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Medical Transportation Minnesota Health Care Programs.

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Presentation on theme: "Medical Transportation Minnesota Health Care Programs."— Presentation transcript:

1 Medical Transportation Minnesota Health Care Programs

2  General Overview  Comparisons  Coverage  Responsibilities  Policy  Billing  Resources  Questions

3  Fee-for-Service MHCP recipients ◦ Contact local county/tribal agency  Prepaid health plan recipients ◦ Contact appropriate managed care organization (MCO) ◦ Limited exceptions contact local/county/tribal agency  Waiver recipients-contact the waiver: ◦ County case manager ◦ MCO Health care coordinator All must qualify for Medical Assistance (MA)

4 1. Access Transportation Service (ATS) Curb-to-curb and door-to-door 2. Special Transportation Services (STS) Door-through-door 3. Ambulance Emergency and Non-emergency 4. Transportation for Waiver Recipients Through waiver programs

5  Is the transportation to a medically necessary covered service?  Does transportation meet the recipient’s appropriate level of need?  Is the transport to the closest facility capable of providing the level of care needed?  Is the transport by the most direct route?

6  Eligible MHCP recipient  Program eligibility includes non-emergency medical transportation  To and/or from the site of an MHCP covered medical service  Local human service /tribal agency provider for Access Transportation Services  Enrolled MHCP special transportation services (STS provider)

7  Multiple riders allowed ◦ Same or different pickup or drop-off points ‣ Multiple Segments Each complete round trip will include multiple segments ‣ Transportation between two Facilities Recipient must be discharged from first facility and admitted to destination (drop-off) facility

8  Bill within 12 months of service date  STS mileage will not pay if base doesn’t pay (for any reason) ‣ STS base and mileage codes must be on same claim

9 ‣ “ Door to door” or “curb to curb service” ‣ Includes wheelchair and ambulatory ‣ Common Carrier  Non-emergency vehicles  Taxi (For Hire & Dial-A-Ride)  Bus  Light Rail

10  Also includes:  Volunteer driver  Personal mileage  Meals  Lodging  Air fare when appropriate  Parking

11  Local county agencies and tribal agencies provide ATS services Required to submit Access Plans to MHCP Policy  Twin Cities metro area-MNET is contact  8 counties

12  Medical Transportation Management’s (MTM) Minnesota Non Emergency Transportation (MNET)  Coordinate ATS for:  8 county metro area Anoka Chisago Dakota Hennepin (Host) Isanti Ramsey Sherburne Washington MNET conducts Level of Need (LON) assessments for STS statewide

13  MHCP Fee-for-service recipients who:  Need transportation to medically necessary covered services, or  Attend MHCP service related appeal hearings

14  Appropriate level transport to meet the need of the recipient  Nearest facility capable of providing the level of care needed  Most direct route  Additional attendant when necessary (contact Bob Ries)  Out-of-state medical facility services require authorization from Medical Review Agent ◦ Access transportation services available

15  Assisting client: ◦ To and from vehicle (curb-to-curb or door-to-door) ◦ To safely enter and exit vehicle (when needed) ◦ With securing of client in vehicle, or ◦ Verifying the client is safely secured in the vehicle

16  Administrative costs to volunteer driver organizations (A0080) as part of mileage code payment  No-show client  No-load miles  Generally not covered (exceptions)  Transport of minors (under18)  Payment for pharmacy transport only

17  May require prior authorization by local county/tribal agency  Local agency determines appropriate level of services to be provided to client  Local agency establishes provider networks ◦ Common carrier, STS, volunteer, etc.

