Medicaid Non Emergency Medical Transportation

Gas Vouchers And Reimbursement Forms

If you have a vehicle or a friend/family member to drive you, please review our handout on gas vouchers. When arranging gas vouchers with our office please send in a copy of the driver’s license and vehicle registration for the vehicle. If one of our contracted gas stations is not on your route, we can approve mileage reimbursement. Please review the reimbursement form for guidelines. All trips must be approved in advance, please contact our call center before your appointment. We can also reimburse for ferry tickets, parking, lodging, etc. with prior approval.

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Discover our conditioned and cold chain solutions.

The Best Healthcare Services In The World Cant Help You If You Have No Way To Get There

In 2005, an analysis by the Transportation Research Board revealed that nearly four million Americans miss or delay medical care each year because they lack transportation. While non-emergency medical transportation and non-emergency transportation services account for under 1% of healthcare spending, consistent transportation access to healthcare vastly enhances the health outcomes of members and leads to dramatic cost savings.

MTM-one of the nation’s largest and most experienced transportation brokers-thinks outside the box to provide customized solutions catered to our clients’ unique needs. With more than 25 years of experience in the NEMT industry, MTM can help you take on your biggest challenges. From implementing in-person assessments and travel training to encourage low-cost mode assignment, to introducing routing and scheduling efficiencies, MTM manages every aspect of the medical transportation programs we operate. We are truly your one-stop transportation solution.

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Requirements To Submit Claims

Claims will be submitted through the Availity Essentials provider portal. Availity Essentials is a secure online portal to submit, review and manage claims.

1. Review the Availity Essentials provider portal getting started course.

• Choose a person to be the administrator for your organization.
• There are two options to register as a NEMT provider through Availity Essentials.
• A provider who has a National Provider Identification number.or
• An atypical provider .
• For questions on Availity Essentials registration, contact Availity Client Services at 1-800-282-4548, Monday through Friday, 7 a.m. – 6:30 p.m.

3. Once registered through Availity Essentials.

• Availity Essential offers free training, to access training, log into your Availity Essentials account.

• Through Help & Training or Payer Spaces, the administrator and provider can find training resources to learn how to submit a claim, review the remittance viewer and administrative responsibilities and tasks.
• Through Claims and & Payments, the provider Administrator will also need to sign up for payment remittance advice notification and electronic funds transfers through transaction enrollment.

4. Providers who are currently unable to complete your Availity Essentials registration, BCBSND Medicaid Expansion will allow NEMT providers to file a paper claim and invoice one of two ways.

Does Medicare Cover Medical Transportation Services

Some modes of transportation are covered by Medicare for beneficiaries who require medical health care services.

Both emergency and non-emergency medical transportation may be covered however, it is more common for Medicare to cover emergency medical transportation.

Emergency ambulance transportation is covered by both Original Medicare and Medicare Advantage.

Original Medicare usually does not cover non-emergency situations unless they are pre-approved. Medicare Advantage, on the other hand, may cover this service as an added benefit.

Key Point: Emergency Medical Transportation vs. Non-emergency Medical Transportation

Emergency medical transportation is transportation provided when life, health, or safety is in danger, such as ambulance or law enforcement transportation.

Non-emergency medical transportation includes transportation services offered to patients and health care users who need assistance or face barriers that prevent them from getting to their medical appointments.

Source: Pexels

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How Is The Medicaid Nemt Benefit Administered

State Medicaid agencies have considerable latitude in how they administer NEMT benefits. Federal law contains a broad guideline that state Medicaid plans must specify the methods used to provide NEMT.5 Most states utilize third-party brokerage firms to coordinate transportation for beneficiaries in return for a capitated payment, while some states deliver NEMT directly via fee-for-service reimbursements, and still others rely on a mix of capitated brokerage, direct delivery, and public transit voucher programs as appropriate based on geographic and beneficiary needs.6

The Medicaid Nemt Benefit Explained

Non-emergency medical transportation technically refers to any medically related transportation service apart from those provided in an emergency situation. Those transportation services assist individuals in accessing medically necessary services, such as primary health care, post-hospitalization appointments, and recurring treatments and therapies. In this broad context, NEMT services are provided through veterans health care programs, the Indian Health Service programs, federally qualified health centers, Medicare Advantage and other Medicare programs, and even through private insurance programs.

