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Minnesota Department of Human Services Provider Manual
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State-Administered NEMT

Revised: 08-10-2017

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Nursing Facility (NF) Recipients Approved for State Administered NEMT Statewide
  • Covered Services
  • Transportation Upgrade
  • Noncovered Services and Excluded Costs
  • Authorization Requirements
  • Documentation
  • Billing
  • Stretcher Transport Attendants
  • Legal References
  • Overview

    State-administered nonemergency medical transportation (NEMT) is a higher level of NEMT provided for eligible Minnesota Health Care Programs (MHCP) recipients who, due to a physical or mental condition, cannot safely use local county or tribal agency NEMT transport services. Refer to the local county and tribal agency administered NEMT section for information about these transportation services.

    State-administered NEMT includes the following services:

  • • Assisted transportation
  • • Ramp or lift-equipped vehicle transportation
  • • Stretcher transportation
  • • Protected transportation
  • Certification is required for eligible fee-for-service (FFS) recipients to receive state-administered NEMT transports. Effective July 1, 2016, MHCP contracts with KEPRO to perform level-of-service (LOS) assessments statewide for assisted, ramp or lift-equipped, and stretcher transports. FFS recipients requiring state-administered NEMT or renewal of state-administered NEMT transport services must contact KEPRO at 844-681-8144 to complete the LOS assessment.

    FFS recipients requiring protected transport will complete the LOS assessment with the local crisis team at the time they need the protected transport service. Refer to the mental health crisis contact numbers list for the county contact number.

    Eligible Providers

    The Minnesota Department of Transportation (MnDOT) must certify state-administered NEMT transportation providers. Certified providers must enroll with MHCP for ramp or lift-equipped, stretcher, and protected transport. Refer to the Provider Enrollment page for MHCP provider enrollment criteria.

    State-Administered NEMT Provider Service Requirements
    State-administered NEMT is a transport level of service that requires the transportation provider to deliver the level of assistance the recipient needs at the time of transport. The state-administered NEMT provider must help the recipient with the following when necessary:

  • • Getting from inside the recipient’s residence or pick-up location to the vehicle
  • • Getting into and out of the vehicle
  • • Fastening seat belts or securing wheelchairs or stretchers in the vehicle
  • • Getting into and out of the recipient’s medical facility
  • • Getting to or from the recipient’s appropriate medical appointment desk inside the medical facility
  • State-Administered NEMT Vehicle Requirements
    All state-administered NEMT vehicles must display identification on both sides of the vehicle, including:

  • • Provider’s business name
  • • Provider’s United States Department of Transportation (USDOT) number, or the
  • MnDOT special transportation services (STS) certificate number preceded by the letters “STS” if you do not have a USDOT number
  • The name and numbers must be:

  • • Marked in a color that sharply contrasts with the background
  • • Easily read during daylight hours from a distance of 50 feet while the vehicle is stationary
  • • Maintained so they continue to be easy to read. Markings may be removable devices if they meet the identification and legibility requirements
  • Provider Type Home Page Links
    Review related Web pages for the latest news and additions, forms, and quick links.

    Eligible Recipients

    For recipients enrolled in a managed care organization (MCO) or transportation services provided through a waiver program, refer to the Eligible Recipient section of the Nonemergency Medical Transportation (NEMT) Services (Overview) page, in addition to the following:

  • • Contact the appropriate MCO for process and procedures for transportation services requirements
  • • For recipient transportation to waiver program services, see HCBS Waiver Services and Elderly Waiver (EW) and Alternate Care (AC) Program sections of the Provider Manual
  • To be eligible for state-administered NEMT, a recipient must be impaired physically or mentally in a way that keeps him or her from safely accessing and using local county or tribal agency-administered NEMT. The recipient must require a high level of driver assistance, which could include assistance inside the origination (pick-up) and destination (drop-off) locations. The recipient must also meet one of the following criteria:

  • • Is eligible for MHCP with NEMT coverage (refer to MHCP Benefits at-a-glance for specific program information)
  • • Is eligible for Emergency Medical Assistance (EMA)
  • • Is eligible for state-only funded MA benefits due to residing in an Institution for Mental Diseases (IMD)
  • • Is a MinnesotaCare enrollee under the age of 21
  • • Is a pregnant woman enrolled in MinnesotaCare
  • • Is enrolled in the Minnesota Family Planning Program (MFPP)
  • • Is eligible for Refugee Medical Assistance (RMA)
  • A recipient must obtain state-administered NEMT certification through the LOS assessment process from KEPRO (844-681-8144) before scheduling state-administered NEMT transport with the provider.

