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

Agenda General Overview Comparisons Coverage Responsibilities Policy Billing Resources Questions

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)

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

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?

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)

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.

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

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

Access Transportation Services (ATS) Also includes: Volunteer driver Personal mileage Meals Lodging Air fare when appropriate Parking

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

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

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

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

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

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

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.

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)

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

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

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

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

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

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

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

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

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

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

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)

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

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

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)

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

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

Ambulance Requirements Providers licensed as a service for: Advanced Life Support Basic Life Support Scheduled Life Support

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

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

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

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

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

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

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

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

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???

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)

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

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

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

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

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

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

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

MHCP Provider Call Center 1-800-366-5411 651-431-2700 Cheryl Newgren Transportation Training & Communications Bob Ries Transportation Policy

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