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Long Term Care (LTC) Provider Training

Long Term Care (LTC) Provider Training

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Long Term Care (LTC) Provider Training

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  1. Long Term Care (LTC) Provider Training Revised 11/17/08 1

  2. HISTORY OF NETSPAP Non-Emergency Transportation Services Prior Approval Program— NETSPAP • Implemented in Cook County in June of 2001. • Except for LTC residents, NETSPAP went Statewide in May of 2004. • LTC resident population last phase-in. 2

  3. HISTORY OF NETSPAP • HFS must ensure that reimbursement of non-emergency transportation meets federal guidelines. • NETSPAP allows HFS to maintain standards and controls necessary to comply with federal requirements. • Effective mechanism in preventing fraud and abuse. 3

  4. TRAINING OBJECTIVE To inform Long Term Care (LTC) Providers about prior approval policies and procedures for non-emergency transportation. 4

  5. INTRODUCTIONWho is First Transit? • First Transit administers the Non-Emergency Transportation Services Prior Approval Program (NETSPAP) for the Department of Healthcare and Family Services (HFS). • In performing this function, First Transit follows HFS’ policies for non-emergency transportation. • First Transit does not provide or arrange transportation services for HFS participants. 5

  6. Non-emergency vs. Emergency Transportation • All non-emergency transportation requires prior authorization by First Transit. • Emergency transportation does not require authorization by First Transit. 6

  7. “Prior Approval” Defined • Beginning September 17th, for dates of service on or after October 1, 2007, non-emergency services for residents of Long Term Care (LTC) Facilities will require prior approval. • “Prior Approval” means that the trip must be authorized BEFORE the Non-Emergency Transportation (NET) Provider transports the participant to their medical appointment. (Prior approval should be obtained at least 2 to 3 business days before the appointment) • If prior approval is not obtained, the NET Provider will not be paid for their service. 7

  8. Non-emergency transportationwill be authorized if: • The participant has an appointment scheduled for a covered medical service, and • The participant is being transported to the closest appropriate medical provider, and • The Category of Service being requested is at the appropriate levelnecessary to meet the participant’s medical needsi.e. service car and medicar. 8

  9. EXAMPLES OFCovered Medical Services • Doctor appointments • Hospital admission or discharge • X-rays, lab work, MRI, etc • Chiropractic care • Renal dialysis, physical therapy, chemotherapy, radiation services • Behavioral health services • Outpatient surgery • Dental appointments 9

  10. EXAMPLES OFServices that are NOT Covered • Acupuncture • Prescription pick-up • SSI evaluations • Wheelchair repair or pick-up • Methadone pick-up or treatment • Smoking cessation • Day Treatment Programs 10

  11. LTC Providers may request single trip transportation services and standing prior approval trips for their residents. On October 5, 2007, a new standing prior approval policy was implemented by HFS. In the new policy, Standing Prior Approvals (SPAs) can be requested by anyone, including the LTC Provider. How can LTC Providers obtain prior approval from First Transit? 11

  12. STEP ONE:Gather all required information 12

  13. Prior to Contacting First Transit,the LTC Provider needs the following info: • The participant’s Recipient Identification Number (RIN) • The participant’s date of birth • Date and time of the medical appointment • Information about the medical appointment (i.e. the type of services that the participant will receive) • Information about the medical provider (i.e. the correctly spelled doctor’s name or facility, the medical provider address, the most direct telephone number, etc.) • Information for the Transportation Screening (i.e. Is the participant able to step into a regular car? Are they wheelchair bound?, etc.) • The participant’s appropriate Category of Service (i.e. service car, medicar, non-emergency ambulance) • The preferred NET Provider 13

  14. STEP TWO:Contact First Transit 14

  15. There are three ways to request prior approval from First Transit • First Transit’s Online System - passPORT • Fax or Mail • Telephone 15

  16. FIRST TRANSIT’sOnline System: passPORT BEST WAY TO REQUEST TRANSPORTATION Service is available 24 hours a day, with no limitation on inquiries 16

  17. FIRST TRANSIT’sFax Numbers(312) 327-3854 or (312) 327-3855 Fax machines are operational Monday through Friday 8:00 a.m. – 5:00 p.m. 17

  18. FIRST TRANSIT’sProvider Toll-Free Number(866) 503-9040 Operators are available Monday through Friday 8:00 a.m. – 5:00 p.m. 18

  19. IMPORTANTTo Remember • Whether requesting prior approval through passPORT, by phone, fax or mail, the LTC Provider must give ALL INFORMATION requested on the NETSPAP Single Trip Form or by the Customer Service Representative. • All forms submitted to First Transit must be complete, accurate and legible. Incomplete forms will be returned. 19

  20. STEP THREE:Wait for First Transit’s Decision 20

  21. Waiting for First Transit’s Decision • Routine requests are usually processed within 2 business days. • Non-routine requests may take up to 5 business days to process. Some medical services must be validated by the Transportation Review Unit (TRU) in order for First Transit to determine whether the request for transportation is approvable or not. 21

  22. EXAMPLESof Non-Routine Requests • Transport by non-emergency ambulance (prior and post approval) • Behavioral Health Services • Standing Prior Approval (SPA) Overrides • Long Distance Trips 22

  23. Notification from First Transit • Participants will receive denial letters. • Participants will receive approval letters for standing prior approvals. • NET Providers will receive both approval and denial letters. • LTC Providers enrolled in passPORT have access to faster notifications online. 23

