CurrentAlaska MedicaidPolicy N/A

Non-Emergency Medical Transportation (NEMT) and travel coverage

Governance of Alaska Medicaid travel benefits, prior authorization requirements, and coverage criteria for arranging member travel including NEMT, escorts, and emergency transportation; affects Alaska Medicaid members, referring and receiving providers, and transportation coordinators.

Policy Summary

PayerAlaska Medicaid

PolicyNon-Emergency Medical Transportation (NEMT) and travel coverage

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit travel authorization requests with a completed Travel Authorization Fax Cover Sheet and required supporting documentation at least 10 days before the appointment (or use urgent process for travel needed within 3 days).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5key components required for travel coverage

RequiredPrior authorization required

10%RTP percentage in March

542total RTP in March

5,166total travel faxes in March

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Travel Coverage Criteria

inv-01: Travel coverage authorization criteria

Coverage of travel services requires that each trip meet all five specified components and follow program rules; transportation benefits are only available when no personal or voluntary options exist and travel is for an Alaska Medicaid covered service.

ALL of the following must be met

Medicaid Benefit Status: Member must be eligible for Alaska Medicaid on the date of the requested service and have a benefit plan that includes travel.
Provider Enrollment: Both the referring and receiving providers must be enrolled with Alaska Medicaid (exceptions include military/VA and emergency situations where the member was transported to the closest acute care hospital that could meet their needs).
Covered Service: Travel must be for an Alaska Medicaid covered service (examples: diagnostic, therapeutic, preventive, therapy, discharge, behavioral health/SUD/inpatient psychiatric/Title 47/court-ordered, or escort services as specified).
Closest, Most Appropriate Provider: Transportation must be to the closest most appropriate provider able to meet the member's needs; Alaska Natives may be approved to travel to the nearest tribal facility; this requirement does not apply to travel within a member's home community.
Medical Necessity: The healthcare service(s) must be reasonable, necessary, and appropriate based on evidence-based clinical standards; medical necessity standards established by the Department of Health or by standards of practice applicable to the ordering or referring provider apply.

Program rules: Providers must supply supporting information for all five components; verbal and written information are typically accepted but some scenarios require written documentation.

inv-02: Core coverage criteria

Five required components must be met before authorizing travel:

Establish all five components

Medicaid Benefit Status: Member eligible for Alaska Medicaid with travel benefit on the date of service.
Provider Enrollment: Referring and receiving providers enrolled with Alaska Medicaid (military/VA and emergency exceptions apply).
Covered Service: Service must be an Alaska Medicaid covered service.
Closest, Most Appropriate Provider: Travel is to the closest appropriate provider able to meet the member's needs; Alaska Natives may go to nearest tribal facility; excludes travel within the member's home community.
Medical Necessity: Service(s) must be reasonable, necessary, and appropriate per evidence-based clinical standards or applicable provider licensure standards.

inv-03: Therapy treatment plan guidance

Treatment-plan related criteria relevant to authorizing travel for therapy visits:

ALL of the following

Treatment plan must include diagnosis, anticipated treatment goals, service type, and the amount, duration, and frequency of each service.
Treatment plan maximum durations vary by therapy and age: typically up to <3 years in some instances (examples noted: 6 months, 1 year, 6 weeks depending on age/type); specific references: PT, OT, SLP rules (7 AAC citations) govern durations.
Certain services are non‑covered (examples: maintenance therapy not related to developmental disability/delay, swimming therapy, therapy for physical fitness/weight loss, habilitation services, services provided by a therapy aide) and may not justify travel coverage.
Prior authorization for travel related to therapy is conditional per the Therapy Billing Manual / Fee Schedule; verify PA requirements for each therapy type.

inv-04: Subsequent travel

Subsequent travel request criteria to streamline follow-up travel when prior documentation exists.

ALL of the following

Applicability: Subsequent requests apply when Alaska Medicaid has previously paid for an initial travel event for the member and relevant documentation is already on file with the fiscal agent.
Initial-trip requirement: If the member traveled initially on their own, the first Medicaid-requested trip must be submitted using an initial packet; subsequent requests can then use the streamlined second-request packet.
Purpose: Subsequent requests are intended to simplify processing when the fiscal agent already holds documentation demonstrating the member's travel needs.
Forms: Use the Out-of-Area Travel Service 2nd Request Fax Packet for subsequent requests (link provided in provider guidance).

inv-05: Travel authorization completion and documentation criteria

Provider must complete required fields on the Travel Authorization Fax Cover Sheet and supply supporting documentation; forms with incomplete provider, appointment, or out‑of‑area details are common reasons for return.