States use a variety of different delivery models and payment structures to implement the NEMT benefit, which are detailed in a 2018 report by the Transportation Research Board . In addition, it is important to note the role that NEMT services play as a key component in the coordinated public transportation model that allows public and community transportation systems to thrive read a report detailing this interdependency here.

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Nemt Listening Session : Economic Factors And Cost Containment Challenges In Nemt

Date: April 28, 2022 Time: 2:00-3:30 PM EST

In this session, we are seeking your input on broker arrangements as well as usage of community transportation and paratransit services, including topics such as:

• Transportation related expenses and direct payments
• Meals, lodging and payment for an attendant
• Transportation for beneficiaries with challenging behaviors
• Direct payments to beneficiaries, family, and volunteer drivers
• Broker conflict of interest
• Broker prohibition on providing transportation

Provider Enrollment Requirements And Eligibility Determinations For Providers/drivers March 10

Date: March 10, 2022 Time: 2:30-4:00 PM EST

In this session, we are seeking your input on provider enrollment requirements and eligibility for providers and drivers, including topics such as:

• Driver background screenings
• Patient abuse, neglect, and exploitation by drivers.
• Driver identification to the State Medicaid Agency
• Subcontracted transportation company identification to the SMA?

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Economic Benefit Of Modern Nonemergency Medical Transportation That Utilizes Digital Transportation Networks

This study used the National Academies NEMT cost-effectiveness model to perform a baseline cost savings analysis for provision of NEMT for transportation-disadvantaged Medicaid beneficiaries. The results found that total annual net savings for traditional NEMT in Medicaid was approximately $4 billion.

Claim Corrections And Void Requests

NEMT providers may need to correct a claim due to billing errors, by submitting a replacement or void of the original claim. Providers will follow the appropriate guidelines and timeframes to correct claims.

• Claim corrections must be:

A: BCBSND will allow the SFN1731 until June 20, 2022. Effective June 23, 2022 we will require the claim to be submitted on the new Medicaid Expansion Non-Emergency Transportation, Meals, Lodging Billing Form or electronic submission through Availity Essentials.

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Medicare Coverage Of Emergency Medical Transportation

Part B of Original Medicare provides coverage for emergency ambulance transportation to the nearest appropriate medical facility.

According to the Centers for Medicare & Medicaid Services , Medicare typically provides ambulance coverage to and from the following places:

Your transportation will be covered if you match any of the following criteria:

• There is a sudden medical crisis

• There is a severe risk to a persons health

• Moving a person from one location to another may be impossible without the help of emergency services

• A person is losing a lot of blood, unconscious, or in shock

• A person is set to receive a Medicare-covered service

• A person is traveling to and from sites that are covered by Medicare

• The ambulance service meets Medicare requirements

Ground transportation may not always be the most efficient means of getting you the emergency care you require. In some situations, Part B may cover the cost of an emergency helicopter or airplane transportation.

If you require emergency medical transportation, you will have to pay 20% of the cost after you have met your Part B deductible, which is $233 in 2022.

Medicare Advantage programs cover the same benefits as Original Medicare, including emergency medical transportation. However, depending on the plan, the rules or needs for emergency medical transportation may differ.

Source: Pexels

What To Know About Non

Only one person per vehicle traveling to an appointment is allowed. Health First Colorado members may bring a family member or caretaker to their appointment. When members call for transportation, they must let them know if they want to bring a family member or caretaker.

NEMT is not for emergencies. Members need to call 911 for medical emergencies.

