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Meals, Lodging, Advanced Funds

  • For Members birth through age 20, the Managed Care Organization must authorize advanced funds to be used to purchase gas, meals, or lodging prior to the trip, if the Member requires these funds in advance to access necessary Health Care Services. The costs are either:
    • Directly associated with a long-distance trip to obtain health care services; or
    • Necessary because a member who is already outside his or her county of residence experiences an unplanned or urgent healthcare event that requires the member to remain in the area overnight for treatment before the member can return home.
  • Advanced funds are intended to cover NEMT services such as meals, lodging, and mileage reimbursement. The health plan may authorize advanced funds in additional situations such as airline tickets, taxicab, commercial bus tickets, toll charges, and parking fees if the health plan determines it is in the best interest of the member or if providing advanced funds is more cost-effective than other NEMT services.

MEALS AUTHORIZATION GUIDELINES

  • A $25 dollar meal per diem for the member and single attendant is allowed.
  • Additional attendants are also eligible for the meal per diem when a health care provider documents the need for such attendant. The member and/or health plan is responsible for providing Access2Care with the documentation from the health care provider for this request.

LODGING AUTHORIZATION GUIDELINES

  • The health plan may approve lodging requests the night before a covered service if:
    • Travel cannot be reasonably accomplished on the day of the appointment.
    • A health care provider's statement of need or equivalent documents the necessity to travel the night before.
  • The health plan may authorize lodging requests the night after a covered service if:
    • Travel to the member's residence qualifies for discounted airfare.
    • Travel to the member's residence reasonably requires an additional day due to length or circumstances beyond the member's control.
    • A health care provider's statement of need or equivalent documents the necessity for additional lodging.
  • Lodging reimbursement will be calculated using the Texas Comptroller of Public Accounts.
  • Lodging reimbursement is limited to the overnight stay and shall not include any amenities or incidental charges incurred during the member's stay (i.e., phone call, room service, laundry, etc.).
  • Access2Care must authorize lodging for an attendant when a health care provider documents the need.