Getting Around in MNMedical Transportation

Minnesota Health Care Programs

General Overview Comparisons Coverage Responsibilities Policy Billing Resources Questions

Agenda

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)

Eligible Recipients

1. Access Transportation Service (ATS) Curb-to-curb and door-to-door

2. Special Transportation Services (STS) Door-through-door

3. Ambulance Emergency and Non-emergency

4. Transportation for Waiver Recipients Through waiver programs

Transportation Types

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?

Considerations

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)

Coverage Criteria

Multiple riders allowed◦ Same or different pickup or drop-off points

‣Multiple SegmentsEach 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

Covered Services Continued

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

Billing - General

‣“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

Also includes: Volunteer driver Personal mileage Meals Lodging Air fare when appropriate Parking

Access Transportation Services (ATS)

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 ChisagoDakota Hennepin (Host) Isanti RamseySherburne Washington

MNET conducts Level of Need (LON) assessments for STS statewide

ATS Responsibilities

MHCP Fee-for-service recipients who:

Need transportation to medically necessary covered services, or

Attend MHCP service related appeal hearings

ATS Medical TransportationEligibility

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

Requirements

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

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 Services Not-covered or excluded

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.

ATS Authorization

Must include:◦ Name of:

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)

Documentation

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

Billing & Reimbursement

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

ATS Billing

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

Special Transportation Services

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

MA Nursing Facility Residents:◦ Residing in◦ Being admitted to, or◦ Discharged from NF

◦ Never require STS LON Assessment◦ Effective statewide

STS Eligibility continued

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 Provider Responsibilities

Providers must: 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

STS Requirements

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

Multiple riders

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

STS Covered Services

Stretcher Services Day Training and Habilitation (DT&H) or

other Day Programs Electro Current Treatment Dialysis Outpatient Procedures w/ sedations Wheelchair Transports

STS Limited Coverage

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 Non-covered Services

LON Assessment through MNET◦ 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:o Single/multiple dayo Week (s)o Month (s)o Year

STS Certification

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

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)

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

STS Stretcher Transport Attendants

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 Services

Providers licensed as a service for:

◦ Advanced Life Support◦ Basic Life Support◦ Scheduled Life Support

Ambulance Requirements

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

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)

Ambulance Covered ServicesContinued

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 AmbulanceCovered Services

Transports to/from outside of MN require authorization from MHCP medical review agent (except contiguous counties in neighboring states)

Use MHCP Medical Review Agent

Air AmbulanceAuthorization Required

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 AmbulanceCovered Services

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

Ground 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

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

Air AmbulanceAuthorization

‣ 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

Ambulance Authorization Non-Emergency Trips

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)

Billing & Reimbursement

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????

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 Recipient Transportation

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

Waiver Transportation Covered Services

Transportation access through MA services

Reimbursement included in contracted rate for:

Adult Day Care Residential Services Supported employment to DT&H

Non-covered Services

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

Case Manager/Service Coordinator Responsibilities

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

Waiver Transportation Billing

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

Resources

MHCP Provider Call Center◦1-800-366-5411◦651-431-2700

Cheryl Newgren Transportation Training & Communications

Bob Ries Transportation Policy

Thank You