§ 438.9 - Provisions that apply to non-emergency medical transportation PAHPs.

§ 438.9 Provisions that apply to non-emergency medical transportation PAHPs.

Cross Reference

Link to an amendment published at 89 FR 8980, Feb. 8, 2024.

(a) For purposes of this section, Non-Emergency Medical Transportation (NEMT) PAHP means an entity that provides only NEMT services to enrollees under contract with the State, and on the basis of prepaid capitation payments, or other payment arrangements that do not use State plan payment rates.

(b) Unless listed in this paragraph (b), a requirement of this part does not apply to NEMT PAHPs, NEMT PAHP contracts, or States in connection with a NEMT PAHP. The following requirements and options apply to NEMT PAHPs, NEMT PAHP contracts, and States in connection with NEMT PAHPs, to the same extent that they apply to PAHPs, PAHP contracts, and States in connection with PAHPs.

(1) All contract provisions in § 438.3 except requirements for:

(i) Physician incentive plans at § 438.3(i).

(ii) Advance directives at § 438.3(j).

(iii) LTSS requirements at § 438.3(o).

(iv) MHPAEA at § 438.3(n).

(2) The actuarial soundness requirements in § 438.4, except § 438.4(b)(9).

(3) The information requirements in § 438.10.

(4) The provision against provider discrimination in § 438.12.

(5) The State responsibility provisions in §§ 438.56, 438.58, 438.60, 438.62(a), and 438.818.

(6) The provisions on enrollee rights and protections in subpart C of this part except for §§ 438.110 and 438.114.

(7) The PAHP standards in §§ 438.206(b)(1), 438.210, 438.214, 438.224, 438.230, and 438.242, excluding the requirement in § 438.242(b)(7), to comply with § 431.61(a) and (b) of this chapter.

(8) An enrollee's right to a State fair hearing under subpart E of part 431 of this chapter.

(9) Prohibitions against affiliations with individuals debarred or excluded by Federal agencies in § 438.610.

(10) Requirements relating to contracts involving Indians, Indian Health Care Providers, and Indian managed care entities in § 438.14.

[81 FR 27853, May 6, 2016, as amended at 85 FR 72840, Nov. 13, 2020; 89 FR 8980, Feb. 8, 2024]