ALL of the following

Complete required cover sheet fields: Include provider/facility names and NPIs in the correct sections (business/facility name and NPI in box 1; individual provider name and NPI in box 2), member contact and Medicaid ID, dates of travel, and appointment details.
Submission timing and urgency: Submit requests at least 10 days prior to scheduled appointment when possible; mark URGENT only for travel needed within 3 days with treating provider attestation that delay would be detrimental.
Documentation completeness: Fax requests with missing or insufficient documentation will be returned to the provider; common RTP reasons include incomplete provider information and missing appointment details in out‑of‑area sections.
Fax failure alternative: If fax fails, email the packet only after obtaining and attaching at least two failed fax confirmations as attestation; include those confirmations with the emailed packet.

inv-06: Rate review project scope and deliverables

Guidehouse will conduct a rate and policy review for transportation services with defined deliverables and stakeholder meetings; final report submitted to Alaska DOH.

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Codes and Treatment Plan Attributes

Therapy-related treatment plan attributesmixed

No codes listed

Examples of transportation/lodging-related codes listed on the travel formmixed

ADT S00210	Meals (example code listed on form)
AD1 B0HDVAD200HD	Lodging - Permaternal Home (form lists lodging codes)

Typical treatment plan max durations (therapy)

Physical Therapy (example)Typical treatment-plan max duration: <3 years (examples by age: <2 yrs = 6 months; 2–3 yrs = 1 year; older pediatric entries include 6 weeks for certain ages)

Occupational Therapy (example)Treatment-plan max duration referenced to 7 AAC 115.110 and 7 AAC 115.120; guidance aligns with PT durations and varies by age and service

Speech Therapy (example)All ages: Treatment-plan max duration = <3 years (examples listed: 6 months, 1 year, 6 weeks depending on age bracket)

Submission, Documentation, and Authorization Actions for Providers

Prior Authorization

Authorization Criteria Overview

Authorization Criteria Overview: Prior authorization for transportation and escorts requires establishing five components before a travel event can be authorized: (1) Medicaid Benefit Status — the member must be eligible on the date of service and have travel included in their benefit plan; (2) Provider Enrollment — referring and receiving providers must be enrolled with Alaska Medicaid (exceptions: VA/military and certain emergency situations); (3) Covered Service — the travel must be for an Alaska Medicaid covered service; (4) Closest, Most Appropriate Provider — travel must be to the closest appropriate provider able to meet the member’s needs (special rules for Alaska Natives and exclusion of local intra-community ground travel); and (5) Medical Necessity — the service and related travel must be reasonable, necessary, and appropriate per applicable standards of care. The department must be able to document compliance with each component prior to authorization.

Medicaid Benefit Status: member eligibility and travel benefit on date of request.
Provider Enrollment: both referring and receiving providers enrolled (exceptions apply).
Covered Service: service must be covered by Alaska Medicaid.
Closest, Most Appropriate Provider: transport to closest appropriate provider; tribal exceptions; local intra-community ground travel excluded.
Medical Necessity: evidence-based standards; applies to services and products used to treat or prevent conditions.

Key Terms and Definitions

Assurance of Transportation

DefinitionAssurance of Transportation requires states to ensure Medicaid enrollees without other transportation means have transportation (including both NEMT and emergency medical transportation) when necessary to access covered services.

Scope of servicesIncludes multiple modes to meet varied individual needs and geography/terrain.

State limitationsStates may set reasonable limitations but must not conflict with ensuring access to necessary covered services.

Emergency transport noteEmergency transportation is included and need not always be to a hospital ED; alternative emergency locations may be approved (e.g., urgent care, crisis centers, clinics).

Coverage components / criteria

Medicaid Benefit Status

Policy Summary

PayerAlaska Medicaid

PolicyNon-Emergency Medical Transportation (NEMT) and travel coverage

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

Helpful practices: QA forms prior to submission, consolidate trips when possible, and include personalized medical necessity rationale; behavioral health providers should list their organization as requesting or receiving provider when applicable.

Note

Subsequent Travel Requests

Subsequent Request Process: Use a Subsequent Travel Request when Alaska Medicaid has previously paid for the member’s initial travel and the fiscal agent already holds required documentation. If the member’s first Medicaid-paid trip was requested using an initial packet or if the member traveled initially on their own (first Medicaid trip requires an initial packet), submit a subsequent request to simplify and expedite processing. Refer to the Travel Service 2nd Request Fax Packet for the required form and guidance.

Subsequent requests apply only when Medicaid previously paid for the member’s travel.
If the first Medicaid-paid trip used an initial packet, follow initial submission for that event; later trips may use the subsequent packet.
Link to packet (provider extranet) must be used for form and detailed instructions.

