Non-Emergent

1. Non-Emergent Medical Transportation Services

2. Goals • The goals of this self-help tutorial are to assist you to: • Identify resources that are necessary to assist eligible Medicaid clients needing non-emergent medical transportation services. • Improve your knowledge and awareness about brokerages. • Create a positive working relationship with brokerages.

3. History • Prior to brokerage implementation: • Branches authorized all transportation services. • DMAP paid transportation providers on a fee-for-service basis. • DMAP had to train transportation providers on how to bill correctly the first time.

4. Non-emergent transportation • As defined in the Medical Transportation Services rulebook, OAR 410-136-0160: “Transportation to or from a source of covered service which does not involve a sudden, unexpected occurrence that creates a medical crisis requiring emergency medical services.”

5. Covered services • OHP covers non-emergent medical transportation services when the following occur: • The client is eligible for non-emergent medical transportation services. • The client has no other means of transportation available to them. • Transportation provider is actively enrolled with a brokerage as a provider of medical transportation services.

6. Covered service examples • As defined in General Rule OAR 410-120-1160 (Medical Assistant Benefits and Provider Rules) • Covered when medically/dentally appropriate and within limitations, some examples include: • Chemotherapy • Chiropractic • Hemodialysis • Naturopathic • Physician • Vision

7. Not-covered services • As defined in General Rule 410-120-1200 (Excluded Services and Limitations), certain services or items are not covered under any program for any group of eligible clients: • Clients with OHP standard benefit package • Services that are considered experimental • Services that are a convenience of the client • Educational or training classes which are not medically/dentally appropriate • Recreational therapy

8. Who is eligible for services? • Clients are eligible for non-emergent medical transportation services only when the client: • Is eligible for Medicaid services (OHP Plus). • Requires OHP-covered services. • Has no other way to reach a medical appointment. • Is in the service area.

9. Transport types: Public transit • Brokerage will ask clients questions to determine the proper mode of transportation, such as: • Can you use the bus? • How far is the nearest bus stop from your home? • Does the bus stop near the medical facility? • Are there other circumstances which effect your ability to use the bus? • Where should we mail the bus tickets? • What is the purpose of your appointment?

10. Taxi Taxis are an alternative mode of transportation for those clients who do not have access to a bus if: The client is physically unable to use the bus, or If there is no other mode of transport available. Wheelchair van Vehicles are equipped with a wheelchair lift for clients who use a wheelchair. Clients are escorted by the driver and receive exceptional door-to-door service. Transport types:Taxi & WC van

11. Transport types: Ambulance • Non-emergent ambulance services are: • Never authorized by the brokerages. • Always authorized by the branch.

12. Transport types: Stretcher car • A vehicle which transports a client in a prone position is a stretcher car. • Client requires no medical care or attendant en route. • Client may have medical equipment that must be transported with the client.

13. Transport types: Secured • Secured transports are for clients that may need to be restrained due to: • Behavioral problems. • Being transferred to a treatment center. • Danger to themselves or others. • Under the influence of alcohol or drugs.

14. Train Not a common way to transport a client. Must be to a covered medical service if out of service area. Must be least costly and appropriate mode of transportation. Airplane Alternative way for an extraordinary appointment due to distance involved. Paid by branch. Transport types: Train or plane

15. Interstate bus service Greyhound or another carrier. May use if the client has to travel quite a distance. Can be provided if no other mode is available, due to distance. Volunteer drivers Clients may be transported by a driver in a volunteer program. Volunteer drivers may use their own vehicles. Volunteer agencies require advanced notice. Transport types: Bus or volunteer

16. Transport types: Client’s own • Clients who are able to transport themselves may be reimbursed for gas and mileage. • Must be to a covered medical service. • Must be authorized in advance.

17. Medicaid requirements • DHS is responsible to provide non-emergent medical transportation to Title XIX (Medicaid) recipients in Oregon. • DMAP received a federal waiver from CMS to introduce a new service and design which allows the flexibility in establishing transportation brokerages. • DHS entered into agreement to establish a brokerage program. • Brokerages will provide non-emergent medical transportation for DHS clients.

