CurrentAlaska MedicaidPolicy N/A

Presumptive Travel Authorization Process for Non-Emergency Medical Transportation (NEMT)

Governs the new Presumptive Travel Authorization Process for requesting and authorizing non-emergency medical transportation (NEMT) travel for Alaska Medicaid members; affects providers who request travel, Medicaid operations, and members receiving travel benefits.

Policy Summary

PayerAlaska Medicaid

PolicyPresumptive Travel Authorization Process for Non-Emergency Medical Transportation (NEMT)

Policy CodePolicy N/A

Change TypeOperational process update

Effective Date

Next Review Date

Key ActionSubmit travel authorization requests up to one year before travel; providers may request all known travel for an entire year in a single request.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

up to 1 yearmax advance request window

60 dayslocal voucher earliest

1 yearout-of-area voucher earliest

monthlylocal auth cadence

annualout-of-area auth cadence

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Travel Authorization Criteria and Operational Rules

Criteria and operational rules for authorizing travel:

ALL of the following

If the member is eligible for Medicaid travel benefits on the date the travel request is submitted, the member is considered eligible for the requested travel dates and the request will proceed without being pended for future-month eligibility determination.

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Providers may submit travel authorization requests up to one year before travel; a single request may include all known future travel up to one year in advance.

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Medical necessity must be established prior to authorizing each travel event.
There is no change to required documents for requesting travel; each travel event remains subject to existing documentation requirements (see Required Documentation for Travel reference).

ALL of the following

Local ground transportation: one service authorization will be created per month in which the member travels.
Out-of-area travel: one service authorization will be created per year per destination.

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Local ground transportation vouchers may be distributed up to 60 days prior to travel once approved.
Out-of-area travel vouchers may be distributed up to one year prior to travel once approved.

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When services have treatment plan or Plan of Care duration limits, approvals may only be granted through the duration of the current plan when applicable.

ALL of the following

If the member is later determined to be ineligible for Medicaid travel benefits, providers will be notified and must inform the member; the member will receive an official denial notice for affected travel.
If vouchers were distributed prior to the determination of ineligibility, providers must instruct the member to destroy distributed vouchers and mark the voucher log as 'destroyed'.

ALL of the following

Requests that meet the eligibility check at submission will move forward immediately in the authorization process rather than being pended until the month of travel; service authorization numbers and details for approved flights will be provided immediately upon determination rather than monthly.

Provider Submission, Consolidation, and Follow-up Actions

Note

Submitting Travel Requests and Eligibility Determination

Providers must submit travel requests in accordance with the Presumptive Travel Authorization Process. Travel requests can be submitted up to one year in advance. Providers may submit a single consolidated request that includes all known travel for an entire year for a member to reduce repeated submissions and administrative burden. Submitting authorizations well in advance supports mailing of vouchers to remote members, reduces lodging and flight availability issues, and allows timely determinations for complex cases.

Providers may request travel up to one year prior to the member's travel
A single annual submission may include all known travel for the entire year
Advance authorizations reduce delays and administrative burden

Billing Rule

Service Authorization Consolidation

Service authorizations will be consolidated to reduce the number of separate authorizations providers must create and manage. Consolidation rules are: - Local ground transportation: one service authorization will be created for each month the member travels. - Out-of-area travel: one service authorization will be created per year for all travel that shares the same destination as designated on the service authorization. Providers should plan requests and billing around these operational rules to avoid creating unnecessary individual authorizations.

Key Terms and Definitions

Presumptive Travel Authorization Process

DefinitionA program-wide process for authorizing non-emergency medical transportation (NEMT) that removes time restraints for obtaining authorizations, stops pending future-month requests for monthly eligibility, and consolidates service authorizations.

PurposeSimplify travel authorization, deliver quicker determinations, consolidate service authorizations, reduce call center hold times, and remove barriers to arranging travel.

ScopeApplies to all NEMT travel requests processed under Alaska Medicaid effective immediately upon implementation of the Presumptive Travel Authorization Process.

Operational ChangeProviders may request travel up to one year in advance and future-month requests will not be pended for monthly eligibility determinations.

Resulting EffectService authorizations will be consolidated to reduce administrative burden (see Local Ground Transportation and Out of Area Travel definitions).

Policy Summary

PayerAlaska Medicaid

PolicyPresumptive Travel Authorization Process for Non-Emergency Medical Transportation (NEMT)

Policy CodePolicy N/A

Change TypeOperational process update

Effective Date

Next Review Date

Key ActionSubmit travel authorization requests up to one year before travel; providers may request all known travel for an entire year in a single request.

SourceLink

On This Page

Local Ground Transportation: one authorization per month traveled
Out-of-Area Travel: one authorization per year per destination

Prior Authorization

Handling Future Ineligibility

If a member is later found to be ineligible for Medicaid travel benefits after an authorization for future travel has been issued, providers will be notified of the change in eligibility status. Upon receiving notification, providers must immediately inform the member of the ineligibility and, if travel vouchers were already distributed, instruct the member to destroy those vouchers. Providers must update voucher tracking by marking affected vouchers as 'destroyed' on the voucher log. The member will also receive an official denial notice from the Department of Health for any affected travel.

Providers will be notified if a member loses Medicaid travel benefits
Providers must immediately inform the member and instruct destruction of distributed vouchers
Mark vouchers as 'destroyed' on the voucher log after notifying the member
Members will receive an official denial notice from the Department of Health

Local Ground Transportation

DefinitionLocal ground transportation refers to travel within the local area for non-emergency medical transportation under Alaska Medicaid.

Authorization CadenceOne service authorization will be created for each month the member travels.

Voucher TimingLocal ground transportation vouchers may be distributed up to 60 days prior to travel once approved.

Purpose of ConsolidationEliminates creating a unique authorization for every travel event to minimize administrative burden.

Out of Area Travel

DefinitionOut of area travel refers to travel with destinations outside the local area for non-emergency medical transportation under Alaska Medicaid.

Authorization CadenceOne service authorization will be created per year for all travel with the same destination designated on the service authorization.

Voucher TimingOut-of-area travel vouchers may be distributed up to one year prior to travel once approved.

Purpose of ConsolidationReduces the number of service authorizations by grouping same-destination travel within a year onto a single authorization.