Medical Transportation Enrollment Criteria and Forms

Revised: November 3, 2023

Transportation organizations must meet the following requirements to enroll with Minnesota Health Care Programs (MHCP), or to complete revalidation with MHCP:

· Current license for state of practice (ambulance, air and other applicable licenses)

· Nonemergency medical transportation (NEMT) providers: Special transportation service (STS) certification and a current vehicle list from the Minnesota Department of Transportation.

· Land and water ambulances: Licensure as emergency medical transportation provider in state of practice.

· Air ambulances: Federal Aviation Administration (FAA) Certification of Airworthiness and ambulance licensure.

· Transportation organizations are required to pay a screening fee to MHCP, or provide proof they have paid the fee to Medicare or another state’s Medicaid agency.

· Before they are enrolled, transportation organizations must undergo a site visit, or provide proof that a site visit was conducted by Medicare or another state’s Medicaid agency.

· Anyone who owns at least five percent of a transportation organization must send proof they have completed a background study through NETStudy 2.0.

Publicly operated transit systems, volunteers, not-for-hire vehicles and ambulance services are exempt from the enrollment requirement and do not need to enroll. Refer to the Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services in the MHCP Provider Manual for more information.

How to Enroll

Transportation Organizations

Transportation organization providers who wish to enroll or reenroll with MHCP, can do so in one of the following ways.

Use the Minnesota Provider Screening and Enrollment (MPSE) portal by following the Registration Instructions. Also, upload the following in the MPSE portal:

· Completed, signed and initialed copy of the Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or MCO In-Network Provider Agreement (DHS-8355) (PDF)

· Copies of current applicable licenses or certifications

· Proof of fee payment and site visits, if applicable

· Complete background studies information

or

Complete and fax the following enrollment forms and required documents to MHCP Provider Eligibility and Compliance at 651-431-7462.

· MHCP Organization – Provider Enrollment Application (DHS-4016A) (PDF)

· Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) or the MCO Provider In-Network Agreement (DHS-8355) (PDF)

· Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF)

· Copies of current applicable licenses or certifications

· Proof of fee payment and site visit, if applicable

· Complete background studies information

Affiliating Individual Transportation Drivers

Refer to Transportation Driver Enrollment Criteria and Forms under Provider Basics in the MHCP Provider Manual for detailed instructions on enrolling and affiliating individual transportation drivers.

Processing Timelines

· We process forms in order of date received. Allow 30 days for processing.

· Allow an additional 60 days for the Minnesota Department of Human Services to complete a site visit if your organization has not completed a site visit with Medicare or another state Medicaid authority

· We will send a request for more information letter through U.S. Postal Service or to your MN–ITS mailbox if more information is needed to complete your enrollment.

· Incomplete applications will delay processing. Each corrected submission restarts the 30-day processing timeline.

Revalidation

MHCP is required to follow the Centers for Medicare & Medicaid Services final federal provider screening regulations.

MHCP will notify you when you are due for revalidation. When you are notified, you must submit a revalidation request through the MPSE portal or fax all required forms and documents listed in the How to Enroll section to DHS.

We recommend using the MPSE portal and following the Revalidation Instructions in the MPSE user manual to revalidate your record. Log in to your MN–ITS account on the MN–ITS: Home webpage and choose the Minnesota Provider Screening and Enrollment (MPSE) portal link. If you have not registered your MN–ITS account, your login information is on your original Welcome Letter. Call the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 if you do not have your Welcome Letter.

Refer to Revalidation in Provider Screening Requirements under Provider Basics in the MHCP Provider Manual for important information, including timelines, about the revalidation process and impacts to your enrollment. Providers who do not meet the revalidation timelines will have their enrollment terminated.

Reporting Changes

Report any changes made on a provider record to MHCP Provider Eligibility and Compliance. Refer to Changes to Enrollment in the Enrollment with MHCP section under Provider Basics in the MHCP Provider Manual for details. MHCP must be notified of changes in ownership 30 days before sale or transfer of ownership.

Legal References

Minnesota Statutes, 256B.0625, subdivisions 17 – 18h (Transportation costs, Access to medical services)
Minnesota Rules, 9505.0315 (Medical Transportation)
Code of Federal Regulations, title 42, section 440.170 (other medical or remedial care recognized under State law)