  24. STEP FOUR:LTC ProviderCoordinates the Participant’s Transportation 24

  25. Coordinating the Participant’s Transportation If First Transit approves the request: • The LTC Provider contacts the NET Provider to schedule the trip. NET Provider will need the approved Request Tracking Number [RTN]. (HFS pays the NET Provider through the RTN) • The participant’s pick-up and drop-off times must be arranged with NET Provider. • First Transit will make every attempt to accommodate existing relationships with NET Providers. • If the LTC Provider is also enrolled as a NET Provider, prior approval must be obtained from First Transit, for trips to be eligible for payment from HFS. 25

  26. Coordinating the Participant’s Transportation If First Transit denies the request: • HFS will not pay for the transportation. • Alternate transportation must be arranged for the participant. 26

  27. Common Denial Reasons • Medical service is not covered by HFS. • Participant is not eligible for transportation on date of service. • Post Approval was requested too late. • Unable to validate medical appointment. • Additional information requested was not received timely. • Closest appropriate medical provider is not being used. • Participant refuses to use the appropriate Category of Service. 27

  28. Completing the NETSPAP Single Trip Form 28

  29. SINGLE TRIP FORM Has 6 Main Sections • Requesting organization information. • Participant information. • Trip information. • NET Provider information. • Category of Service. • Signature of requesting person. 29

  30. SINGLE TRIP FORM Identify the type of Long Term Care Facility on the Form For example: if the resident belongs to a nursing home, check ‘Resident of Nursing Facility (NF) 30

  31. SINGLE TRIP FORM Reason for Trip Must Be Specific For example: doctor appointment, dialysis treatment, etc. Trips for hospital admits or discharges must include the reason for the participant’s hospital admission 31

  32. SINGLE TRIP FORMNET Provider Information • All transportation requests must include a NET Provider that has confirmed that they will transport the participant. • Pick-up and drop-off times must be prearranged with the NET Provider. • If the participant does not have a preferred NET Provider, First Transit can provide information on enrolled transportation companies from a random selection process. 32

  33. SINGLE TRIP FORMCategory of Service The Category of Service must be the MOST ECONOMICALLY FEASIBLE TRANSPORTATION able to meet the participant’s medical needs. 33

  34. Categories of Service • Private Automobile • Service Car or Taxi • Medicar • Non-emergency Ambulance Other Assistance Non-employee attendant Employee attendant 34

  35. Categories of ServiceDEFINED • Private Automobile/Service Car/Taxicab – Transportation by passenger vehicle of a patient whose medical condition does not require a specialized mode. • Medicar– Transportation of a patient whose medical condition requires the use of a hydraulic or electric lift or ramp, wheelchair lockdowns, or transportation by stretcher when the patient’s condition does not require medical supervision, medical equipment, the administration of drugs or the administration of oxygen. • Non-emergency Ambulance – Transportation of a patient whose medical condition requires transfer by stretcher and medical supervision. The patient’s condition may also require medical equipment or the administration of drugs or oxygen, etc. during transport. 35

  36. TYPES OF NON-EMERGENCY AMBULANCES • Basic Life Support (BLS) Ambulance - provides transportation plus the equipment and staff for basic services such as giving first aid, controlling bleeding, administering oxygen, treatment of shock, taking vital signs or administering cardiac pulmonary resuscitation (CPR). • Advanced Life Support (ALS) Ambulance - provides all basic ambulance services and typically has complex life-sustaining equipment and radio or telephone contact with a physician or hospital. Note: Certification of medical need is required for BLS and ALS transports. 36

  37. OTHER ASSISTANCEATTENDANTS When medically necessary, a person can accompany participants in service cars, taxi cabs, and medicars • Non-employee Attendant – a family member or other individual who may accompany the participant when there is a medical need for an attendant. Examples of non-employee attendant include LTC employee assisting a participant in a wheelchair, family member or friend accompanying a participant with mental impairment. • Employee Attendant – a person, other than the driver, who is an employee of a transportation company. 37

  38. EXAMPLETo obtain prior approval for Melvine You need to gather the following information: • RIN 111111111 • Podiatry appointment on October 9, 2007 at 9:00 a.m. with Dr. John Ross. • The appointment is at the Foot Clinic at 111 N. First Street, in Chicago, IL 60015. • She is able to step into a regular car. • She does not use a wheelchair, walker, or cane. • She needs someone to travel with her due to her Alzheimer's condition. • She travels with A & B Transportation at 312-741-5555. 38

  39. FIRST TRANSIT’SNETSPAPSingle Trip Form 39

  40. EXAMPLETo obtain prior approval for Melvine You could submit the NETSPAP Single Trip Form through passPORT, fax or mail. You could also call First Transit. If approved you would contact A & B Transportation to coordinate Melvine’s transportation. 40

  41. Q & A Question and Answer Session 41

  42. passPORT First Transit’s On-Line System 42

  43. FIRST TRANSIT’sOnline System’s passPORT’s Features • LTC Providers may submit Single Trip requests. • LTC Providers may access trip information through the request tracking number. • LTC Providers can receive authorization information. • LTC Providers do not have to wait to receive paper authorization through the mail. 43

  44. LOGGING INTO passPORT Enter User Name and Password 44

  45. LOGGING INTO passPORTRequesting a user name. 45

  46. After logging in, you will reach the passPORT home page: 46

  47. From the home page you may access the trip menu 47

  48. Select ‘Enter Trip’ to process trip requests 48

  49. Screens in passPORT correspond with info requested on Single Trip Form 49

  50. passPORT will immediately inform you of potential problems 50