The Medical Transportation (MT) Program is one of the components of the Pinaymootang First Nation Health Centre that provides transportation benefits to eligible clients with access to medical services required outside of the community.
1. General Principles
1.1 Medical transportation benefits are funded in accordance with the policies set out, to assist clients to access medically required health services that cannot be obtained on the reserve or in the community of residence, when access would otherwise be denied. Exceptions may be granted, with justification and First nations and Inuit Health Branch (FNIHB) approval, to meet exceptional needs.
1.2 Access to medically required health services may include financial assistance to the client or arranging for the provision of services from the reserve or community of residence when the following conditions are met:
The client has exhausted all other available sources;
- Travel is to the nearest appropriate health professional or health facility (when health professionals are brought into the community to provide the service, the community facility is considered the nearest appropriate facility);
- The most economical and efficient means of transportation is used;
- Medically required health services are not available on the reserve or community of residence;
- Transportation to health services is coordinated to ensure maximum cost-effectiveness;
- Transportation benefits are provided when prior approved by FNIHB or post approved upon medical justification if consistent with the framework;
- In emergency situations, when prior approval has not been obtained, expenses may be reimbursed by FNIH when appropriate medical justification is provided to support the medical emergency and approved after the fact; and
- When public transit is not available.
1.3 Medical transportation benefits may be provided for clients to access the following types of medically required health services:
- medical services defined;
- diagnostic tests and medical treatments;
- alcohol, solvent, drug abuse and detox treatment;
- traditional healers; and
- Non-Insured Health Benefits.
1.4 Medical transportation benefits include ground, water and air travel, meals and accommodation.
1.5 Medical transportation benefits may be provided for an approved escort.
1.6 In cases where a client is required to travel repeatedly on a long term basis to access medical care/treatment, medical transportation benefits will be provided for up to four months. During this time, an assessment will be conducted involving the treating physician, other relevant health professional(s) and the client to determine the provision of further benefits, taking into consideration the client's medical condition.
1.7 Medical transportation benefits may be provided when the client is referred by the provincial/territorial health care authority for medically required health services to a facility outside of Canada when such services are covered by a provincial/territorial health plan and the medical transportation benefits are not covered by provincial/territorial health or social programs, other publicly funded programs or private insurance.
1.8 When a request for medical transportation is denied, an appeal process is available. Appeals must be initiated by the client or by a designate acting on their behalf.
2. Coordinated Travel
2.1 When more than one client is travelling to the same location, where practical and economical, appointments and travel arrangements will be coordinated to ensure optimum cost-effectiveness.
2.2 When more than one medically required service is required in a week and/or more than one family member needs to access a medically required service in the same week, where practical and economical, appointments and travel arrangements will be scheduled for the same day to ensure optimum cost-effectiveness.
2.3 When more than one client is travelling in the same vehicle, the rate reimbursed will be for one trip only. Where applicable, an appropriate schedule of fixed rates will be established.
3. Modes of Transportation
3.1 The most efficient and economical mode of transportation consistent with the urgency of the situation and the medical condition of the client is to be utilized at all times as approved by FNIH. Clients who choose to use another mode of transportation will be responsible for the difference in the cost between the two.
3.2 When scheduled and/or coordinated medical transportation benefits are provided by FNIH clients who choose to use another mode of transportation will be responsible for the full cost.
3.3 The following modes of transportation may be utilized for medical transportation benefits:
- Ground travel
- Private vehicle
- Medical Transportation Vehicle
- Air travel
When it has been determined by FNIHB that a private vehicle is the most appropriate, efficient and economical means of transportation, the payment of a per kilometre allowance may be authorized for the use of a private vehicle by a client to access medically required health services.
The payment of a private vehicle per kilometre allowance will not be approved when scheduled and/or coordinated medical transportation is available.
Reimbursement of the per kilometer allowance for the use of a private vehicle will be issued to the client when all eligible justification has been submitted.
Whether Band vehicle and drivers are used to provide medical transportation benefits, FNIHB shall ensure:
- All medical drivers carry and maintain a valid driving permit and appropriate liability insurance in relation to the carriage of passengers by vehicle;
- All medical drivers undergo a screening process, including background checks and references, whereby the general trustworthiness of the driver is assessed, bearing in mind that the driver will not only be operating a motor vehicle, but also entrusted with the transport of medical patients and will frequently be alone with such persons for extended periods;
- All vehicles carry and maintain a valid license, registration and appropriate liability insurance in relation to the carriage of passengers by vehicle or other motorized conveyances;
- All vehicles used for medical transportation are in good working order, including seat belts and child safety seats, and that all laws applicable to transportation are adhered to by all drivers.
