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Okaloosa County BOCC — May 6, 2014 — Medicaid amend 6 — reading text
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Lodging: Itemize daily. For per diem use the rate of $80 per day prorated on a quarterly basis. When calculating per diem Class A travel day starts at midnight and Class B travel day
begins at time of departure. For actual lodging, copy of receipts must be submitted with travel form.
Map Mileage: Point to point mileage calculated from the Official Department of Transportation map (in state).
Incidental Expenses: List the amount and the type of charge being charged (do not itemize daily). Copy of receipts must be submitted with travel form.
Column Total: Total cost for Class A & B Meal Allowance.
Column Total: Total cost for Per Diem/Actual Lodging.
Total Miles: Total of map mileage at $0.445 per mile.
Column Total: Total cost of incidental expenses.
Summary Total: Total cost to the Subcontracted Transportation Provider for the transport of a Medicaid recipient.
Subcontracted Transportation Provider Manager: Signature of authorized official/manager of Subcontracted Transportation Provider.
Date: Date the travel form was prepared by Subcontracted Transportation Provider official.
Commission for the Transportation Disadvantaged Project Manager: Signature of authorized official/Project manager of the Commission for the Transportation Disadvantaged.
Date: Date of travel form review by Commission for the Transportation Disadvantaged Project Manager.
Meal Allowances and Travel Status are as follows:
CLASS A TRAVEL STATUS - Continuous travel of 24 hours or more away from origin.
CLASS B TRAVEL STATUS - Continuous travel of less than 24 hours requiring overnight absence from origin.
Maximum Allowances for Meals as Follows:
Breakfast $6.00 When travel begins before 6 a.m. and extends beyond 8 a.m.
Lunch $11.00 When travel begins before 12 noon and extends beyond 2 p.m.
Dinner $19.00 When travel begins before 6 p.m. and extends beyond 8 p.m. or when travel occurs during nighttime hours due to special assignment.
Refer to Disbursement Handbook, Section 112.061, F.S. and Chapter 691-42 F.A.C. and Department of Financial Services for complete instructions.
(NOTE: No allowance shall be made for meals when travel is confined to the same city/town, immediate vicinity, or day trips where the traveler is not away from his or her origin overnight.)