    State-administered NEMT certified recipients are responsible for selecting and contacting a state-administered NEMT provider and scheduling their own state-administered NEMT rides. After KEPRO approves state-administered NEMT, they will provide, upon request, up to five state-administered NEMT provider names and phone numbers relative to the client’s county of residence. Recipients may also use the MHCP Provider Directory to access a list of enrolled state-administered NEMT providers.

    Nursing Facility (NF) Recipients Approved for State-Administered NEMT Statewide

    MA recipients residing in, or being admitted to or discharged from a licensed nursing facility automatically qualify for state-administered NEMT-level transportation for all non-stretcher state-administered NEMT transport level trips. These people do not need a LOS certification through KEPRO. The local county human service agency updates the recipient’s living arrangement code and must indicate the recipient resides in a nursing facility. The recipient living arrangement must be one of the following for the provider to receive reimbursement for state-administered NEMT transports (verify these living arrangement codes through the recipient Eligibility Request in MN–ITS):

    41 – NFI (Nursing Facility I) Medicare certified
    42
    – NFII (Nursing Facility II) Non-Medicare certified
    44
    – Short Term Stay NFI
    45
    – Short Term Stay NFII

    Exception for State-Administered NEMT Transport to Nursing Facility on Date of Discharge from the Hospital
    State-administered NEMT transports for an MHCP recipient to a nursing facility on the date of discharge from a hospital are eligible for reimbursement if the county has not updated the recipient’s living arrangement three months after the month of admission. See documentation requirements later in this section.

    Covered Services

    Refer to the Transportation Overview section of the Provider Manual for more information on Covered Services (for general service coverage), Multiple Riders, Reconsideration Procedures and other information.

    Ramp or Lift-Equipped Vehicle Transports
    A recipient who needs a wheelchair-accessible vehicle (ramp or lift-equipped) is defined as an MA recipient with severe permanent or temporary mobility impairments who meets all of the following:

  • • Is unable to walk or move from one place to another without a wheelchair
  • • Cannot transfer independently from the wheelchair to a regular transport seat
  • • Has a condition that requires the use of a vehicle lift or ramp, as in a wheelchair-accessible van
  • A recipient who transfers independently from the wheelchair to a vehicle seat is considered ambulatory and is not eligible for wheelchair transport.

    A wheelchair-accessible van must operate under the authority and in compliance with the official regulations of the MnDOT, and be registered as such by MnDOT. The reimbursement rate for recipients who need a wheelchair-accessible van is higher than for those who do not need a wheelchair-accessible van. MHCP will not pay bills submitted with the wheelchair van base rate and mileage codes unless they meet all of the following criteria:

  • • The recipient is documented as a wheelchair user with wheelchair state-administered NEMT certification on the recipient file
  • • State-administered NEMT is indicated in the MN–ITS eligibility response
  • • The van providing the service is wheelchair-accessible and certified by MnDOT
  • • The provider record with MHCP has the wheelchair code indicator
  • Stretcher Transport Services
    Stretcher (gurney) transport is a state-administered NEMT covered service. Obtain stretcher transport certification through the KEPRO LOS process. State-administered NEMT certification is required for all stretcher transports and is based on the medical need of the recipient.

    Transportation Upgrade

    Electroconvulsive Therapy (ECT), Dialysis and Outpatient Procedures with Sedation
    Recipients who receive electroconvulsive therapy (ECT), dialysis or outpatient procedures with sedation and are eligible for local county or tribal agency NEMT, may be eligible to be transported by state-administered NEMT for the return trip. Request state-administered NEMT transport for the return trip only. KEPRO will enter a single day state-administered NEMT certification for ECT, dialysis and outpatient procedures with sedation for return trips only unless state-administered NEMT is determined necessary at all times.