Documentation Required

Fax Cover Sheet and Return-to-Provider (RTP) Handling

Travel Authorization Fax Cover Sheet and RTP Handling: Submit travel requests by fax or telephone using the Travel Authorization Fax Cover Sheet. Requests should be submitted at least 10 days prior to the appointment; urgent travel is defined as travel needed within the next 3 days where delaying more than 3 days would be detrimental to the member’s health. The cover sheet includes indicators for new requests, updates to authorized travel (requires PA number and Travel Authorization Update Form), supplemental documentation, behavioral health/long-term care flags, and linkage to other members traveling together. Providers must attach the required Travel Packet and supporting documentation when faxing. Fax submissions that are missing or have insufficient documentation will be returned to the provider (RTP).

Submit via Travel Authorization Fax Cover Sheet by fax or telephone.
Requests should be submitted at least 10 days prior to the appointment; urgent = within 3 days with treating provider attestation.
Use Update form and provide PA # when updating an authorized travel.
Missing or insufficient documentation will be returned to provider (RTP).

Denial Risk

Documentation Completeness Requirement

Documentation Completeness Requirement: All required documentation identified in the Medicaid Travel Request Packets and Documentation Guidance must accompany the submission. Incomplete packets or absent required attachments (including proof of at least two failed fax attempts when applicable — see alternate email attestation) will result in the request being returned to the provider for completion. Providers should coordinate appointments to minimize repeat trips and ensure documentation demonstrates lack of other transportation means and reasonableness of travel.

Refer to Medicaid Travel Request Packets and Documentation Guidance for full required document list.
Incomplete or missing documentation will cause RTP (returned to provider) and delay authorization.
Documentation must show lack of personal means of transport and that travel is for a covered, medically necessary service.

Documentation Required

Alternate Email Attestation for Fax Failures

Alternate Email Attestation for Fax Failures: If a provider is unable to successfully fax the Travel Packet to HMS, email submission is allowed only after the provider has obtained at least two failed fax confirmations. The provider must attach those two failed fax confirmations to the Travel Packet and include the following attestation in the emailed submission: confirmation that two failed fax attempts occurred and acknowledgement that email use is limited to instances of fax failure. Email requests and attachments should be sent to skservicesauthorizations@gainwelltechnologies.com as noted on the Fax Cover Sheet. Note that email submission is solely a fallback for fax issues and does not waive the required documentation completeness standard; requests sent by email with missing or insufficient documentation will be returned to the provider.

Email allowed only after at least two failed fax confirmations are attached.
Include attestation that email is used only because of fax issues.
Email address for fallback submission as specified on Fax Cover Sheet.
Emailed requests with missing/insufficient documentation will be returned to provider.

Member must be eligible for Alaska Medicaid on the date of the requested service and have a benefit plan that includes travel.

Provider EnrollmentBoth referring and receiving providers must be enrolled with Alaska Medicaid (exceptions: military/VA and emergency situations).

Covered ServiceTravel must be for an Alaska Medicaid covered service (diagnostic, therapeutic, preventive, behavioral health, inpatient psychiatric, Title 47/court-ordered services, escorts as specified).

Closest/Most Appropriate ProviderTransportation must be to the closest, most appropriate provider able to meet the member’s needs; Alaska Natives may travel to the nearest tribal facility; does not apply within a member’s home community.

Medical NecessityService(s) must be reasonable, necessary, and appropriate per evidence-based clinical standards or departmental/provider-specific standards.

Urgent Travel

DefinitionUrgent Travel: travel needed within the next 3 days, based on a treating provider’s recommendation stating it would be detrimental to the member’s health to delay travel more than 3 days.

Submission timing noteProviders should submit requests at least 10 days prior to scheduled appointment when possible; urgent designation is for travel within 3 days.

Provider attestationUrgency requires a treating provider attestation that delay would be detrimental to health.

Closest, Most Appropriate Provider

DefinitionClosest, Most Appropriate Provider: the nearest healthcare provider able to meet the member’s needs; transportation must be to that provider unless approved otherwise.

Tribal exceptionAlaska Natives may be approved to travel to the nearest tribal health facility rather than the geographically closest provider.

Home-community exclusionRequirement does not apply to travel within a member’s home community (local ground travel).

Urgent Travel (alternate entry)

Alternate urgent definition entryUrgent Travel is defined on the Travel Authorization Fax Cover Sheet as travel needed within the next 3 days when a treating provider states delaying travel more than 3 days would be detrimental to the member’s health.

Processing expectationAlaska Medicaid cannot guarantee processing of submissions received within 10 days of the scheduled appointment; use urgent designation only when within 3 days and attested.

Use on formThe fax cover sheet includes an URGENT REQUEST checkbox and the urgent-travel definition for provider use.

Fax failure attestation

RequirementProviders must attach at least two failed fax confirmations to the Medicaid Travel Packet before emailing it to the designated address.

Email addressPackets may be emailed to skservicesauthorizations@gainwelltechnologies.com only after two failed fax confirmations are attached.

ScopeAttestation on the Travel Authorization Fax Cover Sheet must state the office experienced fax issues and include the failed fax confirmations.