Family and Children's Medicaid MA-3550 MEDICAID TRANSPORTATION

IV. POLICY PRINCIPLES

Transportation to and from providers is a critical component for Medicaid recipients to obtain necessary health care. Non-Emergency Medical Transportation (NEMT) services consist of arranging and/or paying for transportation. When the recipient has access to a suitable mode of transportation, but lacks the means to use it, the county must assist with the means through gas vouchers, mileage reimbursement, etc. When the recipient lacks both means and mode, the county is responsible for arranging transportation at a cost within allowable Medicaid regulations. However, the obligation to provide transportation is not without qualifications.

REVISED 01/01/12 – CHANGE NO. 01-12

(IV.)

A. Transportation Criteria

Federal regulations require that the state assure necessary transportation (see 42 CFR 431.53). Necessary means no other appropriate transportation resources are available to the recipient.

Medicaid only pays for transportation:

1. By the least expensive mode available and appropriate for the recipient (see VIII.C.1.),

2. To the nearest appropriate medical provider (see VIII.B.);

3. For a Medicaid-covered service (see VIII.A.) provided by an enrolled NC Medicaid provider.

B. Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

EPSDT is 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).

The county DSS must arrange for or provide transportation to children meeting EPSDT requirements for necessary services that might not be covered under the Medicaid state plan but are covered under EPSDT. When EPSDT recipients request transportation for a non-covered service, verify with the provider that prior approval was obtained. If unable to obtain a copy of the approval letter from the provider, call the DMA Clinical Policy section to verify prior approval. Clinical Policy can be reached by calling (919) 855-4260.

C. Recipients Not Eligible for Transportation Assistance

1. MQB-Q, B, or E recipients (Note that dually eligible individuals are entitled to transportation assistance, including transportation to pick up prescriptions, even though Medicaid does not pay for their prescription drugs).

2. Recipients in deductible status. An applicant/recipient is not eligible for Medicaid transportation assistance until his deductible is met.

3. North Carolina Health Choice (NCHC) recipients.

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(IV.C.)

4. Nursing home recipients (see X.D.)

5. Recipients who live in adult care homes or other assisted living facilities (see X.E.)

6. Certain mental health services have transportation costs included in the Medicaid provider’s fee; therefore recipients are not eligible for NEMT to these services.

a. The following Community Alternative Program – Mental Retardation/Developmental Disabilities (CAP-MR/DD) Waiver covered services have transportation included in the Medicaid provider’s fee:

CAP-MR/DD SERVICE	CODE
Day Supports – Individual	T2021
Day Supports – Group	T2021HQ
Supported Employment – Individual	H2025
Supported Employment – Group	H2025HQ

b. The following Mental Health/Substance Abuse (MH/SA) Benefits covered services have transportation included in the Medicaid `provider’s fee:

MH/SA ENHANCED SERVICE	CODE
Assertive Community Treatment Team (ACTT)	H0040
Intensive In-Home Services	H2022
Mobile Crisis	H2011
Multi-systemic Therapy (MST)	H2033

MH/SA BENEFIT SERVICE	CODE
Professional Treatment Services in Facility-Based Crisis Program	S9484
Substance Abuse Medically Monitored Residential Treatment	H0013
Substance Abuse Non-Medical Community Residential Treatment	H0012HB
Medically Supervised Detoxification/Crisis Stabilization	H2036
Non-Hospital Medical Detoxification	H0010

REVISED 01/01/12 – CHANGE NO. 01-12

(IV.)

D. County Participation in Community Transportation Services Plan (CTSP)

Every county has an approved Community Transportation Services Plan (CTSP) which must be updated periodically. The purpose of a CTSP includes:

1. Develop and promote the full integration of the community transportation system’s programs with other federal and state programs supporting public and human service transportation;

2. Support and promote the coordination of public transportation services across geographies, jurisdictions, and program areas for the development of a seamless transportation network;

3. Support the provision of dependable transportation options to the general public, low income individuals, elderly persons, and/or persons with disabilities within the guidelines and funding levels provided by NCDOT and FTA.

To assure that transportation is provided to Medicaid recipients in a timely and cost-effective manner, the county is encouraged to participate in CTSP development of the planning, design and delivery of local Medicaid transportation services.