18  Must include: ◦ Name of:  Client  Individual service provider/vendor  Destination medical provider/facility ◦ Date (s) of service ◦ Type of access service (s) ◦ Pickup-up location & destination addresses ◦ Amount of reimbursement claimed and allowed ◦ Receipt for service(s)  Except: Meter parking and personal mileage (requires a signed statement by client for mileage incurred by most direct route)

19  Bill after an allowed expense incurred  Within 12 months of service  Requires receipts for: ◦ Meals ◦ Lodging ◦ Parking (except meters) ◦ Client paid transportation services ‣ Includes client and when necessary, one additional person

20  Effective July 1, 2011 counties/tribes will no longer bill MHCP using aggregate billing method  Required: ◦ Subscriber ID #/Name ◦ Pay to agency/tribe NPI ◦ Date (s) of service ◦ Separate service codes ◦ Appropriate modifier ◦ Units per service provided 30 miles=30 units ◦ Total submitted charge for each service ◦ Diagnosis code V68.9

21  Persons who cannot safely use ATS because of emotional, physical or mental impairment  Level of Need (LON) assessment required (MNET)  Door-through-door /station-to station service  Direct driver assistance

22  Recipient must require high level of direct driver assistance  Eligible for: ◦ Medical Assistance (MA) ◦ Emergency MA (EMA) ◦ Refugee MA (RMA) ◦ MA -Residing in IMD ◦ MinnesotaCare enrollees:  Under 21  Pregnant

23  MA Nursing Facility Residents: ◦ Residing in ◦ Being admitted to, or ◦ Discharged from NF ◦ Never require STS LON Assessment ◦ Effective statewide

24  MN/DOT certification  Assist recipient:  Inside the residence/pick-up location  To/from vehicle–entering and exiting  With passenger securement  Ambulatory, wheelchairs, stretchers  To/from medical facility-entering/exiting  Inside medical facility to/from appropriate medical desk

25  Providers must:  Enroll with MHCP  Check eligibility  Verify STS level of certification (Does not guarantee payment)  Keep appropriate records  MHCP recipients: ‣Select/contact their own STS provider ‣Schedule own trips

26  Multiple recipients allowed in one vehicle to same or different pickup points or destinations  Base rate and mileage charges are prorated when multiple riders have same pickup point  Destination does not affect proration  See STS section in provider manual

27  Transport to and/or from the site of an MHCP covered medical service

28  Stretcher Services  Day Training and Habilitation (DT&H) or other Day Programs  Electro Current Treatment  Dialysis  Outpatient Procedures w/ sedations  Wheelchair Transports

29  Transports to: ◦ Non-covered MHCP service  Grocery store, health club, church, e.g.  Residence to DT&H or Adult Day Program  Other waiver program services ‣ Extra attendant charges (Personal Care Assistants)

30  LON Assessment through MNET ◦ Ambulatory ◦ Wheelchair ◦ Stretcher  Requested by: ◦ County/tribal case managers ◦ Health care staff (doctor, nurse, discharge planner, etc.) ◦ Client, parent, guardian, authorized representative, individual with sufficient knowledge of the medical needs of the client, etc. ◦ DOES NOT include STS provider ‣ Certification periods: o Single/multiple day o Week (s) o Month (s) o Year

31  Appropriate level of service  STS only when “station to station” or “door through door” was provided at both ends of each trip leg  Wheelchair only when recipient cannot transfer and needs a wheelchair equipped van  Stretcher transports need LON approval/certification (MNET) when in nursing home living arrangement

32  Special Transportation Procedure Codes, Modifiers and Payment rates sheet  HCPCS Origin/Destination Codes (modifiers)  Bill individual units ◦ 1 pickup (base) =1 unit (RT =2) ◦ 1 mile = 1 unit  Contact MNET for change in status (i.e. wheelchair to ambulatory)

33  Document name of extra attendant in trip  Bill extra attendant code (T2001) and stretcher code (T2005) on same claim  Use procedure code T2049 for STS stretcher mileage

34  The transport of a recipient whose medical condition or diagnosis requires medically necessary services before and during transport  Air and Ground  Emergency ◦ All MHCP Recipients  Non-emergency ◦ Medical Assistance (MA) recipients ◦ Certain MN Care recipients

35  Providers licensed as a service for: ◦ Advanced Life Support ◦ Basic Life Support ◦ Scheduled Life Suppo rt

36  MHCP covers ambulance services when transportation is: ◦ In response to:  A 911 emergency call  A police or fire department call  An emergency call received by the provider ◦ Between two facilities Only if facility must discharge the recipient because they cannot provide required level of care Must be discharged from pick-up facility and admitted to the destination (drop-off) facility

