CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Transplants - Transportation & Lodging

Defines coverage, limits, exclusions, and requirements for transportation and lodging when a Neighborhood Health Plan member receives a transplant at a facility outside the normal community pattern of care; applies to specified dual-eligible MA products.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyTransplants - Transportation & Lodging

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 8, 2026

Next Review DateApr 8, 2026

Key ActionObtain Neighborhood pre-approval for the associated transplant prior to requesting travel or lodging reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$10,000maximum per transplant

5 days priorcoverage period starts

up to 1 yearcoverage period ends

180submission window (days)

coachairfare limit

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Initial coverage criteria

Covered when ALL of the following are met

Core coverage conditions: 1) The associated transplant has been pre-approved by Neighborhood for the transplant recipient; 2) The transplantation service is performed at a Center for Medicare & Medicaid Services' Medicare-approved provider that is outside of the normal community pattern of care; 3) Costs are for transportation and/or lodging for the transplant recipient and one eligible companion only (any additional miles during the stay are ineligible); 4) Travel and lodging dates fall within the defined transplant period: beginning 5 days prior to the transplant and ending when the transplant recipient returns home after discharge from inpatient (Skilled Nursing or Rehabilitation) facility, not to exceed one year after surgery; 5) Automobile mileage is reimbursed at the IRS medical mileage rate in effect on the date of travel; 6) Lodging reimbursement is limited to the US General Services per diem rate for lodging; 7) Travel modes and costs must be reasonable and related to the approved transplant (airfare limited to coach/economy as applicable).

Automobile mileage rate and GSA lodging per diem referenced; see IRS and GSA websites for current rates.

This benefit explicitly excludes coverage for travel and accommodations related to transplant evaluation and follow-up visits. Requests for reimbursement that are solely for pre-transplant evaluation or post-transplant follow-up travel and lodging will be denied. Additionally, lodging with family or friends is not reimbursable under this policy. The policy also limits airfare reimbursement to coach/economy fares and excludes airline travel when the only reason for air travel is that the member is located at a secondary or temporary residence rather than the primary residence.

Non-covered transportation modes and services include air ambulance and private jets, as well as transportation options for which mileage reimbursement does not apply, such as rental cars, taxis, rideshare services (e.g., Uber, Lyft), and other ride services. The policy also excludes reimbursement for transportation that is not via the member’s personally owned vehicle when mileage is claimed, and disallows payment for indirect or excessive routes, sightseeing, or trips for personal reasons.

Transplant-related travel and lodging costs are not covered unless the member is enrolled in Neighborhood INTEGRITY for Duals (FIDE) or Duals CONNECT at the time of the transplant and at the time the expense is incurred. Members in other products are not eligible for reimbursement under this benefit.

Provider Requirements and Documentation

Prior Authorization

Pre-approval required

The associated transplant must be pre-approved by Neighborhood prior to travel or lodging reimbursement. Prior authorization request forms are available on Neighborhood's provider website (see Authorization Request Forms) and assistance is available via the provider phone line.

Note

Not applicable

Not applicable.

Documentation Required

Approval and receipts

Documentation must demonstrate that travel and lodging dates align with the defined transplant period and that travel was directly related to the transplant event; receipts must be legible and submitted within the required timeframe.

Transportation dates must align to all lodging dates.
Receipts must be legible.

Denial Risk

Timely submission

All reimbursement requests must be submitted within 180 days from discharge; requests submitted more than 180 days from discharge are ineligible for reimbursement.

Denial Risk

Documentation and ineligible charges

Expenses that are excessive or for non-direct routes, non-legible receipts, and expenses already paid by third parties (including grants, charity groups, SNAP, etc.) will be denied.

Excessive mileage or longer/indirect routes (must take most direct route) is subject to audit and denial.
No reimbursement for expenses paid by third parties (e.g., grants, charity groups, SNAP, GoFundMe).
Non-legible receipts will be denied.

Policy Background

This policy covers non-clinical supports—transportation and temporary lodging—required when a member receives an approved transplant at a facility outside the normal community pattern of care. Coverage is limited to the transplant recipient and one companion, is constrained to the defined transplant period, and is subject to the policy’s monetary and mode-of-travel limits (including the $10,000 per transplant maximum for recipient plus companion). The transplant itself must be pre-approved by Neighborhood and performed at a Medicare‑approved transplant center for travel and lodging benefits to apply.

Key Definitions

Companion

Who qualifies as a companionA spouse or partner, family member, legal guardian, or any other person (related or not) actively involved in the transplant recipient's care

RoleMay accompany the transplant recipient for transportation and lodging related to the approved transplant

LimitCoverage is limited to one eligible companion per transplant recipient

Lodging

DefinitionTemporary place to stay or sleep such as hotels, motels, extended-stay facilities, or apartments

Family/friends exceptionLodging provided by family or friends is not reimbursable

Reimbursement basisLodging reimbursement is based up to the US General Services Administration per diem rate

Transplant Recipient

DefinitionA Neighborhood-enrolled member who is receiving a covered, approved transplant service

ScopeTravel and lodging benefits apply to the transplant recipient (exclusive of the inpatient hospital admission)

Approval requirementThe associated transplant must be pre-approved by Neighborhood for coverage of travel and lodging

Transportation

DefinitionMovement of humans between locations by automobile, bus, rail, and/or air

Mileage reimbursementAutomobile mileage reimbursed at the IRS medical care mileage rate in effect on the date of travel

Airfare limitationAirfare is limited to coach/economy fares; certain airfare is excluded when travel is due to secondary/temporary residence status

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyTransplants - Transportation & Lodging

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 8, 2026

Next Review DateApr 8, 2026

Key ActionObtain Neighborhood pre-approval for the associated transplant prior to requesting travel or lodging reimbursement.

SourceLink

On This Page

OpenPayer

Transplants - Transportation & Lodging

Coverage Criteria and Limits

Transplant Period Definition & Coding

Provider Requirements and Documentation

Policy Background

Key Definitions

Evaluation & Pre-approval

Facility Requirements

Post-Transplant Travel & Lodging Coverage