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File: Medicare Pdf 43573 | Wnemtdochandout042616f
4 14 2016 non emergency medical transportation presentation learning objectives identify general medicaid covered non emergency medical transportation nemt benefits identify methods states can use to authorize available nemt options ...

icon picture PDF Filetype PDF | Posted on 16 Aug 2022 | 3 years ago
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                                                                                                                                                                                            4/14/2016
                                               Non-Emergency 
                                               Medical Transportation
                        Presentation
                       Learning Objectives
                       • Identify general Medicaid-covered non-emergency medical 
                         transportation (NEMT) benefits
                       • Identify methods States can use to authorize available 
                         NEMT options
                       • Identify common medical transportation fraud and abuse issues
                       Centers for Medicare & Medicaid Services                              2
                       Non-Emergency Medical 
                       Transportation Defined
                       Under Federal law, State Medicaid 
                       agencies (SMAs) must:
                           • Ensure necessary transportation 
                             to and from providers
                           • Use the most appropriate form 
                             of transportation
                           • Include coverage for transportation 
                             and related travel expenses 
                             necessary to attend medical 
                             appointments
                       Centers for Medicare & Medicaid Services                              3
                                                                                                                                                                                                             1
                                                                                                                                                                                             4/14/2016
                       Unmet Transportation Need
                       Unmet transportation needs can include:
                           • Not having a valid driver’s license 
                           • Not having a working vehicle available in the household 
                           • Not being able to drive because of a medical condition
                           • Other situations, such as no money for gas
                       Centers for Medicare & Medicaid Services                              4
                       Emergency Transportation Is Different
                       • Medical needs are immediate
                       • Symptoms are severe
                       • Symptoms may be life-threatening (for 
                         example, heart attack)
                       • Symptoms may be due to a serious event 
                         (for example, automobile accident)
                       Centers for Medicare & Medicaid Services                              5
                       State Rules for Non-Emergency 
                       Medical Transportation
                                                • May vary by State
                                                • Require providers to 
                                                  have a Medicaid contract
                       Centers for Medicare & Medicaid Services                              6
                                                                                                                                                                                                              2
                                                                                                                                                                                               4/14/2016
                       State Rules for Non-Emergency 
                       Medical Transportation—Continued
                       • Loaded mileage—beneficiary must be 
                         in the vehicle
                       • Appropriate location
                       • Wait times are not usually reimbursable
                       Centers for Medicare & Medicaid Services                               7
                       Types of Transportation
                                                • Wheelchair vans
                                                • Taxis
                                                • Stretcher cars
                                                • Buses
                                                • Other SMA 
                                                  approved transportation
                       Centers for Medicare & Medicaid Services                               8
                       Knowledge Check
                       For a transportation provider to receive 
                       reimbursement for furnished services, a 
                       transported beneficiary must:
                           A.   Have his or her own car
                           B.   Be ineligible for Medicaid
                           C. Be eligible for Medicaid
                           D. Take an ambulance
                       Centers for Medicare & Medicaid Services                               9
                                                                                                                                                                                                                3
                                                                                                                                                                                               4/14/2016
                       Transportation Entities
                                                • States
                                                • Brokers
                                                • Managed care plans
                                                • Transportation companies
                       Centers for Medicare & Medicaid Services                              10
                       Transportation Drivers
                       Drivers must be: 
                           • Licensed
                           • Qualified
                           • Competent
                           • Courteous
                       Centers for Medicare & Medicaid Services                              11
                       Qualified Vehicles
                                                • Proof of ownership
                                                • Legally licensed
                                                • Current license plates
                                                • Safe
                                                • Well-maintained
                                                • Liability insurance
                       Centers for Medicare & Medicaid Services                              12
                                                                                                                                                                                                                4
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...Non emergency medical transportation presentation learning objectives identify general medicaid covered nemt benefits methods states can use to authorize available options common fraud and abuse issues centers for medicare services defined under federal law state agencies smas must ensure necessary from providers the most appropriate form of include coverage related travel expenses attend appointments unmet need needs not having a valid driver s license working vehicle in household being able drive because condition other situations such as no money gas is different are immediate symptoms severe may be life threatening example heart attack due serious event automobile accident rules vary by require have contract continued loaded mileage beneficiary location wait times usually reimbursable types wheelchair vans taxis stretcher cars buses sma approved knowledge check provider receive reimbursement furnished transported his or her own car b ineligible c eligible d take an ambulance entiti...

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