Frequently Asked Questions for Medicaid Transportation
Can transportation providers advertise free Medicaid travel, in order to get more business?
“Solicitation” is a specific term that can lead to unacceptable practices, as defined in 18 NYCRR 504 (provider responsibilities.)
As you can imagine, a transportation provider cannot solicit business by giving a lottery ticket to every rider, or submitting names of every rider for a weekly free television drawing. Likewise, they cannot put up a billboard stating “free transportation to Medicaid riders!”
Transportation providers can introduce themselves to doctors, and leave business cards. (Hint)
Enrollee has both Medicaid and Medicare? What happens?
These two programs are designed to work together.
As an example: Since Medicare does not reimburse oxygen as a separate amount (the costs of any oxygen used is included in the base rate approved by Medicare), they request a prior approval from Medicaid transportation staff for the oxygen amount. This oxygen amount is over and above the coinsurance and deductible amount that Medicaid has to reimburse on a Medicare approved claim.
When Medicare approves an ambulance claim, Medicaid will pay up to the approved amount, i.e., Medicaid will pay the coinsurance and deductible amount. Therefore, it is inappropriate for Medicaid to pay more than the Medicare approved amount.
If a provider’s ambulance claim has been approved by Medicare, the provider does not need a prior authorization from Medicaid, as the claim is submitted directly to Medicaid. Medicaid will pay the difference between the Medicare approved amount and the Medicare paid amount.
When an enrollee uses an ambulette service, what are the expectations? What is the responsibility of the transportation provider? At what point is paying for an assistant appropriate?
Title 18 NYCRR § 505.10(16) reads: Personal assistance means the provision of physical assistance by a provider of ambulette services or the provider’s employee to an MA enrollee for the purpose of assuring safe access to and from the enrollee’s place of residence, ambulette vehicle and MA covered health service provider’s place of business.
Personal assistance is the rendering of physical assistance to the enrollee in walking, climbing or descending stairs, ramps, curbs or other obstacles; opening or closing doors; accessing an ambulette vehicle; and the moving of wheelchairs or other items of medical equipment and the removal of obstacles as necessary to assure the safe movement of the enrollee.
In providing personal assistance, the provider or the provider’s employee will physically assist the enrollee which shall include touching, or, if the enrollee prefers not to be touched, guiding the enrollee in such close proximity that the provider of services will be able to prevent any potential injury due to a sudden loss of steadiness or balance.
Medicaid Transportation Policy Manual, Version 2010-1 October 2010 Page 7 of 63
An enrollee who can walk to and from a vehicle, his or her home, and a place of medical services without such assistance is deemed not to require personal assistance.
Here is MAS’ expectation of an ambulette service:
- The provider does not need to go into the home. To the door is appropriate.
- The provider should not dress the enrollee.
- An ambulette service is required provide transportation to the paratransit disabled in its geographic region. Certainly, some trips will be easy (an apartment building with an elevator), while others will be more difficult (down a driveway in the midst of a snowstorm). Similarly, some wheelchair users need to be transported over curbs and up and down steps. We expect the ambulette company to do these trips also–safely. If this requires a second employee, then a second employee should be used.
The issue here is the reimbursement from Medicaid. It is our belief that an established amount, say $24 one way, is to cover the costs of the provider over a period of time. Some trips are short,mand therefore profitable, and some trips take more time, somewhat more unprofitable. One day, the provider may be able to group some rides, whole another day, there are few trips. Thus, what is the intent of the amount the county has established? Is it intended to cover more expensive transports, such as a two employee trip? Some districts have chosen to add on an “extra man” charge, when needed. Others say: it’s included in the rate. You decide.
Should the provider dictate what is and what is not in the reimbursement fee?
No, as this enables the provider to skim off all the “cream” trips, and refuse the unprofitable trips.We expect that riders on an ambulette are able to wait in the vehicle while another passenger is dealt with. However, we do not expect that the cognitively disabled are dumped with the ambulette provider, with the expectation that the driver will drive, and monitor against selfinjury or getting out of one’s seat. This “attendant” service is to be provided by a relative, or the staff of the nursing home, or a paid attendant. We require the ambulette service to deliver safe transportation. The provider is not to act as a medical attendant.
An ambulette company wants to add taxis to their fleet. Could the ambulettes be used as a taxi and paid the taxi rate?
Yes. Medicaid pays for taxi service in an appropriately licensed vehicle. This does not mean that a taxi vehicle must be used. Taxi service is curb-to-curb, ambulette service is door-to-door.
The LDSS can reimburse the ambulette provider at the taxi amount, but cannot use a taxi procedure code. The LDSS will either have to use the unassigned ambulette code or the “ambulette as taxi service” procedure code.
The LDSS receives requests to transport Association for Retarded Citizens (ARC) enrollees to medical appointments. Isn’t ARC responsible for transportation?
