service by the referring physician to the designated hospital on the island of destination.

(e) In a non-emergency situation, air transportation:

(1) Shall be subject to prior review and authorization by the department's medical consultant;

(2) May be provided in the form of a round-trip ticket when medical services on another island are recommended by the attending physician and the recipient is expected to return home in two weeks or less;

(3) May be provided in the form of a round-trip ticket to a person accompanying the recipient if an attendant's service is recommended by the commercial carrier. Payment may be made for an attendant's services when rendered by a person other than a relative under section 17-1739-7; and (4) Shall be by regularly scheduled commercial flights.

(f) In both emergency and non-emergency situations, the department shall allow other related inter-island travel expenses, such as:

(1) Cost of outside meals and lodging, while receiving necessary and authorized medical services; and

(2) Vendor payments for meals and lodging made only to designated providers of the services who have been authorized to participate under the department's medical assistance program.

(g) Ground ambulance service may be allowed as follows:

(1) Emergency ambulance service for injuries shall be available in each county to the patient. Ambulance service may be used in an emergency; and

(2) Ambulance transfer service for transporting a recipient to, from, and between medical facilities and other providers may be utilized when recommended by the attending physician.

(h) Taxi service may be allowed as follows:

(1) Transportation by taxi may be authorized by the payment worker to assist a recipient to obtain covered medical services where:

(A) A recipient resides in an area not served by a bus system;

(B) A recipient has no means of transportation;

(C) Transportation is available but the recipient cannot be accommodated at a suitable hour; or

(D) A recipient is acutely ill, injured or has a physical or mental impairment verified by a physician, and travel by bus would be either hazardous to that person's health or would cause physical hardship; and

(2) For rural areas, available taxi service nearest to the recipient's home shall be utilized.

(3) The department shall not be required to provide transportation beyond the closest geographic area where appropriate health care services are readily available.

(i) Handicab services may be used for recipients who are confined to a wheelchair or who are physically unable to take care of themselves.

(j) Transportation services shall be available for those individuals eligible for medical assistance, provided all the provisions in this section are met. An individual who utilizes benefits for other than their intended purpose, may be referred for potential prosecution of fraud. A provider who knowingly and willfully falsifies, misrepresents, conceals, or fails to disclose material facts to obtain transportation services for an individual, may be referred by the department to the Medicaid fraud control unit for investigation and potential prosecution of fraud. The department may seek the recovery of monies associated with the fraudulent act.

Haw. Code R. § 17-1737-82

[Eff 08/01/94; am 02/10/97; am 02/07/05] (Auth: HRS § 346-14) (Imp: 42 C.F.R. §§ 431.53, 440.170 )