18. Clients Advocates Providers Facilities Department of Human Services (DHS) Oregon Department of Transportation (ODOT) Council of Government (COG) State and local programs Federal partners (CMS) Local transportation districts Stakeholder coordination

19. Statewide coordination • Provides broader and better transportation access and service by: • Increasing transportation availability. • Enhancing service quality. • Improving cost effectiveness . • Simplifying access to transportation for clients. • Maximizing the use of current transportation resources (shared rides). • Reducing duplication of efforts (fuel, training, purchasing, dispatching).

20. Outcomes • DMAP and DHS are able to: • Monitor the overall system and service contract agreement. • Track costs. • Track services.

21. DHS expectations • Centralized system: • Client transportation services are managed through a single system. • Call centers focus on transportation service. • Program efficiencies: • Program policies are consistently applied. • Increased competition between providers keeps the rates lower.

22. DHS expectations • Transportation providers: • Continue to operate their own business and dispatch their own drivers. • Set their own rates based on actual costs or rides provided. • Have standard operating requirements. • Program oversight increases: • Safety standards. • Client and provider accountability. • Program efficiency and performance.

23. Brokerage responsibilities • Brokerage will: • Assure access to necessary non-emergent medical services for all Medicaid clients who have no other means of transportation. • Arrange the most appropriate, least costly mode of transportation. • Assure consistent quality of transportation services. • Act as a gatekeeper to control costs and the usage of services.

24. Brokerage responsibilities • Brokerage will: • Provide a toll-free call center to serve clients. • Verify medical and ride eligibility. • Verify client resources. • Verify client appointment. • Track provider ride costs. • Authorize each ride. • Post the reservation. • Determine most appropriate ride at lowest cost. • Assign a ride to appropriate provider/resource.

25. Brokerage responsibilities • Brokerage will not: • Establish client eligibility. • Make Medicaid policy. • Provide case management or social services. • Arrange for ambulance transportation. • Arrange for caregivers while client is being transported.

26. Brokerage responsibilities • Brokerage will not make payment for transportation: • To a specific provider based solely on client/family preference or convenience. • When local services are available. • Rides that were not authorized. Sorry

27. Brokerage responsibilities • Brokerages will screen clients’ calls. They will ask clients for the following information: • Medicaid identification number • Address • Phone number • Appointment date and time • Health care provider’s name and address

28. Brokerage responsibilities • Questions the brokerages may ask the client: • Can someone else take the client to their appointment? • How did they get to their last medical appointment? • How far do they live from the nearest bus stop? • Is there a reason they cannot take the bus? • Has anything changed since the last time they used transportation? • How long is the visit (e.g., routine or tests)?

29. Brokerage responsibilities • Brokerage verifies Medicaid eligibility: • If eligibility cannot be confirmed, brokerage contacts the client’s branch office. • If eligibility cannot be verified, transportation cannot be authorized. • If authorizing in advance, re-verify on the actual date of service to ensure client status has not changed.

30. Brokerage responsibilities • Same-day requests may be authorized when the medical service is: • Urgent. • Necessary for continuity of care. • Needed for medical monitoring. • Same day treatment or testing according to physician’s instructions. • Dental care.

31. Out of area Trips provided to counties outside the brokerage service area should be negotiated with providers: Coordinate with other brokerages for capacity or cheaper transportation option. Verify services. After hours After-hours transportation to medical services should be granted on an urgent basis: Emergency room Hospital discharges Brokerage responsibilities

32. When things go wrong • Client no-shows: • Transportation providers do not receive payment for no-shows. • Brokerages cannot charge no-show clients. • Letters will be sent to no-show clients and their case managers.

33. When things go wrong Denial of service • Clients may be denied a ride for the following reasons: • Not eligible for Medicaid. • Not going to a covered medical service. • Other transportation resources are available. • Provider capacity.

34. When things go wrong Client complaints go to: • Brokerage manager (local process). • DHS DMAP (state level process). • Non-urgent = Critical or negative comment concerning an experience, observation or opinion • Urgent = Serious action that, if true, violates a law or endangers public safety.

