(1) These requirements are in addition to those rule provisions generally applicable to Medicaid providers.

(2) Coverage of specialized nonemergency medical transportation is limited to transportation of persons with disabilities for the purpose of obtaining nonemergency medical services covered by the Medicaid program.

(a) The person must be in need of specialized transportation due to the person either being wheelchair-bound or subject to transport by stretcher.

(3) Coverage of specialized nonemergency medical transportation is not available if another mode of transportation is appropriate for the transport of the recipient and is less costly.

(4) Coverage of specialized nonemergency medical transportation is not available for costs for the service incurred during a retroactive eligibility period.

(5) Mileage reimbursement is rounded to the nearest whole mile.

(6) Coverage of specialized nonemergency medical transportation is limited to mileage fees and does not include any other fees. Reimbursement is not available for other fees.

(7) Specialized nonemergency medical transportation services must be prior authorized by the department or its designee.

(a) If a medical appointment has been rescheduled, any prior authorization of the original appointment does not apply to the rescheduled appointment. Prior authorization must be obtained for the rescheduled appointment if the appointment is scheduled for a date other than the original appointment date.

(8) Commercial providers are required to maintain and retain original dispatch records for services provided to a Montana Medicaid recipient that include:

(a) name of recipient;

(b) originating address;

(c) destination address;

(d) date;

(e) time;

(f) authorized units;

(g) charges; and

(h) the authorization number.