Getting Around in MN

1. Getting Around in MN Medical Transportation Minnesota Health Care Programs

2. Agenda • General Overview • Comparisons • Coverage • Responsibilities • Policy • Billing • Resources • Questions

3. Eligible Recipients • 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)

4. Transportation Types • Access Transportation Service (ATS) Curb-to-curb and door-to-door • Special Transportation Services (STS) Door-through-door • Ambulance Emergency and Non-emergency • Transportation for Waiver Recipients Through waiver programs

5. Considerations • 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?

6. Coverage Criteria • 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)

7. Covered Services Continued • Multiple riders allowed • Same or different pickup or drop-off points • Multiple Segments Each 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

8. Billing - General • 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

9. Access Transportation Services • “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

10. Access Transportation Services (ATS) • Also includes: • Volunteer driver • Personal mileage • Meals • Lodging • Air fare when appropriate • Parking

11. ATS Responsibilities • 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

12. ATS Responsibilities • Medical Transportation Management’s (MTM) Minnesota Non Emergency Transportation (MNET) • Coordinate ATS for: • 8 county metro area Anoka Chisago Dakota Hennepin (Host) Isanti Ramsey Sherburne Washington MNET conducts Level of Need (LON) assessments for STS statewide

13. ATS Medical TransportationEligibility • MHCP Fee-for-service recipients who: • Need transportation to medically necessary covered services, or • Attend MHCP service related appeal hearings

14. Requirements • 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

15. ATS Services • 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

16. ATS Services Not-covered or excluded • 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

17. ATS Authorization • 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.

18. Documentation • 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)

19. Billing & Reimbursement • 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

20. ATS Billing • 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

21. Special Transportation Services • 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

22. STS Eligibility • 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

23. STS Eligibility continued • MA Nursing Facility Residents: • Residing in • Being admitted to, or • Discharged from NF • Never require STS LON Assessment • Effective statewide

24. STS Provider Responsibilities • 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

25. STS Requirements • 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

26. Multiple riders • 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

27. STS Covered Services • Transport to and/or from the site of an MHCP covered medical service

28. STS Limited Coverage • Stretcher Services • Day Training and Habilitation (DT&H) or other Day Programs • Electro Current Treatment • Dialysis • Outpatient Procedures w/ sedations • Wheelchair Transports

29. STS Non-covered Services • 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)

30. STS Certification • 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: • Single/multiple day • Week (s) • Month (s) • Year

31. STS Billing • 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

32. 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)

33. STS Stretcher Transport Attendants • 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

34. Ambulance Services • 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

35. Ambulance Requirements • Providers licensed as a service for: • Advanced Life Support • Basic Life Support • Scheduled Life Support

36. Ambulance Covered Services • 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

37. Ambulance Covered ServicesContinued • 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)

38. Air AmbulanceCovered Services • 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

39. Air AmbulanceAuthorization Required • Transports to/from outside of MN require authorization from MHCP medical review agent (except contiguous counties in neighboring states) • Use MHCP Medical Review Agent

40. Ground AmbulanceCovered Services • 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

41. Ground Ambulance 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 ambulanceprovided medically necessary treatment to the recipient at the pickup pointand did not transport

42. Air Ambulance MHCP covers when: • The recipient has a potentially life-threatening condition that does not permit the use of another form of ambulancetransportation • 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

43. Air AmbulanceAuthorization • 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

44. Ambulance Authorization Non-Emergency Trips • 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

45. Billing & Reimbursement • 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)

46. Waiver Recipient Transportation • 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????

47. 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

48. Waiver Transportation Covered Services • 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

49. Non-covered Services • Transportation access through MA services • Reimbursement included in contracted rate for: • Adult Day Care • Residential Services • Supported employment to DT&H

50. Case Manager/Service Coordinator Responsibilities • 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