ARC 1976C
HUMAN SERVICES DEPARTMENT[441]
Adopted and Filed
Pursuant to the authority of Iowa Code section 249A.4, the Department of Human Services amends Chapter 78, “Amount, Duration and Scope of Medical and Remedial Services,” Iowa Administrative Code.
These amendments are in accordance with a new request for proposal (RFP) for Iowa Medicaid’s Non-Emergency Medical Transportation (NEMT) program. These amendments eliminate the two- business-day advance notice requirement for mileage reimbursement trips. These amendments also define a time frame within which a member or transportation provider may submit a claim to the broker for mileage reimbursement.
In the recent past, there has been a shift in NEMT trips classified as mileage reimbursement, from 73 percent of all NEMT trips as measured from October to December 2010 to only 46 percent of NEMT trips as measured from January to March 2013. This shift means the majority of the current trips are provider rides, which are more costly. By eliminating the two-business-day advance notice for members who require only mileage reimbursement, the Department is anticipating a greater incentive for members to drive themselves and thus reduce program costs.
Most states with a brokerage require members to submit claims within 60 to 120 days from the date of service. Rules in Chapter 80 address medical and remedial care providers’ submission of claims for services rendered. These amendments adopt new provisions for members’ submission of claims.
Notice of Intended Action was published in the Iowa Administrative Bulletin as ARC 1901C on March 4, 2015. The Department received no comments during the public comment period. These amendments are identical to those published under Notice of Intended Action.
The Council of Human Services adopted these amendments on April 8, 2015.
These amendments do not provide for waivers in specified situations because requests for the waiver of any rule may be submitted under the Department’s general rule on exceptions at 441—1.8(17A,217).
After analysis and review of this rule making, no impact on jobs has been found.
These amendments are intended to implement Iowa Code section 249A.4.
These amendments will become effective July 1, 2015.
The following amendments are adopted.
	Item 1. Amend paragraph 78.13(3)“a” as follows:
	a. 	Member request. When a member needs nonemergency transportation to receive medical care provided by the Iowa Medicaid program, the member must contact the broker with as much advance notice as possible, but not more than 30 days’ advance notice.
	(1)	Generally, the member members who require a ride from a transportation provider scheduled by the broker must contact the broker at least two business days in advance of the member’s appointment to schedule the transportation. For purposes of calculating the two-business-day notice obligation, the advance notice includes the day of the medical appointment but not the day of the telephone call.
	(2)	If the member’s nonemergency transportation needs make need for a ride from a transportation provider scheduled by the broker makes the provision of two business days’ notice impossible because of the member’s urgent transportation need, the member must provide as much advance notice as is possible before the transportation need so that the broker can appropriately schedule the most economical form of transportation for the member. Urgent transportation needs for a ride from a transportation provider scheduled by the broker are limited to unscheduled episodic situations in which there is no immediate threat to life or limb but which require that the broker schedule transportation with less than two business days’ notice. Examples of urgent trips include, but are not limited to:
	1.	Postsurgical or medical follow-up care specified by a health care provider;
	2.	Unexpected preoperative appointments;
	3.	Hospital discharges;
	4.	Appointments for new medical conditions or tests; and
	5.	Dialysis.
	(3)	The two-business-day advance notice obligation does not apply when the member requests only mileage reimbursement. To be eligible for mileage reimbursement:
	1.	The member must notify the broker no later than the day of the trip;
	2.	The transportation must be provided by a driver with a valid driver’s license and insurance coverage on the vehicle at the time of the transport; and
	3.	The other requirements of rule 441—78.13(249A) must be met.
	Item 2. Adopt the following new paragraph 78.13(3)“i”:
	i. 	Member claim submission. Members must submit claims and supporting documentation to the broker within 120 days of the date of service. The broker shall deny member claims submitted more than 120 days from the date of service.
[Filed 4/8/15, effective 7/1/15]
[Published 4/29/15]
Editor’s Note: For replacement pages for IAC, see IAC Supplement 4/29/15.