CoverSummaryTrans310 BB820CS.Pdf Form

K:\WINWORD\CC\Tribal Consultation\Transportation Policy\Cover summary Transportation 310-BB 820 CS.doc AHCCCS MEDICAL POLICY MANUAL

Policies 310-BB, Transportation, & 820, Prior Authorization Requirements

Policy Revision Presented 01/12/2012

POLICY CHANGES APPROVED AT APC XX/XX/XXXX

Responsible Division/Office & Persons:

Rebecca Fields, Claire Sinay, Maureen Sharp, Heidi Oliver, Melina Solomon, Linda Chelius, Carol Sanders, Dr. Leib, Gina Relkin, Kim Elliott, Kyra Westlake, Susan McLuty, Elizabeth Stackfleth, Jami Snyder, Penny Ellis

Why is the proposed policy amendment needed?

Policy 310-BB, Transportation, was amended to update and clarify AHCCCS’ transportation policy.

Definitions for ambulatory vehicle, stretcher van, wheelchair van and taxi have been added for clarification. Requirements for medically necessary non-emergency transportation furnished by non-ambulance providers have been added to the policy. Reorganization of the policy has been proposed to clarify the following categories:

• Emergency Transportation Provider Requirements for Emergency Transportation Services Provided for AHCCCS American Indian Health Program Members • Medically Necessary Non-Emergency Transportation Furnished by Non-Emergency Transportation Providers for Medical and Behavioral Health Services • Medically Necessary Non-Emergency Transportation Furnished by Non-Ambulance Providers • Medically Necessary Non-Emergency Transportation Furnished by Ambulance Providers

Language related to prior authorization requirements to receive non-emergency transportation for American Indian Health members was relocated from AMPM Chapter 300 to Chapter 800.

Is input needed from external parties?

No.

Is Consultation with Tribes and Indian Health Service, Tribal Health Programs Operated under P.L. 93- 638, and Urban Indian Health Programs (I/T/U) needed?

No.

Summarize any financial impacts.

None.

Summarize any AHCCCS operational and systems impacts.

None.

Identify any applicable AHCCCS contract changes.

None.

Does this policy relate to reimbursement?

K:\WINWORD\CC\Tribal Consultation\Transportation Policy\Cover summary Transportation 310-BB 820 CS.doc No.

Identify the applicable federal and state citations that apply to the policy. C.F.R, A.R.S., A.A.C., State Plan, Waiver

A.A.C. R9-22-211

A.R.S. § 28-2515