If members are having COVID-19 symptoms, they must call their health care provider and let them know before using transportation or going to their providers office. A members provider may need to talk to them about their symptoms before their scheduled visit.

Transportation Providers: Please read Operational Memo HCPF OM 21-055 for Department guidance about preventing the spread of COVID-19.

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Why Do Medicaid Beneficiaries Use Nemt

NEMT can be a cost-effective means of facilitating access to care for Medicaid beneficiaries. One study estimated that at least 3.6 million people miss or delay medical care each year because they lack available or affordable transportation.10 This study found that improved access to NEMT for this population is cost-effective or cost-saving for all 12 medical conditions analyzed, including preventive services such as prenatal care, and chronic conditions such as asthma, heart disease, and diabetes.11 Another study found that adults who lack transportation to medical care are more likely to have chronic health conditions that can escalate to a need for emergency care if not properly managed.12 This study also noted that adults who lack transportation to medical care are disproportionately poor, elderly, and disabled and more likely to have multiple health conditions.13 Most recently, a report for the Arkansas Health Reform Task Force cited national studies showing a positive return on investment for NEMT and recommended that the state retain its current Medicaid NEMT benefit structure as it has proven cost effective.14

Figure 1: Medicaid Non-Emergency Medical Transportation Trips in 32 States, by Treatment Type

How Do I Get Money For Gas

If you need money for gas, you can fill out a trip log to get mileage reimbursement. You may be eligible to get 24 cents a mile for every mile you drive to get to your appointment. This applies if you have a car and are able to drive yourself to your appointment, but cannot afford to pay for gas.

Fill out a trip log

Want to know more about

• Scheduling different types of rides, who you can bring, extra stops, and canceling rides? View the How to Schedule a Ride fact sheet.
• Getting paid for meals and overnight stays? View the Getting Paid for Meals and Overnight Stays fact sheet.

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What Is The Impact Of Waiving Nemt For Expansion Adults

CMS conditioned extension of Iowa and Indianas NEMT waivers on an evaluation of the waivers impact on beneficiary access to care.32 Iowas initial NEMT waiver was approved from January through December 2014, and its Medicaid expansion demonstration expires on December 31, 2016. Indianas initial NEMT waiver was approved from January, 2015 through January, 2016, and its Medicaid expansion demonstration expires in January, 2018.

Preliminary state data evaluating the impact of Iowas NEMT waiver indicate that the waiver may have adverse implications for beneficiary access to care. A fall 2014 beneficiary survey found that Iowa Medicaid beneficiaries whose benefit package does not include NEMT are more likely than those with access to NEMT to need assistance with travel to a health care visit.33 CMS noted that these data raised concerns about beneficiary access particularly for those with incomes below 100 percent of the FPL.34

CMS has extended Iowas and Indianas NEMT waivers, pending additional evaluation results. Iowas waiver was extended through July 31, 2015, and again through March 31, 2016. Indianas waiver has been temporarily extended through November 30, 2016.

Supplemental Transportation Benefits Of Medicare Advantage

CMS expanded Medicare Advantage businesses’ ability to provide transportation services in 2019.

This enables businesses to incorporate transportation for things like nutrition and well-being, such as trips to therapeutic massage appointments or the supermarket.

In 2021, nearly 50% of Medicare Advantage Plans offered some supplemental transportation benefits.

Because not all Medicare Advantage Plans provide these additional transportation alternatives, and because they may vary from plan to plan, a person should find out and learn more about their plan’s specific features.

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What Is Medicaids Non

State Medicaid programs are required to provide necessary transportation for beneficiaries to and from providers. NEMT services are not included in the statutory list of mandatory Medicaid benefits but are required by a long-standing federal regulation,2 based on the Department of Health and Human Services statutory authority to require state Medicaid plans to provide for methods of administration necessary for their proper and efficient operation.3 Additionally, as part of the Early and Periodic Screening, Diagnostic, and Treatment benefit, states are required to offer children from birth to age 21 and their families necessary assistance with transportation to and from providers.4

How Do I Receive Reimbursement

To receive reimbursement, call MTM. Call in advance of your appointment to schedule the trip. You will be provided instructions on how to complete the reimbursement form. You will need to submit the required documentation for reimbursement.