Day treatment transportation is the responsibility of the ARC day treatment program.
For all other transports, the following applies:
- If the enrollee resides in an OMRDD-certified intermediate care facility (ICF), a supervised community residence, a supervised and supportive individualized residential alternative; or attends day habilitation, the residence is responsible for all non-ambulance transportation. The LDSS is responsible for ambulance transportation.
- If the enrollee lives at home, or in a Family Care home, the LDSS is responsible for medical transportation.
Reference: April 2008 Medicaid Update, Responsibility for Transportation Provider Reimbursement.
Does the Medicaid Program require the enrollee’s signature on file when submitting a claim for services rendered?
For ambulance transportation claims, the Medicaid Program does not require the ambulance provider to have the Medicaid enrollee’s signature on file as a precondition of submitting a valid claim to the Program. Some counties have enrolled in a Signature Verification program in which a patient’s signature is obtained when transporting to a Medicaid service, as a condition of authorizing the trip.
What happens in case of a no-show, an enrollee who misses transportation?
A transportation provider cannot be reimbursed if they did not provide a service. No-show enrollees are an unfortunate cost of doing business.
Will transportation providers be notified if an enrollee’s eligibility changes?
When a prior authorization is issued, the system checks eligibility on the date authorization is entered. It cannot guess that in two months, a person will die or otherwise become ineligible for services.
This is why it is CRUCIAL that transportation providers check a person’s eligibility prior to each date of service. Medicaid will not pay for these claims as the beneficiary is enrolled in Family Health Plus.
A taxi provider stated that taxis could no longer wait in front of the hospital, but must use the hospital parking lot. Should the LDSS reimburse the parking fee?
Yes. The provider should submit the receipt to the LDSS.
What is the procedure for payment of Non-Emergency Ambulance Claims denied by Medicare
The following policy, disseminated to counties in March 2001, applies to non-emergency ambulance claims that have been denied by Medicare.
- The ambulance company must continue to seek payment from the Medicare program through the appeals process for the denied claim.
- The ambulance company will contact the fiscally responsible local department of social services (LDSS) to request a prior authorization for the non-emergency transport The LDSS will determine whether the ambulance transport was necessary based upon documentation supplied by the ambulance company.
- If approved, the LDSS will prior authorize the ambulance transport at the Medicaid payment amount.
- The ambulance company must follow the existing zero-fill procedures and use the prior approval number in its resulting claim to the Medicaid Program.
- If a subsequent decision by Medicare results in a Medicare payment to the provider, the provider is required to adjust any Medicaid paid claims to reflect the Medicare approved and Medicare paid amounts in accordance with 18 NYCRR 540.6.
- The effective date of this revised payment policy is January 1, 2000.
The State has always defined each mode of transportation. Do individual counties have the right to redefine these modes?
No. The definition for ambulance and ambulette are in regulation 18 NYCRR 505.10.
There is no definition for taxi.
(1) Ambulance means a motor vehicle, aircraft, boat or other form of transportation designed and equipped to provide emergency medical services during transit.
(2) Ambulance service means any entity, as defined in section 3001 of the Public Health Law, which is engaged in the provision of emergency medical services and the transportation of sick, disabled or injured persons by motor vehicle, aircraft, boat or other form of transportation to or from facilities providing hospital services and which is currently certified or registered by the Department of Health as an ambulance service.
(3) Ambulette or invalid coach means a special-purpose vehicle, designed and equipped to provide nonemergency transport, that has wheelchair-carrying capacity, stretcher carrying capacity, or the ability to carry disabled individuals.
(4) Ambulette service means an individual, partnership, association, corporation, or any other legal entity which transports the invalid, infirm or disabled by ambulette to or from facilities which provide medical care. An ambulette service provides the invalid, infirm or disabled with personal assistance as defined in this subdivision.
Transportation Provider Refuses to Provide Taxi Transport to Nursing Home Resident
One of our primary ambulette/taxi transporters was contacted by a local nursing home for a taxi transport to an appointment. The transportation provider indicated that they cannot do taxi transports for nursing home residents – mentioning safety and leaving them at the curb, which in this case is the front door. Is this correct and do you have any written policy on this?
Medicaid Transportation Policy Manual
Version 2010-1 October 2010 Page 17 of 63
Medicaid does not have any policy on disallowing taxi transports of nursing home residents. The medical practitioner, in this situation nursing home staff, determines and requests the most appropriate mode of transportation. Nursing home staff know the mobility needs of residents.
Do vendors have to give notice before raising their fees?
YES. The amount reimbursed for a Medicaid transport is based upon an agreement between the county and the provider. A provider can not force you to pay any amount. Even when a provider’s public rates increase, the agreement has to be reached with you before Medicaid will pay the higher amount.