Title XIX Non-Emergency Medical Transportation
The Title XIX Non-Emergency Medical Transportation (NEMT) Program provides assistance for non-emergency medical transportation needs for eligible recipients.
Mileage, Meals and Lodging:
- A recipient may be reimbursed for mileage, meals and lodging at the current rate of payment.
- Transportation is from an eligible recipient’s city of residence to a medical provider located in another city, between medical providers located in different cities, or from a medical provider located in one city to the recipient’s city of residence. Mileage is limited to the actual miles between two cities and does not include miles driven within the city.
- Transportation to the closest Primary Care Provider (PCP) or Health Home Provider (HHP) is reimbursable. If travel is not to the closest PCP or HHP, transportation will only be reimbursed if a "good cause" exception has been granted from the Managed Care Program.
- Lodging and meals are not reimbursable when travel is to a PCP or HHP.
- Lodging and meals are reimbursable when the provider is at least 100 miles from the recipient’s city of residence and travel is to obtain specialty care or treatment that results in an overnight stay. Meals and lodging are limited to the recipient and, if medically necessary, one escort or volunteer driver.
- Meals will be reimbursed only if an overnight stay is medically necessary and the overnight meets the lodging requirement criteria.
- During inpatient or outpatient medical stays, meals and lodging are limited to 14 days for each medical stay unless the department prior authorizes additional days. All efforts to secure a temporary place to stay either by the hospital or a nonprofit organization need to be exhausted first.
- A recipient may not receive reimbursement for lodging and meals for days the recipient is an inpatient in a hospital or medical facility.
- The Department of Social Services reserves the right to deny coverage for any requests made outside the general coverage guidelines of these rules.
- A recipient must be on a medical assistance program that provides Title XIX (Medicaid) coverage.
- Transportation must be to the closest medical facility or medical provider capable of providing the necessary services, unless the recipient has a written referral or a written authorization from the recipient's medical provider.
- The service must be a Medicaid covered service provided by a medical provider who is enrolled in the medical assistance program.
- Trips prior to your eligibility date cannot be reimbursed.
- Trips to medical specialty providers other than your primary care provider (PCP) or Health Home Provider (HHP) require a referral card.
- A Title XIX Medical Transportation Reimbursement Form must be completed and submitted for each medical trip. This form, along with any necessary documentation, may be turned in at your local Department of Social Services’ office, mailed directly to: Department of Social Services, Office of Finance/EBT, 700 Governors Drive, Pierre, SD, 57501, or faxed to (605) 773-8461.
- The Title XIX Medical Transportation Reimbursement Form must be completed and signed by the recipient, parent or guardian. The Medical Provider section of the form must be completed and signed by the receptionist, nurse or medical provider.
- A recipient will receive your reimbursement when all required forms and verifications have been received in our office and processed.
- The Non-Emergency Medical Transportation program must receive a completed claim form within six months following the month the service was provided.
Important Information Regarding NEMT Payment Distribution: