Adult Medicaid Admin. Letters

DMA ADMINISTRATIVE LETTER NO. 17-06, MEDICAID TRANSPORTATION REVISIONS

DATE: December 15, 2006

SUBJECT: Medicaid Transportation

DISTRIBUTION: County Directors of Social Services

Medicaid Staff

I. BACKGROUND

In October 20, 2006, the Division issued DMA Administrative Letter No: 15-06, titled “Medicaid Transportation.” It has come to our attention that several mental health/substance abuse services were incorrectly included. Meaning, some of those rates neither required that transportation be provided or that a particular service be brought to the client.

Services that should have been omitted from chart found on pages 2-3 of Administrative Letter No. 15-06 are: psycho-social rehabilitation (PSR), Partial Hospital, Child and Adolescent Day Treatment, Diagnostic Assessment, Ambulatory Detoxification, Opiod Outpatient Treatment, SA Intensive Outpatient Program and SA Comprehensive Outpatient Treatment services do not reflect the costs associated with transportation.

If transportation is needed, the county departments of social services (DSSs) are authorized to arrange for transportation and seek reimbursement from Medicaid for those costs.

II. MEDICAID CHANGES

A. The CAP-MR/DD Waiver includes Medicaid covered services which have transportation included in the rate that Medicaid reimburses the Medicaid provider. The medical provider is responsible for arranging and providing transportation to and from the recipient’s residence for individuals receiving these services.

The following Medicaid covered services with the corresponding codes have transportation included in the Medicaid provider’s fee:

Day Supports – Individual T2021

Day Supports – Group T2021HQ

Supported Employment – Individual H2025

Supported Employment – Group H2025HQ

1. Day Supports provide assistance with acquisition, retention, or improvement in self-help, socialization and adaptive skills, which take place in a non-residential setting, separate from the home or facility in which the individual resides.

Supported Employment services are conducted in a variety of settings, particularly work sites in which persons without disabilities are employed. Supported employment includes activities needed to sustain paid work by individuals receiving waiver services, including supervision and training.

2. The county departments of social services are not responsible for arranging or providing transportation to individuals receiving Supported Employment and Day Supports services. Do not claim Federal and State Medicaid transportation reimbursement for these services. Refer Medicaid recipients for assistance with transportation to the Medicaid provider.

B. Mental Health/Substance Abuse (MH/SA) Enhanced Benefits are Medicaid covered services that transportation is included in the rate that Medicaid reimburses the Medicaid provider. The medical provider is responsible for arranging and providing transportation to and from the recipient’s residence for individuals receiving these services.

The following Medicaid covered services with the corresponding codes have transportation included in the Medicaid provider’s fee (for the last five services, see the “NOTE” under 2 below):

SERVICE	CODE
Community Supports Service – Adult	H0036HB
Community Supports Services – Child	H0036HA
Community Supports Services – Group – Adult or Child	H0036HQ
Community Support Treatment Team (CST)	H2015HT
Assertive Community Treatment Team (ACTT)	H0040
Intensive In-Home Services	H2022
Mobile Crisis	H2011
Multi-Systemic Therapy (MST)	H2033
Professional Treatment Services in Facility-Based Crisis Program	S9484
Substance Abuse Medically Monitored Residential Treatment	H0013
SERVICE (continued)	CODE
Substance Abuse Non-Medical Community Residential Treatment	H0012HB
Medically Supervised Detoxification/Crisis Stabilization	H2036
Non-Hospital Medical Detoxification	H0010

1. Clinical Policy’s service definitions for each service can be viewed on the DMA website at: http://www.dhhs.state.nc.us/dma/bh/8A.pdf.

2. The county departments of social services are not responsible for arranging or providing transportation to individuals receiving the aforementioned MH/SA Enhanced Benefits services. Do not claim Federal and State Medicaid transportation reimbursement for these services. Refer Medicaid recipients for assistance with transportation to the Medicaid provider.

NOTE: The last five services in the chart above are considered residential services. As such, the local department of social services would not need to provide transportation.

III. EFFECTIVE DATE AND IMPLEMENTATION

This policy is effective upon receipt.

NOTE: County departments of social services which provided transportation for those services that have now been correctly omitted from the chart in Section II.B., can submit those bills to Medicaid for payment. This would involve transportation provided with dates of service November 1 – December 15, 2006.

If you have any questions regarding this policy change please contact your Medicaid Program Representative.

L. Allen Dobson, Jr., M.D., Assistant Secretary for Health Policy and Medical Assistance

(This material was researched and written by Staff in DMH/DD/SAS and DMA’s Rate-setting section.)