4. Emergency Transportation
4.1 Assistance with the cost of ambulance services will be provided when such services are required for emergency situations.
4.2 Salaries for doctors or nurses accompanying clients on the ambulance are not covered.
4.4 Medical transportation benefits for emergency ground ambulance include only the portion of the services not covered by provincial/territorial health or social programs, other publicly funded programs, or private health insurance plans (equivalent amount billed to other provincial/territorial residents).
4.5 Medical transportation benefits for emergency air ambulance/medevac services include only the portion of the services not covered by provincial/territorial health or social programs, other publicly funded programs or private health insurance plans (equivalent amount billed to other provincial/territorial residents).
5. Client Escorts
5.1 Medical transportation benefits may include the provision of transportation, accommodation and meals for medical or non-medical escorts for clients travelling to access medically required health services.
5.2 The use of an escort must be preauthorized by FNIH. The length of time for which the escort is authorized will be determined by the client's medical condition or legal requirements.
5.3 Medical transportation benefits do not include the payment of a fee, honorarium or salary to medical or non-medical escorts.
5.5 The provision of a non-medical escort may be approved, following a doctor's or community health professional's request, only when there is a legal or medical requirement such as:
- Where the client has a physical/mental disability of a nature that he or she is unable to travel unassisted;
- Where the client is medically incapacitated;
- Where the client has been declared "mentally incompetent" by a court;
- When there is a need for legal consent by a parent or guardian;
- To accompany a minor who is accessing medically required health services;
- When a language barrier exists; or
When an escort has been authorized, the following criteria should be considered in selecting the escort:
- A family member who is required to sign consent forms or provide a patient history;
- A reliable member of the community;
- Physically capable of taking care of themselves and the client and not requiring assistance or an escort themselves;
- Proficient in translating from local language to English/French;
- Able to share personal space to support client;
- Interested in the well-being of the client; and
- Able to serve as driver when client is unable to transport him/herself to or from appointment.
5.7 Unless there is a medical or legal requirement for an escort to stay longer, or it is more practical financially to have the escort stay longer, the escort shall return to the community by the earliest and most economical reasonable means.
6.1 When accessing medical transportation benefits, confirmation that the client has accessed a medically required health service must be obtained from the health care professional.
6.2 When a client does not attend a scheduled appointment and medical transportation benefits have been provided, the client may have to assume the cost of the return trip or of the next trip to access medically required health services unless proper justification is provided to explain why the client was unable to attend or to notify the appropriate public carrier of the cancellation.
7. Addictions Treatment Travel Policy
7.1 Travel will be funded to the closest appropriate NNADAP funded/referred facility in the home province only. Exceptions are made to travel outside the province only when the required treatment is not available in the home province or when a neighbouring province's treatment centre is the closest centre and approved by the NIHB Regional Office.
7.2 Clients are required to meet all treatment centre entry requirements prior to medical transportation benefits being authorized.
7.3 Only the most efficient and economical method of transportation will be authorized, taking into account the medical condition of the client.
7.4 An escort is only provided for a client as defined in Section 5 (Client Escorts).
7.5 Trips home during the course of treatment will not be authorized unless part of the treatment plan as established by the facility and approved prior to starting treatment.
7.6 Family trips to the treatment facility will not be authorized .
7.7 Transportation to return the client to the community will not be provided for clients who discharge themselves from treatment.
7.8 Travel to access additional treatment within a one year period requires approval from the NIHB Regional Office.
7.9 Medical transportation benefits will only be provided for clients while in the care of the treatment centre when approved by the NIHB Regional Office.
7.10 Exceptions may be authorized, with appropriate justification, when approved by the NIHB Regional Office.
8. Traditional Healer Services Travel Policy
8.1 Medical transportation benefits, within the client's region/territory of residence, may be provided for clients to travel to see a traditional healer or, where economical, for a traditional healer to travel to the community.
8.2 Medical transportation benefits to access traditional healer services must be preauthorized by FNIH. On an exception basis, authorization may be granted after the fact by FNIH when appropriate medical justification is provided and approved.
8.3 When the traditional healers selected by the client are outside of the client's region/territory of residence, travel costs will be reimbursed for travel to the region/territorial border only.
