Transportation to and from school may be claimed as a Medicaid service when a child receives a Medicaid covered IDEA health related service, other than transportation, in school on a particular day when both the covered IDEA health-related service and the need for medically necessary transportation are included in the child's IEP or IFSP; and

The transportation provided is adapted to serve the needs of the disabled child pursuant to 42 CFR 440.170 (a)(1). The IEP or IFSP should include only specialized services that a child would not otherwise receive in the course of attending school.

Transportation may also be billed to Medicaid when a child resides in an area that does not have school bus transportation (such as those areas in close proximity to a school) but has a medical need for transportation that is noted in the child’s IEP or IFSP; or

When a child receives a Medicaid-covered IDEA health-related service at an off-site facility, the transportation is billable to the off-site facility and back; or if the child is transported to a provider in the community to receive an IDEA-covered SBHS, the transportation to the community provider and back may be billed. This must not include the distance the child is transported from home to the school and then to the off-site facility or community provider to receive a Medicaid-covered service.

If a Medicaid-eligible student is able to ride on a regular school bus, but requires the assistance of a delegated health care aide, trained by an RN to provide a delegated nursing task specific to the student, who cannot be transported safely without the delegated health care aide, the transportation on the regular school bus is not billable. However, the service provided by the delegated health care aide is reimbursed under the delegated health care code. See the standards for delegation of a Nursing Care Task as outlined in the Nurse Practice Act, Division 47, OAR 851-047-000.

If a Medicaid-eligible student requires the assistance of a delegated health care aide and transportation adapted to serve the needs of the disabled student, both the necessary and appropriate transportation and the Medicaid-covered service provided by the delegated health care aide may be reimbursed when both are specified on the Medicaid-eligible student’s current IEP or IFSP.

If an education agency provides special transportation to a Medicaid-eligible student to a covered service outside the district or the Medicaid-eligible student’s resident school and the student cannot be transported safely without a transportation aide as specified on the IEP or IFSP, the transportation is billable. However, a transportation aide who is not a delegated health care aide trained by an RN cannot be billed as a separate cost because the cost of the transportation aide is included in the cost of the transportation. Transportation is not reimbursed by OMAP when provided by the parent or relative of the child.

Important! Please go to the SBHS information page and review the DHS communication dated 9/2/2005 regarding coding and billing transportation. Also, review the SBHS rules for additional information regarding covered services, documentation requirements, services not covered, cost calculation and determination, and medically qualified staff, etc. You will also find information on the cost calculation instruction sheet regarding transportation costs.