37  Medically necessary and documented ◦ Prehospital Care Data statute 144E.123  Transfer of an infant from NICU Level II or III to a hospital near family’s home(40 miles+)   Recipient dies: ◦ Enroute or DOA ◦ After transportation is called, but before it arrives (to point of pickup)

38  Recipient has potentially life-threatening condition/no other transport is adequate  Referring facility lacks adequate facilities to provide needed medical services  Transport to nearest appropriate facility providing required level of care  No-load transportation only if medically necessary treatment is provided at pickup point

39  Transports to/from outside of MN require authorization from MHCP medical review agent (except contiguous counties in neighboring states)  Use MHCP Medical Review Agent

40  Potentially life-threatening condition/no other transport is adequate  Service is medically necessary  Referring facility lacks adequate facilities to provide needed medical services  Nearest appropriate facility/most direct route

41 MHCP covers when:  Recipient has a potentially life-threatening condition that does not permit the use of another form of transportation  Referring facility lacks adequate facilities to provide approriate medical services  Transport must be to the nearest appropriate facility by the most direct route  No-load transportation only if the ambulance provided medically necessary treatment to the recipient at the pickup point and did not transport

42 MHCP covers when:  The recipient has a potentially life-threatening condition that does not permit the use of another form of ambulance transportation  The referring facility lacks adequate facilities to provide the medical services needed by the recipient  Transport must be to the nearest appropriate facility capable of providing the level of care required by the recipient

43  Required when: ◦ Transport is originating from or going to a destination outside of MN ◦ Excludes destinations to facilities located in neighboring states when the county of the neighboring state is contiguous to MN

44 ‣ Required for recipients who will be transported for more than six one-way trips (3 RT) during a single calendar month ‣ Submit request to MHCP’s Medical Review Agent for any authorizations

45  Bill DHS according to Medicare guidelines ◦ ICD-9 Codes (acceptable diagnosis code list)  Air Ambulance ◦ Submit Air Ambulance Checklist (DHS-5208) ◦ Medical necessity must be proved and properly documented (if denied-rebill as ground)  Ground Ambulance ◦ Submit Ground Ambulance Billing Checklist (DHS- 5208A) with medical resident facility-to-facility (hospitals, nursing facilities, physician offices, residential facilities)

46  Waiver recipients need access to programs within their individualized service plans ◦ Natural Source (neighbor, relative) ◦ Common Carrier (ATS) ◦ Special Transportation (STS)  Waivers: ◦ CAC ◦ CADI ◦ DD-Developmentally Disabled ◦ TBI-Traumatic Brain Injury  EW AC-non medical transportation????

47  Contact individual county waiver program  Counties are responsible for eligibility/providing screening/contracting drivers  Transportation to and from waiver service programs must be authorized on valid Service Agreement  Transportation to/from waiver services programs are not separately billable fee-for-service special transportation services  See HCBS Waiver Services and Elderly Waiver (EW) and Alternate Care (AC) Program

48  Access to community services and activities (as stated in service plan) ‣ Access to waiver services that are not part of the contracted rate for:  Adult Day Care  Residential Services  Supported Employment ‣ Payment for an attendant accompanying a client

49  Transportation access through MA services  Reimbursement included in contracted rate for:  Adult Day Care  Residential Services  Supported employment to DT&H

50  Determine if: ◦ Transportation need meets MA State Plan criteria ◦ Contracted rate for other service does not include transportation ◦ Person will use a natural support, common carrier or special transportation ◦ Confirm person is certified for special transportation ◦ An attendant is required

51  Bill using a valid Service Agreement (SA)  SA will include: ◦ Vendor’s name/NPI (multiple) ◦ Client’s name ◦ Assigned SA number ◦ Appropriate HCPCS billing code ◦ Authorized # of units Authorized rates ‣ A valid SA does not guarantee eligibility or payment

52   Provider Manual: ◦ HCBS Waiver Services ◦ Transportation Services:  Transportation Overview  ATS  STS  Ambulance  MN–ITS User Guides: ◦ Ambulance 837P ◦ Ambulance 837I Outpatient ◦ Special Transportation Services ◦ Waiver Services

53  MHCP Provider Call Center ◦ ◦ Cheryl Newgren Transportation Training & Communications Bob Ries Transportation Policy


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