The purpose of this policy is to establish guidelines for transporting of patients for medical appointments.
Guidelines will be utilized to be most effective and efficient and are defined below:
- Transportation is for Medical Appointments to/from Medical Facilities Only
- Other options (with involvement of IHS or other programs) may be explored before transport is approved
- Receiving funding from other sources will result in ineligible for transport, i.e. funding from other programs for the same service.
- Transports are limited to tribal members of the Eastern Shoshone Tribe and other Federally Recognized Tribes who are eligible for Direct IHS services and live within the defined local community.
- Transports for patients over the age of 18 will be for the patient only. Patients under the age of 18 will require an escort of legal guardianship.
- All CHR/Diabetes/Chronic Disease Program employees do not transport prisoners, people intoxicated, or people physically or verbally abusive.
- For Medical Appointments within Fremont County, patients must schedule transport at least one (1) business day before appointment. For Medical Appointments outside Fremont County, patient must schedule transport at least three (3) business days before appointment. If the patient is Medicaid eligible, enough time will be required for the patient to request and complete the paperwork.
- Patients that fail to be at home for pick up or don’t call to notify CHR’s of cancellation will be allowed three (3) missed scheduled transports. After three (3) missed scheduled transports, the patient is no longer eligible for transport.
- Transports for same day appointments may not be available.
- For all Emergencies, call 911
- Patients need to be ready and be at the place of pick up for scheduled transports, the transporter is only required to wait 10 minutes. If place of pick up has changed, call early to notify CHRs.
- Appointment verification is required for all transports and must be faxed to Eastern Shoshone Tribal Health at (307) 332-0458. Both in-state and out-of-state transportation’s referral from their provider is also needed and must meet the criteria listed above.
- Transportation by the CHRs will be given after all existing sources have been exhausted.
- All patients will be required to use seat belts as required by law. All infant car seats need to be placed into the CHR vehicle. This is a safety factor for both the patient and the CHR, especially if the patient is wheelchair bound or has special needs.
The program will utilize and adopt the same rules required by Wyoming Medicaid for transportation assistance to eligible patients:
- The service must be medically necessary. Medically necessary is defined as a service that is required to diagnose, treat, cure or prevent an illness, injury, or disease which has been diagnosed or is reasonably suspected to relieve pain, or to improve and preserve health and be essential to life. The services must be:
- Consistent with the client’s diagnosis and treatment
- In accordance with the standards of good medical practice among the provider’s peer group
- Required to meet the medical needs of the client and undertaken for reasons other than convenience of the client and provider
- Provided in the most appropriate and cost-effective setting required by the client’s condition
- If transportation is to be reimbursed outside of Wyoming but still within the defined service area. (Service Area for Wyoming Medicaid include Craig CO; Idaho Falls, Montpelier and Pocatello ID; Billings and Bozeman, MT; Kimball and Scottsbluff, NB; Belle Fourche, Custer, Deadwood, Rapid City, and Spearfish, SD; and Ogden and Salt Lake City, UT) the referral meets the following criteria:
- The service is not available in the local trade area (the local trade area is the geographic area surrounding the client’s residence, excluding portions of states other than Wyoming, commonly used by other persons is the same area to obtain similar services.
- The specified city within the service area is closer (in highway miles) than the nearest location in Wyoming where the service is available.
- If the transportation to be reimbursed is outside the service area:
- The service is not available in the service area
- The location referred to is the closest available service location to the client’s primary residence.
- If the Medicaid eligible client is requesting transportation assistance from the CHR Program, the CHR Program’s Medical Billing Specialist will assist the client on how to complete the paperwork.