5-018.05B1 Medicare (Primary) and Medicaid (Secondary)

If the client has Medicare as his/her primary insurance and Medicaid is secondary, the client does not require out-of-state treatment approval from Medicaid.  The DHHS Central Office Transportation Coordinator will determine if out-of-state transportation assistance is approved.  The Coordinator must use components of the definition of medical necessity found in 471 NAC 1-002.02A to determine whether out-of-state transportation may be authorized.  If out-of-state transportation assistance is disapproved because the client is requesting routine medical services (for example, using a distant out-of-state clinic as the primary care provider), Department staff must deny the transportation service.

{8/20/07}