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West Virginia Income Maintenance Manual Chapter 27

West Virginia Income Maintenance Manual Page 6 Chapter 27 Non-Emergency Medical Transportation (NEMT)

27.5 SPECIFIC ELIGIBILITY REQUIREMENTS 27.5.1 EXCEPTIONS TO ELIGIBILITY The following individuals are not eligible for non-emergency medical transportation (NEMT): • Individuals designated only as Qualified Medicare Beneficiaries (QMB), Specified Low Income Medicare Beneficiaries (SLIMB), Qualified Individuals (QI-1), or Qualified Disabled Working Individuals (QDWI) and who are not dually eligible for any full- coverage Medicaid group • Medicaid public school patients being transported to schools for the primary purpose of obtaining an education, even though Medicaid-reimbursable school-based health services are received during normal school hours, except for children receiving services under the Individuals with Disabilities Education Act (IDEA) when the child receives transportation for a Medicaid-covered service, and both the transportation and service are included in the child’s Individualized Education Plan (IEP) Reimbursement is allowed in certain circumstances for trips to pick up medicine, eyeglasses, dentures, or medical supplies, or for repairs or adjustments to medical equipment. When services are paid for by any other program, or otherwise not charged to Medicaid, NEMT is not approved. When other reimbursement is available, Medicaid is always the last payer. Reimbursement is not approved for services normally provided free to other individuals. 27.5.2 PRIOR AUTHORIZATION The following situations require prior authorization from the broker. • All requests for out-of-state transportation and certain related expenses, except for travel to those facilities which have been granted in-network status. Facilities granted in- NOTE: Individuals who receive both Medicare and Medicaid do not require prior approval for out-of- state transportation.