    Also, see One-time Transport Assessments and Upgrades in the Nonemergency Medical Transportation (NEMT) Services (Overview) section.

    Noncovered Services and Excluded Costs

    Refer to the Nonemergency Medical Transportation (NEMT) Services (Overview) section for Excluded Costs and Noncovered Services.

    Authorization Requirements

    Refer to the Authorization section for general authorization requirements.

    Refer to the Authorization Requirements table in the Transportation Overview section for specific requirements.

    State-Administered NEMT Level-of-Service (LOS) Assessment
    Recipients must be determined eligible through the LOS assessment process and certified based on their need to receive state-administered NEMT. The LOS assessment is completed no more than annually unless the recipient’s circumstances have changed significantly to require a new LOS determination.

    An LOS assessment is not required if the recipient is being discharged to, residing in or being discharged from a nursing facility.

    KEPRO enters state-administered NEMT certifications into the DHS eligibility system immediately following the LOS approval determination. It is the responsibility of the state-administered NEMT provider to check MN–ITS to verify the recipient is eligible to receive state-administered NEMT.

    All requests to backdate the LOS assessment based on a retroactive MA eligibility determination require verification of the eligibility begin date and the date eligibility was entered into the recipient’s eligibility file system.

    If the recipient received state-administered NEMT transport while he or she was not eligible for MHCP, the recipient or his or her representative, has 60 business days from the date the eligibility was entered into the system to contact the MHCP medical review agent. The medical review agent can then complete the LOS assessment to determine the appropriate level of service.

    The medical review agent may approve state-administered NEMT certification spans for single or multiple days, weeks, months or years.

    Documentation

    Trip documentation sheets must be consistent with Minnesota Statutes 256B.0625, subdivision 17b. Requirements include the following:

  • • The record must be in English and must be legible according to the standard of a reasonable person
  • • The recipient's name must be on each page of the record and each entry in the record must document the following:
  • • The date on which the entry is made
  • • The date or dates the service is provided
  • • The printed last name, first name and middle initial of the driver
  • • The signature of the driver attesting to the following: "I certify that I have accurately reported in this record the trip miles I actually drove and the dates and times I actually drove them. I understand that misreporting the miles driven and hours worked is fraud for which I could face criminal prosecution or civil proceedings."
  • • The signature of the recipient or authorized party attesting to the following: "I certify that I received the reported transportation service" or the signature of the provider of medical services certifying that the recipient was delivered to the provider
  • • The address, or the description if the address is not available, of both the origin and destination, and the mileage for the most direct route from the origin to the destination
  • • The mode of transportation in which the service is provided
  • • The license plate number of the vehicle used to transport the recipient
  • • The time of the pickup and the time of the drop-off with "a.m." and "p.m." designations
  • • The name of the extra attendant when an extra attendant is used
  • • The electronic source documentation used to calculate driving directions and mileage
  • Documentation must also include the following:
  • • State-administered NEMT provider’s NPI or UMPI number for ramp or lift-equipped, stretcher and protected transports
  • • Recipient’s MHCP ID number
  • • Destination provider or recipient signature. The driver at the medical facility must obtain a signature indicating a scheduled medical appointment and that the recipient was taken to the appropriate medical appointment desk
  • Record all required trip information on your trip sheet and make this information available for review.

    Documentation Reviews
    All state-administered NEMT providers with paid state-administered NEMT claims are subject to review. MHCP may conduct reviews requiring state-administered NEMT providers to fax trip documentation upon request. MHCP sends review notifications to selected state-administered NEMT providers by mail or fax indicating what specific trip documentation they are requesting and the timeframe to submit the documentation to MHCP. In addition, DHS may conduct investigations and request trip documentation and other business documentation.

    Billing

    Refer to the Billing Policy section of the Nonemergency Medical Transportation (NEMT) Services (Overview) page. Refer to the Billing for State-Administered NEMT for instructions.

