1. Medical Transportation Minnesota Health Care Programs
Getting Around in MN
Medical Transportation
Minnesota Health Care Programs

2. Agenda General Overview Comparisons Coverage Responsibilities Policy
Billing
Resources
Questions

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

5. Considerations
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. Coverage Criteria 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. Covered Services Continued
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
Multiple segments; Example: Recipient is picked up at point A and transported to point B service provider; the transportation provider waits; then transports the recipient from point B service provider to point C service provider, final destination A. This is 3 segments/units.

8. Billing - General 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. Access Transportation Services
“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. Access Transportation Services (ATS)
Also includes:
Volunteer driver
Personal mileage
Meals
Lodging
Air fare when appropriate
Parking

11. ATS Responsibilities
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. ATS Responsibilities
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. ATS Medical Transportation Eligibility
MHCP Fee-for-service recipients who:
Need transportation to medically necessary covered services, or
Attend MHCP service related appeal hearings

14. Requirements
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. ATS Services 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. ATS Services Not-covered or excluded
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. ATS Authorization
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. Documentation Must include: Name of: Date (s) of service
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. Billing & Reimbursement
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. ATS Billing
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. Special Transportation Services
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
LON: permanent, several weeks, one day or single trip

22. STS Eligibility
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. STS Eligibility continued
MA Nursing Facility Residents:
Residing in
Being admitted to, or
Discharged from NF
Never require STS LON Assessment
Effective statewide
Won’t show STS on elig screen

24. STS Provider Responsibilities
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. STS Requirements Providers must: MHCP recipients: 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 riders
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
Reduced percentage—see manual section STS

27. STS Covered Services
Transport to and/or from the site of an MHCP covered medical service

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

29. STS Non-covered Services
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. STS Certification LON Assessment through MNET Requested by:
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:
Single/multiple day
Week (s)
Month (s)
Year

31. STS Billing 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. STS Billing
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. STS Stretcher Transport Attendants
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. Ambulance Services
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. Ambulance Requirements
Providers licensed as a service for:
Advanced Life Support
Basic Life Support
Scheduled Life Support

36. Ambulance Covered Services
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. Ambulance Covered Services Continued
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)
NICU neonatal ICU
Legally authorized person must pronounce recip dead

38. Air Ambulance Covered Services
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. Air Ambulance Authorization Required
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. Ground Ambulance Covered Services
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. Ground Ambulance 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. Air Ambulance 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. Air Ambulance Authorization
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. Ambulance Authorization Non-Emergency Trips
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
Ground???

45. Billing & Reimbursement
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 Recipient Transportation
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????
Ask danni

47. Waiver Recipient Transportation
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. Waiver Transportation Covered Services
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
Individualized plan

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

50. Case Manager/Service Coordinator Responsibilities
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. Waiver Transportation Billing
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. Resources www.dhs.state.mn.us/provider 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 1-800-366-5411 651-431-2700
Cheryl Newgren
Transportation Training & Communications
Bob Ries
Transportation Policy

54. Thank You