PART I: QUALIFYING FOR MEDICAID NEMT SERVICES C.5.1 Covered Transportation Services C.5.1.1 The Contractor shall provide NEMT services for medically necessary transportation for any Eligible Beneficiary and an Escort, if required. These services ensure access to medical evaluations, treatments, prescription drugs, and medical equipment. Additionally, NEMT services shall be provided for medical services reimbursed under the District Medicaid program, even if provided by non-participating health practitioners or entities. C.5.1.2 The Contractor shall provide NEMT services with applicable service limitations for the following covered Medicaid services: 1. Ambulatory services; 2. Podiatry, Optometry, and Dental services; 3. Physical Therapy and Occupational Therapy (Home Health Agency or medical rehabilitation facility); 4. Private Duty Nursing; 5. Clinic services; 6. Speech, hearing, and language disorder services (supervised); 7. Prescription Drugs and Prosthetic devices; 8. Eyeglasses and Diagnostic services; 9. Preventive and Rehabilitative services; 10. Inpatient Psychiatric Hospital services (65+ years); 11. Skilled Nursing and Intermediate Care Facility services (including non-Mental Disease facilities); 12. Distinct part unit services for Developmental Disability; 13. Inpatient psychiatric services (Under 22 years); 14. Hospice Care; 15. Targeted Case Management and Tuberculosis-related services; 16. Pregnancy-related and postpartum services, including complications; 17. Gastric bypass; 18. Emergency hospital services (non-Medicare participating hospitals); and 19. Personal Care services (in-home, under treatment plan and supervision). C.5.1.3 In accordance with 42 CFR 440.170, the Contractor shall be responsible for providing, at its own expense, an Attendant to accompany an Eligible Beneficiary when such assistance is determined necessary to ensure the Eligible Beneficiary’s safe transportation and participation in medical services. The Contractor shall also bear all costs associated with the Attendant’s transportation, meals, and lodging. If the Attendant is not a member of the Eligible Beneficiary’s family, the Contractor shall additionally be responsible for payment of the Attendant’s salary. These costs shall not be separately reimbursable by the District and are deemed included in the Contractor’s rate. The Contractor is solely responsible for ensuring that all Attendants meet the qualifications and service standards required under this Contract and applicable law. C.5.1.4 The Contractor shall modify applicable systems to capture and report Beneficiary utilization among these categories listed in C.5.1.2. Policies and procedures, including reasonable trip limits for therapeutic services, shall be developed in coordination with the District. C.5.1.5 The Contractor shall provide transportation to and from District points of origin and Medicaid-reimbursable service locations at the request of the Eligible Beneficiary or an authorized representative. No co-payments shall be collected for these services. C.5.1.6 The Contractor shall provide transportation outside the Washington, DC Metropolitan Area only when adequate medical resources are unavailable locally or when a healthcare provider refers the Eligible Beneficiary to necessary medical care outside the area. Out-of-boundary trips must originate within the District and be deemed medically necessary. A written referral from a healthcare provider shall be required.