    All MHCP enrolled state-administered NEMT providers bill MHCP directly for state-administered NEMT reimbursements.

    Exception: The local county or tribal agency coordinates and reimburses transportation providers for assisted transport services.

    Bill the appropriate level of service provided to meet the needs of the nursing facility or community recipient, whether ambulatory, wheelchair or stretcher. Follow these requirements:

  • • Bill state-administered NEMT level of service only when you provided appropriate transport and assistance to the recipient at both ends of each trip leg. A “trip leg” is the transport of the recipient from the pick-up (origination) location to the drop-off (destination) location.
  • • Bill state-administered NEMT ramp or lift-equipped transport only when the recipient cannot transfer to the vehicle seat without assistance and must remain in the power chair or scooter, requiring a MnDOT certified wheelchair or scooter transport vehicle.
  • • KEPRO must approve or certify all state-administered NEMT stretcher transports through the LOS process, even when the recipient resides in, is being admitted to, or is being discharged from a nursing facility.
  • • Do not report noncovered miles.
  • • Use the HCPCS code that describes the services rendered. Use HCPCS modifiers to:
  • • Indicate both point of origin and destination for pick up and return trips
  • • Clarify two trips on the same date. If the modifiers are the same, combine the HCPCS codes. Report a maximum of two trips per base and mileage claim lines
  • • Include appropriate units on all base and mileage lines
  • Nursing Facility Resident Transport Checklist
    Complete and submit the State-Administered Nonemergency Medical Transportation (NEMT) Trip Sheet (DHS 7047) (PDF) and required documentation for fee-for-service (FFS) state-administered NEMT claims when all of the following apply:

  • • State-administered NEMT is required to transport an MHCP member to or from a nursing facility and to or from a covered medical service
  • • The county worker has not yet updated the living arrangement of the member to nursing facility (41, 42, 44, 45) in MMIS
  • • The nursing facility resident has fee-for-service (FFS) Medical Assistance (MA) eligibility
  • • It has been at least 30 days since the date the transportation was provided
  • Facility staff at both the origination (pick-up) and destination (drop-off) facility or medical provider locations must sign the form.

    Mileage Billing

    Bill destination and return trip on separate lines. Enter the same modifiers used for the base rate code on the mileage claim lines. Billing is limited to two base limits per line.

    Example of billing lines:

    Procedure Code

    Modifier

    Rate

    Units

    A0130

    RP

    18.00

    1

    S0209

    RP

    1.55

    2

    A0130

    PR

    18.00

    1

    S0209

    PR

    1.55

    2


    Refer to State-Administered Transportation Procedure Codes, Modifiers and Payment Rates for more information.

    Billing Attendants for Stretcher Transport

    Nonemergency stretcher transports that require an attendant are eligible for reimbursement and are paid at the MHCP maximum allowed rate.

    You must:

  • • Document the name of the extra attendant in the trip log
  • • Bill the extra attendant code (T2001) and the stretcher code (T2005) on the same claim
  • Legal References

    Laws of Minnesota 2014, chapter 312, article 24, section 28: NEMT provider requirements
    Minnesota Statutes 174
    : Department of Transportation
    Minnesota Statutes 174.29
    : Coordination of Special Transportation Service
    Minnesota Statutes 174.30
    : Operating Standards for Special Transportation Service
    Minnesota Statues 256B.04, subd 14a:
    Level of Need Determination
    Minnesota Statutes 256B.0625
    , subd.17: Covered Services, Transportation costs
    Minnesota Statutes 256B.0625
    , subd.17b: Covered Services, Documentation Required
    Minnesota Statutes 256B.0625
    ,
    subd. 18: Covered Services, Bus or taxicab transportation
    Minnesota Rules 8840.5925
    : Vehicle Equipment
    Minnesota Rules 9505.0315
    : Medical Transportation
    Minnesota Rules 9505.0445
    : Payment Rates, Medical transportation services
    Minnesota Rules 9505.2175
    ,
    subd. 4: Medical Transportation Service Records

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    © 2017 Minnesota Department of Human Services Updated: 8/10/17 8:31 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 8/10/17 8:31 AM