Medical Justification Requirements for Travel
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Defines the documentation and submission requirements for non-emergency transportation requests for Alaska Medicaid members, including when telehealth must be considered and exceptions for certain prior-authorized or urgent situations. Affects providers arranging or requesting Medicaid-funded patient travel in Alaska.
No material clinical or coverage changes in this revision.
Coverage Criteria and Documentation Requirements
Required documentation by travel type
Documentation required for travel requests varies by travel type; covered when required documentation is submitted as specified:
Letter of Medical Necessity is required for each visit that is not under a Plan of Care / Treatment Plan.
Medical Exhaust Letter must state services are not available locally and provide clinical rationale for the requested location; Medical Exhaust Letter must be from a specialist and include details of services and why local options do not meet needs.
Examples include charter vs commercial flight or wheelchair van vs taxi/bus.
Plan of Care/Treatment Plan must be current and describe needed care, frequency, continuity and known future travel needs.
This policy describes the medical justification requirements for non-emergency Medicaid travel and does not replace or remove any other documentation obligations that may apply under separate programs. Specifically, it does not negate documentation requirements already in place for programs such as travel for long term care and Behavioral Health; those program-specific rules remain in effect and must be followed in addition to the requirements set forth here.
Providers arranging travel must inform members and escorts that extensions unrelated to a member's medical needs are not covered by the department. Authorization or scheduling of additional travel for reasons other than documented medical necessity will not be approved under this policy.
Provider Submission, Authorization, and Telehealth Requirements
Provide prior authorization number for related services
If the department has prior authorized services related to the travel, provide the prior authorization number when requesting travel. Additional medical justification may be requested for prior-authorized travel (examples include inpatient admissions, facility transfers, and follow-up appointments related to prior approvals).
- Include the prior authorization number on the travel request.
- Be prepared to submit additional medical justification if requested.
Consider telehealth before requesting transportation
Telehealth must be considered prior to requesting transportation services. If telehealth is unavailable for the service, the medical justification must explain why telehealth cannot be utilized.
- Document that telehealth was considered before requesting transportation.
- If declining telehealth, include language in the justification explaining why telehealth is not appropriate or available.
Submit required medical documentation and where to send it
Providers must submit required medical documentation for travel requests and ensure documents are signed by the healthcare provider (electronic signatures acceptable). Submit documents via the listed fax or email addresses.
- Required documents (as applicable by travel type): Letter of Medical Necessity; Plan of Care / Treatment Plan; Medical Exhaust Letter when bypassing a closer specialist; medical records if requested.
- Letters/plans must include required elements (recipient name, diagnosis/date, why care cannot be provided locally, rationale for requested location; Plan must describe needed care, frequency, continuity, collaboration, and known future travel needs).
- Send documentation to the TCC/ANTHC/YKHC addresses or fax numbers listed in the policy.
Requests will be denied for late or missing documentation
Required medical justification must be submitted in writing within 5 business days of the travel request; requests without timely written justification will be denied.
- If written medical justification is not received within 5 business days of the request, the travel request will be denied.
Travel Type Definitions
Background and Scope
This document is an administrative policy focused on the required clinical documentation to support travel (for example, Letter of Medical Necessity, Plan of Care/Treatment Plan, Medical Exhaust Letter, and medical records) rather than a discussion of clinical disease states. It clarifies which documents must be submitted for different travel types (local, out-of-state or bypassing a closer provider, bypassing the least expensive mode, and reoccurring appointments) and the circumstances in which each document is required.
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