Those that need a wheelchair or some other accommodation will need a Level of Need form . This form must be completed by your primary care physician or treating provider. MTM will need this form when you make your appointment. In addition, certain transportation services require prior authorization by WellCare, including:

• trips over 75 miles one-way
• out-of-state trips
• air ambulance
• trips requiring hotel, flight, and/or meals

You must first call MTM, they will then inform WellCare. WellCare will contact your primary care physician or treating provider. This is required to complete the steps for prior authorization. The transportation broker will follow up with you to finish scheduling the appointment.

We may deny you this service. If denied service, you may appeal. To appeal:

Please see the NEMT Fact Sheet to learn more about this service.

We review the conduct policy with members before booking NEMT. This policy is on the WellCare website. If a member harms the driver, we will address it with the members care manager and primary care physician. MTM drivers are trained to de-escalate.

If a Medicaid-covered service is scheduled before suspension, will reimburse the miles.

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Does Medicare Advantage Cover Non

Medicare Advantage offers the same coverage and provides the same benefits as Original Medicare, but through private insurance companies.

This means that you would receive the same emergency and non-emergency medical transportation under Medicare Advantage as you would under Original Medicare.

Source: Unsplash

What Is Medicare

Medicare is a U.S. federal health insurance program for people 65 or older, some younger people with disabilities, as well as people with end-stage renal disease or amyotrophic lateral sclerosis

You can get Medicare coverage either through the government-run Original Medicare program, or you can get private coverage known as Medicare Advantage.

Key Point – What Are the Different Parts of Medicare?

Original Medicare

Medicare Part A refers to inpatient treatment and hospital care, including hospital stays, hospital treatments, and general nursing costs.

Medicare Part B relates to outpatient medical coverage and includes preventive treatments, doctors consultations, scans, and tests.

Medicare Advantage Plans

Part C/Medicare Advantage Plans are health plans offered by insurance companies that have contracts with Medicare.

These policies can cover Part A, B, and D expenses, including costs for hospital care, prescription drug coverage, and doctors visits.

Prescription Drug Plans

Stand-alone Part D Plans cover self-administered prescription drugs. For example, medications for high blood pressure, pain tablets, and antidepressants.

Medicare Supplement Insurance

A type of insurance sold by private insurance companies to cover any gaps in Original Medicare coverage. Some medical expenses that the Original Medicare Plan does not cover are covered by Medigap plans.

Source: Pexels

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How To Get Non

The first step you will need to take to get non-emergency medical transportation with supplementary medical insurance would be to call your transportation providers and set up your needed ride in advance.

If you need to reschedule or cancel the transportation, you should also give your transportation providers a call.

Once your ride has been arranged, the driver can provide you or an eligible family member with a trip to and from a medical office.

Note: If the driver gives you a ride anywhere else that is not to and from the medical facility, you will not receive mileage reimbursement. Rather, you and the driver could be charged with defrauding Medicaid.

Follow these steps to ensure that Medicaid approves and pays for your ride. Drivers may only be authorized to pick up their passengers at specified hours therefore, it is important to:

• Be ready on time for the pickup

In some states, Medicaid might not pay for the time a driver has to wait for you to arrive, or if you do not show up for a scheduled pickup. In other states, there may be limits on how long the driver can wait for you if you are not on time.

If you have a pattern of missing booked rides, you may need to phone the ride provider multiple times, or find it difficult to confirm future medical appointments.

Medicaid may also place further restrictions on your ability to receive reliable transportation, such as requiring you to use only one service.

Source: Pexels