441—78.13 (249A) Transportation to receive medical care. Payment will be approved for transportation to receive services covered under the program, including transportation to obtain prescribed drugs, when all of the following conditions are met.
	 78.13(1) Transportation costs are reimbursable only when:
	  a.   	 The source of the care is located outside the city limits of the community in which the member resides; or
	  b.   	 The member resides in a rural area and must travel to a city to receive necessary care.
	 78.13(2) Transportation costs are reimbursable only when:
	  a.   	 The type of care is not available in the community in which the member resides; or
	  b.   	 The member has been referred by the attending physician to a specialist in another community.
	 78.13(3) Transportation costs are reimbursable only when there is no resource available to the member through which necessary transportation might be secured free of charge. Exception: Costs of transportation to obtain prescribed drugs may be reimbursed irrespective of whether free delivery is offered when the prescription drug is needed immediately.
	 78.13(4) Transportation is reimbursable only to the nearest institution or practitioner having appropriate facilities for the care of the member.
	 78.13(5) Transportation may be of any type and may be provided from any source.
	  a.   	 When transportation is by car, the maximum payment that may be made will be the actual charge made by the provider for transportation to and from the source of medical care, but not in excess of 30 cents per mile.
	  b.   	 When public transportation is utilized, the basis of payment will be the actual charge made by the provider of transportation, not to exceed $1.40 per mile.
	  c.   	 In all cases where public transportation is reasonably available to or from the source of care and the member’s condition does not preclude its use, public transportation must be utilized. When the member’s condition precludes the use of public transportation, a statement to the effect shall be included in the case record.
	 78.13(6) In the case of a child too young to travel alone, or an adult or child who because of physical or mental incapacity is unable to travel alone, payment subject to the above conditions shall be made for the transportation costs of an escort. The worker is responsible for making a decision concerning the necessity of an escort and recording the basis for the decision in the case record.
	 78.13(7) When meals and lodging or other travel expenses are required in connection with transportation, payment will be subject to the same conditions as for a state employee and the maximum amount payable shall not exceed the maximum payable to a state employee for the same expenses in connection with official travel within the state of Iowa.
	 78.13(8) When the services of an escort are required subject to the conditions in subrule 78.13(6), payment may be made for the escort’s meals and lodging, when required, on the same basis as for the member.
	 78.13(9) Payment will not be made in advance to a member or a provider of medical transportation.
	 78.13(10) Payment for transportation to receive medical care is made to the member with the following exceptions:
	  a.   	 Payment may be made to the agency that provided transportation if the agency is certified by the department of transportation and requests direct payment. Reimbursement for transportation shall be based on a fee schedule by mile or by trip.
	  b.   	 In cases where the local office has established that the member has persistently failed to reimburse a provider of medical transportation, payment may be made directly to the provider.
	  c.   	 In all situations where one of the department’s volunteers is the provider of transportation.
	 78.13(11) Form 470-0386, Medical Transportation Claim, shall be completed by the member and the medical provider and submitted to the local office for each trip for which payment is requested. All trips to the same provider in a calendar month may, at the member’s option, be submitted on the same form.
	 78.13(12) No claim shall be paid if presented after the lapse of 365 days from its accrual unless it is to correct payment on a claim originally submitted within the required period.
This rule is intended to implement Iowa Code section 249A.4.
[ARC 8344B, IAB 12/2/09, effective 12/1/09]