| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | NON-EMERGENCY MEDICAL TRANSPORTATION |
DISCUSSION:
The Non-Emergency Medical Transportation (NEMT) program assures transportation to Medicaid recipients who do not have access to other transportation resources to and from scheduled Medicaid covered services. As discussed in EMAIL-IM- #163 dated November 8, 2005, LogistiCare Solutions, L.L.C. is the NEMT broker for the Division of Medical Services (DMS). NEMT should not be used for an emergency. For medical emergencies, recipients should call 911 or their local emergency phone number.
NEMT is only available for transportation to services covered by Medicaid. Recipients must make other transportation arrangements for services not covered by Medicaid. Recipients must explore other transportation resources including relatives, friends, and neighbors prior to utilizing NEMT. If the recipient has access to the covered service through other assistance programs or other means, NEMT will not transport the recipient to the service as it has been assured that the individual can get to the service. NEMT is not available for pharmacy services as many pharmacies can mail or deliver prescriptions to recipients.
The following information on the NEMT program will be discussed in this memorandum:
Who is Eligible to Receive NEMT Services;
Circumstances When NEMT Services Are Not Available To Medicaid Recipients;
How Transportation Is Provided;
Recipient Costs for NEMT Services; and
- What Recipients Should Do If Their Ride Is Late.
Who is Eligible to Receive NEMT Services
NEMT services are available to recipients who are Medicaid eligible on the day of transport. LogistiCare will verify Medicaid eligibility the day prior to the trip and will cancel the ride if the individual is not Medicaid eligible on that day. Medical Assistance spenddown claimants cannot receive NEMT services prior to meeting their spenddown. It is important that bills submitted to meet spenddown are entered into MSPA as soon as possible as the recipients will not be able to access NEMT services if their coverage is not showing active in the DMS system. MSPA entries take overnight to process and update information in the DMS system. Therefore, if a recipient is attempting to access NEMT services on the day his or her coverage was entered into MSPA, the NEMT provider will not be able to determine that the recipient is Medicaid eligible.
Circumstances When NEMT Services Are Not Available To Medicaid Recipients
Some Medicaid recipients do not receive NEMT coverage as part of their Medicaid benefits. MC+ CHIP, Presumptive Eligibility for Children, Temporary Medicaid for Pregnant Women, Blind Pension, and recipients eligible for QMB/SLMB only are not eligible to receive NEMT services.
MC+ Managed Care recipients do not receive NEMT through LogistiCare. MC+ Managed Care recipients access non-emergency medical transportation services through their MC+ Managed Care health plan.
NEMT services are not available to Medicaid recipients for services they are receiving through any of the following:
The Comprehensive Substance Treatment Abuse and Rehabilitation (CSTAR) program;
The Community Psychiatric Rehabilitation (CPR) program for psychosocial rehabilitation and medication management services ;
Adult Day Health Care;
Hospice;
Mentally Retarded and Developmental Disability (MRDD) waiver;
Services provided in the recipient's home; and
- Services included in a child's individual education plan (IEP) and/or IEP medical related services.
All of the above services and programs include transportation for non-emergency medical transportation as a part of their services; therefore, transportation is not provided through the Medicaid NEMT program.
How Transportation Is Provided
Medicaid recipients must contact the NEMT provider, LogistiCare, at 1-866-269-5927 at least three days prior to the scheduled appointment unless urgent care is required. The NEMT program will set up transportation with the least costly most appropriate provider for the recipient. The recipient does not have the freedom to choose a transportation provider. Transportation may be provided through public transportation or bus tokens, gas reimbursement, vans, taxi, or ambulance. Medicaid reimburses the most appropriate and least costly transportation alternative suitable for the recipient's travel to the closest qualified, enrolled medical service provider for the service unless the recipient can provide proof of one of the exceptions listed below:
The recipient has a previous history of other than routine medical care with the qualified, enrolled medical service provider for a special condition or illness. A note can be provided from the provider as proof that the recipient meets this exception;
The recipient has been referred by an attending or local physician to a qualified, enrolled service provider for a special condition or illness; or
- There is not a routine or specialty care appointment available within 30 calendar days to a qualified, enrolled medical service provider that is suitable.
In addition to the listed exceptions, an exception can be made if the appointment is an appointment that was scheduled by the Family Support Division (FSD) for a medical review to determine continued eligibility for Medical Assistance. The recipient will need to inform LogistiCare when he or she calls for transportation that the appointment is for a medical review appointment that was scheduled by his or her eligibility specialist.
Recipient Costs for NEMT Services
Senate Bill 539 which became effective on August 28, 2005, changed the cost sharing requirements for Medicaid recipients for some medical services, including NEMT. These cost sharing requirements do not apply to recipients who are under the age of 19, pregnant, or blind. All other Medicaid recipients must pay $3.00 co-pay per trip for NEMT. If the recipient cannot pay the $3.00 co-pay his or her ride cannot be denied, but it may affect his or her eligibility to receive future NEMT services because the debt to the provider is outstanding.
What Recipients Should Do If Their Ride Is Late
Medicaid recipients should call one of two “Where's My Ride” lines at 1-866-269-5944 or 1-866-269-5435 if their ride is more than 15 minutes late. LogistiCare will work with the recipient and transportation provider to assure transportation.
Call 1-866-269-5944 for the following counties: Atchison, Nodaway, Worth, Harrsion, Mercer, Putnam, Schuyler, Holt, Andrew, Gentry, DeKalb, Daviess, Grundy, Sullivan, Adair, Buchanan, Clinton, Caldwell, Livingston, Linn, Macon, Platte, Clay, Ray, Carroll, Chariton, Randolph, Jackson, Lafayette, Saline, Howard, Boone, Cass, Johnson, Pettis, Cooper, Moniteau, Cole, Bates, Henry, Benton, Morgan, Miller, St. Clair, Hickory, Camden, Vernon, Cedar, Polk, Dallas, Laclede, Pulaski, Barton, Dade, Jasper, Lawrence, Greene, Webster, Wright, Texas, Newton, McDonald, Barry, Stone, Christian, Taney, Douglas, Ozark and Howell.
Call 1-866-269-5435 for the following counties: Scotland, Clark, Knox, Lewis, Shelby, Marion, Monroe, Ralls, Pike, Audrain, Callaway, Montgomery, Lincoln, Warren, St. Charles, St Louis County, St. Louis City, Osage, Gasconade, Franklin, Jefferson, Maries, Crawford, Washington, St. Francois, St. Genevieve, Perry, Phelps, Dent, Iron, Madison, Bollinger, Cape Girardeau, Shannon, Reynolds, Wayne, Stoddard, Scott, Carter, Oregon, Ripley, Butler, Mississippi, Dunklin, New Madrid and Pemiscot
NECESSARY ACTION:
- Review this memorandum with all appropriate staff.