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Attendant – A person whose presence is needed to assist the recipient during transport.
Casehead – The person whose name appears on the case data screen in EIS and on minor’s Medicaid identification cards.
REVISED 01/01/12 – CHANGE NO. 01-12
(II.)
Certification Period – The period of time for which assistance is requested and in which al eligibility factors except need and reserve (when applicable) must be met. Generally, certification periods last 6 or 12 months.
Community is the geographical area within which Medicaid consumers and the general population in the county routinely access Medicaid services.
Community Alternatives Program (CAP) – The Community Alternative Programs (CAP) provide sets of services (called “waiver services”) not normally covered under the NC Medicaid programs. The waivers allow individuals who are in need of institutional care to remain in the home. A CAP recipient, who is eligible for Non-Emergency Medicaid Transportation, may be transported to any service listed in the Medicaid column in the CAP plan of care (see IV.C.6. for exceptions).
Community Transportation Plan (CTP) – a five year plan to address transportation needs and resources of the community transit system designated to provide coordinated transportation at the County level. Every county has an approved Community Transportation Services Plan (CTSP). See IV.D.
Deductible –A Medicaid deductible is an amount of medical expenses that must be incurred before Medicaid can be authorized when a Medicaid applicant’s income exceeds the limit.
DMV Search – The county DSS has access to the Division of Motor Vehicles data base. Income Maintenance Caseworkers conduct inquiries (searches) in this data base when determining eligibility for Medicaid programs.
Dually Eligible – Individuals who are eligible for both Medicare and full Medicaid.
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) – A federal
Medicaid requirement that requires the state Medicaid agency to cover services,
products, or procedures for Medicaid recipients under 21 years of age if the service is medically necessary health care to correct or ameliorate a defect, physical or mental illness, or a condition [health problem] identified through a screening examination, (includes any evaluation by a physician or other licensed clinician).
REVISED 01/01/12 – CHANGE NO. 01-12
(II.)
Family Members & Friends – Family members other than spouses and parents of minor children, as well as other non-related individuals, who comprise a Medicaid recipient’s potential support for transportation needs.
Financially Responsible Person (FRP) – For Medicaid purposes, including NEMT, spouses are financially responsible for one another, and parents are financially responsible for their minor children.
Gas Voucher – A voucher that is issued to the recipient/FRP or other driver with which he may purchase gasoline at a contracted station.
Least Expensive Means – Most cost effective mode of transportation.
Medically Necessary Ambulance Transport – Medically necessary means the recipient’s condition requires ambulance transportation and any other means of transportation would endanger the recipient’s health or life.
Medicare Qualified Beneficiary – MQB (Q, B or E) –Medicaid programs for Medicare recipients that offer limited benefits. MQB recipients are not eligible for Medicaid transportation assistance.
Mental Health/Substance Abuse (MH/SA) Enhanced Benefits – A list of services covered by Medicaid for which the cost of transport is included in the provider reimbursement rates. These services are not eligible for Medicaid transportation assistance. (See IV.C.6.b.)
Mileage Reimbursement – Reimbursement to a Medicaid recipient/FRP and/or other driver based on a specific rate per mile driven to allow a Medicaid recipient to receive covered services.
Mobility Device – wheelchair, scooter or other device used to aid personal mobility.
Non-Emergency Medical Necessity – The need for ambulance-type transport due to a medical or physical condition that precludes transport in a regular motor vehicle. This involves a person who is bed-confined and must be transported on a stretcher via ground transport.
REVISED 01/01/12 – CHANGE NO. 01-12
(II.)
Non-Emergency Medical Transportation (NEMT) – Transportation to and from medical services on a non-emergent basis. Emergency transportation needs are provided by emergency service vehicles and are billed directly to Medicaid by the provider. NEMT needs for Medicaid recipients are addressed by the county Medicaid transportation coordinator when requested.
North Carolina Health Choice (NCHC) – A medical coverage program for individuals under age 19. Recipients of NCHC are not eligible for Medicaid transportation assistance. Verify the program with the Income Maintenance Caseworker or in the Eligibility Information System (EIS).
No-Shows/No-Show Policy – A no-show occurs when a Medicaid recipient is scheduled for a trip to a medical service and fails to show up to be transported. A no-show policy consists of rules governing missed transportation pick-ups.
Plan of Care (POC) – A document which summarizes the CAP evaluation and assessment information into a statement of how the recipient’s needs are to be met; outlines goals and objectives; and indicates the specific services needed, both formal and informal.
Provider – An individual or entity that provides a medical service, such as a doctor, hospital or pharmacy.
Public Transportation – or public transit is shared transportation available for use by the general public. Public transportation includes buses, trolleys, trains, and ferries, share taxi in areas of low-demand, and paratransit for people who need a door-to-door service.
Transportation Vendors consist of businesses with which the county contracts to provide Non-Emergency Medicaid Transportation. Vendors may be public, such as local transit systems, or private, such as private van services.
Review/Reenrollment – Medicaid cases are reviewed at the end of each certification period to re-determine eligibility for the Medicaid programs.
Series of Appointments – A group of transportation dates for medical services with the same medical provider which are requested and approved at the same time, rather than as they occur.
Suitable Transportation – The mode of transportation that is appropriate to the Medicaid recipient’s medical and other identified needs.
REVISED 01/01/12 – CHANGE NO. 01-12
(II.)
Transportation Coordinator – The person designated by the county DSS to coordinate Medicaid transportation trips. This person may be employed by the DSS or by an entity under contract with the DSS to arrange transportation
Trip – A NEMT “trip” consists of the length between one pick-up and drop-off. For example, picking up a recipient at his home and driving him to a doctor’s office is one trip. If the same recipient is picked-up at the doctor’s office and driven back to his home, that is a second trip. If before being driven home, the same recipient is driven to a drug store, that would constitute a third trip.
Urgent Transportation Need– A need for transportation to a medical service which does not warrant ambulance transport, but cannot be postponed to another time. Examples include acute illnesses and non-emergent injuries, as well as necessary medical care that cannot be rescheduled to another time (i.e., due to provider availability, etc).
Vendor No-Show – The failure of a transportation vendor to pick-up a recipient for a scheduled trip.
Volunteers/Volunteer Drivers – Individuals screened and approved by the county DSS to transport Medicaid recipients, either in their own vehicles or in agency vehicles.
Voucher – A document exchangeable for goods or services.
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For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
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