8.4 The following criteria must be considered prior to approving medical transportation benefits for traditional healer services:
- The traditional healer is recognized as such by the local Band, Tribal Council or health professional;
- The traditional healer is located in the client's region/territory of residence;
- A licensed physician, or if a licensed physician is not routinely available in the community, a community health professional or FNIH representative has confirmed that the client has a medical condition.
8.5 The NIHB Program does not pay for any associated honoraria, ceremonial expenses or medicines. These costs remain the sole responsibility of the client.
9. Meals and Accommodation
9.1 Medical transportation benefits may include assistance with meals and accommodation when these expenses are incurred while in transit for approved transportation to access medically required health services.
9.3 Accommodation arrangements will be made by FNIH. Clients who choose to make different accommodation arrangements will be responsible for the difference in the cost between the two.
9.4 When available, meals and accommodation must be obtained from the boarding homes or commercial establishments with which FNIH have a negotiated Standing Offer or other contractual agreement.
9.5 Assistance with meals may be provided where the time away from home to attend the medically required appointment is more than 6 hours in one day.
9.7 Assistance with overnight accommodation may be provided on a case by case basis, which may include the review of the medical justification, time of appointment, distance traveled and scheduled and/or coordinated medical transportation.
9.8 When accommodation is provided in a private home, assistance not to exceed the regional rate set out for private accommodation may be reimbursed.
9.9 Other expenses are the responsibility of the client (e.g., telephone charges, parking, room damage, movie rentals, game rentals, room service, tips, gratuities, etc.) and will not be reimbursed.
10. Reimbursement of Travel Expenses
10.1 Reimbursement to clients, approved escorts and service providers will be in accordance with the transportation policies and benefits of the NIHB Program and based on:
- Negotiated rates;
- Rates set out in the terms and conditions of the relevant contribution agreement;
- Published First Nations and Inuit Health Branch (FNIHB) rate(s);
- The actual expense of a commercial carrier/service with the submission of original itemized receipts.
10.2 Only service providers who have a negotiated contractual arrangement or who have been approved by FNIH will be reimbursed for medical transportation benefits they have provided.
10.3 All invoices submitted for payment for the reimbursement of expenses for medical transportation benefits must be submitted within 1 year of the service being provided. Requests for reimbursements submitted more than 1 year after the service is rendered will be rejected.
10.4 Medical transportation benefits include coverage for some or all of the travel expenses incurred by clients to access medically required health services at the nearest appropriate facility. If clients wish to access equivalent services elsewhere, they will be responsible for the difference in the cost of such travel. In cases where scheduled and/or coordinated medical transportation benefits are provided by FNIHB or a First Nations or Inuit Health Authority or organization, the clients will be responsible for the full cost.
10.5 Reimbursement to the client for meal allowances and private accommodation will be as per the regional rates.
10.6 When private vehicles are used, reimbursement to the client will be as per the regional rate.
11.1 Certain types of travel may be considered on an exceptional basis with the appropriate justification.
- Diagnostic tests for educational purposes, such as hearing tests;
- Speech assessment and therapy when coordinated;
- Medical Supplies and Equipment benefits where a fitting is required;
- Transportation for clients to visit a pharmacy for pharmacist-supervised methadone ingestion may be provided for up to four months for methadone patients in order to allow stabilization for carries (e.g., where the patient takes doses home) or alternate arrangements to be made. Extensions with justification be considered;
- Provincially/territorially supported preventative screening programs when coordinated with other medical travel and the cost of the testing is covered under the provincial/territorial health plan;
- Other requests for travel will be reviewed on a case by case basis with appropriate justification.
12.1 Certain types of travel, benefits and services will NOT be provided as benefits under the NIHB Program under any circumstances and are not subject to the NIHB appeal process.
- Compassionate travel;
- Appointments for clients in the care of federal, provincial or territorial institutions;
- Court-ordered treatment/assessment, or as a condition of parole;
- Appointments while travelling outside of Canada;
- Travel for clients residing in an off-reserve location where the appropriate health services are available locally;
- Travel for the purposes of a third-party requested medical examination;
- The return trip home in cases of an illness while away from home other than for approved travel to access medically required health services;
- Travel only to pick-up new or repeat prescriptions or vision care products;
- Travel to access health related services that are not identified in section 1.3, unless coordinated;
- Payment of professional fee(s) for preparation of doctor's note /document preparation to support provision of benefits;
- Transportation to adult day care, respite care and/or interval/safe houses.
NIHB - TOLL FREE NUMBERS
Medical Transportation 1-877-983-0911
Vision, Pharmacy, Medical Supplies & Equipment 1-800-665-8507