35. When things go wrong • Refer to General Rule OAR 410-120-1865 about client hearing rights. • Out of 1.2 million transports a year: • The DMAP Hearings Unit received fewer than 21 requests last year. • All but one hearing were denied due to the fact that: • Clients were not eligible. • Appointments were not confirmed. • Clients were going to a non-covered service. • The providers were not enrolled.

36. Brokerage/transportation providers • Transportation providers will: • Follow the same contract, requirement and process. • Subcontract, establish and coordinate existing resources within each service area. • Ensure they meet federal, state and local qualifications for the safe operation of vehicles. • Pay transportation providers. • Coordinate training of transportation providers. • Conduct criminal background checks. • Audit provider billings.

37. Client services • Clients receive the same information: • Booklet template cannot be changed. • Booklets are provided in alternate formats. • Clients learn about brokerages from multiple resources such as: • Letters • Social services staff • Advisory boards • Medical providers • Local outreach efforts

38. Client services • Various people may request transportation to clients’ health care appointments: • Clients. • Case managers. • Hospitals. • Nursing facilities. • Advocates (family members, neighbors).

39. Client services • Clients will have one phone number to call to request a ride. • Report all complaints and compliments to the brokerage. • Send all transportation-related issues, contacts, or requests to the brokerage. I need a ride!

40. Client questions • How long does it take to get my ride? • Clients should call for medical transportation well in advance. • The more notice, the more likely a ride will be available. • How do I cancel a ride? • Clients should call the brokerage as soon as possible.

41. Client questions • My ride is late, now what? • Clients should call for the brokerage as soon as possible. • What if I need a ride after business hours? • A brokerage recorded message will tell the client how to arrange a ride. • Clients should have the medical identification ready.

42. Client questions • What if I need a personal care attendant? • Client is responsible to provide a personal care attendant (PCA) if one is required. • The PCA rides free in taxi or wheelchair van. • Non-PCA additional passengers need to pay. • Bus tickets are paid by the brokerage.

43. Social services staff • Social services staff will continue to: • Receive and process client reimbursements. • Receive and authorize non-emergency ambulance ride requests. • Case manage the clients.

44. Social services staff • Social service staff will no longer: • Authorize non-emergency medical transportation (except non-emergent ambulance). • Talk to clients about their transportation needs (refer clients to the brokerage). • Handle complaints (refer all complaints and compliments to the brokerage to research and resolve).

45. Key to success • Communication is your key to success: • Client • Brokerage • Transportation Advisory Committee • DHS central office staff • Brokerages communicate by: • Mail • Phone • E-mail

46. Maintain know-how • It is crucial that you are familiar with: • Medicaid rules, procedures, and policies. • Brokerages. • Covered/non-covered transports. • Authorizing the transport. • Variety of transports. • Travel expenses. • Transportation Advisory Committee.

47. Advisory Committee • Transportation Advisory Committee will: • Provide regional broker and DHS with input on the transportation program. • Assist in monitoring and evaluating the transportation program. • Advise regional broker and DHS on priorities for policy changes and program improvements. • Identify service issues and develop recommendations to improve transportation service delivery.

48. Client reimbursements • Social services staff will continue to reimburse clients for mileage, gas, meals and lodging. • Only one brokerage, NW Ride Center, is currently doing reimbursements: • Authorize client or guardian mileage/gas reimburse-ments in advance. • Checks are issued directly to the client or guardian by either: • Direct mileage reimbursement. • Gas voucher or ticket.

49. Client reimbursements • Client and attendant meals may be reimbursable when: • Client is required to travel for a minimum of four hours out of their local, geographical area. • When the course of that travel spans the normal meal time. • Breakfast: Travel begins before 6:00 a.m. • Lunch: Travel begins before 11:30 or ends after 1:30 p.m. • Dinner: Travel ends after 6:30 p.m.

50. Client reimbursements • Client and attendant lodging may be reimbursable when: • Client’s medical appointment necessitates an overnight stay. • Begin travel before 5:00 a.m. • End travel after 9:00 p.m. • Lodging is payable for the attendant (non-shared room).