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Non-Emergency Medical Transportation and Escort Coverage
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Governs Alaska Medicaid coverage, prior authorization, and criteria for non-emergency medical transportation and authorized escorts for members who lack personal means of transport to access medically necessary services.
No material clinical or coverage changes in this revision.
Coverage Criteria for NEMT and Escorts
General coverage preconditions
Covered when ALL of the following are met
Regulatory citations provided in policy
Local ground transportation criteria
Local ground transportation — coverage varies by service type and member age and referral status
Initial visit exceptions noted
POC/treatment plan must be on file after initial visit
POC/treatment plan must be on file after initial visit; SUD form required for SUD services
Document behavioral health assessment date and diagnosis on Facility Discharge Travel Request Form
Out-of-area transportation criteria
Out-of-area transportation — covered when specific availability, referral, and medical necessity conditions are met
Travel COMN (Section 1) must be on file when care needed before local availability
Must be combined with other travel when possible
POC/treatment plan must be on file after initial visit; Travel COMN (Sec. 1) to establish medical need
Medical records supporting request must be on file for transitions to alternate locations
Escort coverage criteria
Covered escorts when all applicable conditions below are met:
Examples and required documentation detailed in policy
Coverage excludes travel arranged for members' personal needs; Alaska Medicaid travel benefits are only available when a member has no personal means of transport and no other voluntary services are available. Attempts must be made to coordinate appointments and combine travel events when possible to avoid multiple trips. Transport to an inpatient facility that is required as a result of a court order (Title 47/court-ordered involuntary commitment) is not covered. Facility discharge transports are subject to specific documentation and coverage conditions depending on who transported the member to the facility, admit reason, facility location, and destination upon discharge.
Escort coverage for adults with anxiety or other behavioral/mental health disorders is limited: an escort is covered only when the member is being treated by a behavioral health provider or mental health clinician and the Travel COMN (Section 2) documents the behavioral/mental health reason, includes the appropriate diagnosis code, and contains the required additional medical justification certified by the treating behavioral health provider. An adult with an anxiety or behavioral diagnosis who is not currently being treated by a behavioral health provider or clinician (with or without medication) is not covered for an escort. The Travel COMN (Section 2) must be completed and signed as required for behavioral health–related escort requests.
Requests for travel are considered not medically necessary when telehealth is a feasible option for the service, or when the requested service is expected to be locally available within 3 months (unless the referring licensed provider documents medical necessity for care before local availability and Travel COMN (Section 1) is filed). For therapies and other services that require a referral or treatment plan, travel is not medically necessary without the required referral or documented POC/treatment plan after the initial visit. Preventive travel outside the member's home community is not medically necessary when the service will be available locally within 3 months or can be combined with other upcoming Medicaid travel events, except in limited one-per-year circumstances when criteria are met.
Requests for escorts that lack the required clinical justification or documentation are not covered. For behavioral health–related escorts, the Travel COMN (Section 2) must be on file with the behavioral/mental health box selected, an appropriate diagnosis code provided, and the treating provider's additional medical justification completed and certified. Escorts requested solely for translator purposes, or for adults with behavioral diagnoses who are not in active treatment with a behavioral health provider, are examples of requests that will be denied.
Key Coding and Availability Timeframes
Provider Responsibilities, Prior Authorization, and Documentation
Prior authorization required for travel; out-of-area needs Travel COMN (Sec.1)
Prior authorization is required for Alaska Medicaid transportation benefits. For out-of-area travel that is needed before the service is expected to be locally available within 3 months, a Travel COMN (Section 1) and supporting medical necessity documentation must be on file with the Department.
Prior authorization or facility intake must be on file for discharge transports
Prior authorization or a facility intake record must be on file with the Department for certain transports. For facility discharge transports, submit the Facility Discharge Travel Request Form and ensure any required POC/treatment plan or SUD form is on file after the initial visit when applicable.
Coordinate and combine travel events to avoid multiple trips
Coordinate appointments and combine travel events when possible to minimize multiple trips; preventive travel may be limited and must be combined with other travel when feasible or will be limited to one per calendar year if allowed.
Use required Department forms (Travel COMN or Facility Discharge) for travel and escort requests
Providers must follow the Department's required submission and documentation processes for travel and escort requests, including use of the Travel COMN (Section 1 or 2) or Facility Discharge Travel Request Form as applicable.
Submit Facility Discharge form with behavioral health assessment date and diagnosis for discharge/SUD/therapy transports
When arranging facility discharge or behavioral health/SUD/therapy-related transports, submit the Facility Discharge Travel Request Form and include the date of the last behavioral health assessment and the member's diagnosis; POC/treatment plan must be on file after the initial visit where required.
- Include date of last behavioral health assessment and member diagnosis on Facility Discharge Travel Request Form
- Ensure POC/treatment plan is on file after the initial visit for therapies and behavioral health; SUD form required for SUD services
Provide medical records and Travel COMN when discharge is to non‑home locations or out‑of‑area care is needed
When facility discharge is to a location other than the member's home or when out-of-area services are requested before local availability, medical records and Travel COMN (Section 1) supporting medical necessity must be on file with the Department.
- Medical records supporting transition to an alternate location must be submitted
- Travel COMN (Section 1) required for out-of-area needs before local availability
Submit Facility Discharge form or Travel COMN (Sec.2) with required fields and provider certification
Providers must submit either the Facility Discharge Travel Request Form or the Travel COMN (Section 2) with all required fields completed (diagnosis, appointment/procedure/date/time, and for behavioral visits the date of last assessment). For escorts, the Travel COMN (Section 2) must include appropriate checkboxes, diagnosis codes, and additional medical justification certified by the treating provider.
- Facility Discharge Travel Request Form or Travel COMN (Section 2) must be completed and on file
- Travel COMN (Section 2) must include boxes checked, diagnosis codes, appointment details, and treating provider certification
Denied when personal/voluntary transport available, travel for personal needs, or authorization criteria unmet
Travel requests may be denied if the member has personal means of transport or other voluntary services are available, if travel is for personal needs, or if prior authorization and the Department's regulatory criteria are not met.
- Travel benefits only available when member has no personal means of transport and no voluntary services are available
- Travel may not be arranged for members' personal needs
- Denials possible when prior authorization or regulatory criteria are unmet
Escort requests for adults lacking behavioral health treatment or for translator purposes are common denial triggers
Escort requests for adults with anxiety or other behavioral/mental health disorders are not covered unless the member is currently being treated by a behavioral health provider or mental health clinician and documentation is provided; translator-only escorts and escorts for developmental disability without significant cognitive/physical dysfunction are not covered.
- Adult anxiety/behavioral disorder escorts require active treatment by a behavioral health provider and a current Travel COMN (Section 2) with behavioral health box checked and diagnosis code
- Translator-only escorts and adults with developmental disability without significant dysfunction are not covered
Background and Purpose
Non-emergency medical transportation exists to support access to medically necessary diagnostic, therapeutic, preventive, and behavioral health services for members who lack personal means of transport. Medical necessity for travel and escorts is determined according to Department standards and applicable provider scope-of-practice, and prior authorization is required when the coverage criteria are not otherwise met.
Key Definitions
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