State-Administered NEMT

Revised: July 7, 2025

· Overview

· Eligible Providers

· Enrollment

· Eligible Members

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

· Covered Services

· Transportation Upgrade

· Noncovered Services and Excluded Costs

· Authorization Requirements

· Documentation

· Billing

· Billing for Stretcher Transport Attendants

· Legal References

Note: Information about living arrangements was removed with an update made in June 2025. We have restored policy language to what was posted before the June 2025 update; and are working to resolve any inconsistencies in guidance this may have caused.

Overview

State-administered nonemergency medical transportation (NEMT) is a higher level of NEMT provided for eligible Minnesota Health Care Programs (MHCP) members.

State-administered NEMT includes the following services:

· Mode 5 – Ramp or lift-equipped vehicle transportation (wheelchair or scooter)

· Mode 6 – Protected transportation

· Mode 7 – Stretcher transportation

Certification is required for eligible fee-for-service (FFS) members to receive state-administered NEMT transports. The state medical review agent creates the level-of-service (LOS) assessments for statewide assisted, ramp or lift-equipped wheel chair, and stretcher transports. FFS members requiring state-administered NEMT or renewal of state-administered NEMT transport services must contact the medical review agent at 866-433-3658 to complete the level-of-service (LOS) assessment.

FFS members requiring protected transport will complete the LOS assessment with the local crisis team or with specific medical providers in specific situations when they need the protected transport service. Refer to the mental health crisis contact numbers 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 Enrollment with Minnesota Health Care Programs (MHCP) section under Provider Basics in the MHCP Provider Manual for 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 member needs at the time of transport. The state-administered NEMT provider must help the member with the following when necessary:

· Getting from inside the member’s residence or pick-up location to the vehicle

· Getting into and out of the vehicle, including use of a ramp or lift or stretcher

· Fastening seat belts or securing wheelchairs or stretchers in the vehicle

· Getting into and out of the medical facility

· Getting to or from the member’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 U.S. 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 the following related webpages for the latest news and additions, forms, and quick links. · Hospital Services · Intermediate Care Facilities (ICF/DDs) · Tribal and Federal Indian Health Services · Managed Care Organizations (MCO) · Nursing Facilities

Enrollment

All state-administered NEMT drivers must now be enrolled with MHCP and be affiliated with the transportation provider organization. Starting Jan. 1, 2023, all state-administered NEMT claims will require the MHCP-enrolled individual NEMT driver’s Unique Minnesota Provider Identifier (UMPI) be listed on the claim as the rendering provider for the claim to pay.

Publicly operated transit systems, volunteers, not-for-hire vehicles and ambulance services are exempt from this enrollment requirement and do not need to enroll.

Refer to Transportation Enrollment Criteria and Forms in the Enrollment with Minnesota Health Care Programs (MHCP) section of the MHCP Provider Manual for how to enroll with MHCP.

Eligible Members

For MHCP members enrolled in a managed care organization (MCO) or transportation services provided through a waiver program, refer to the Eligible Member section under Nonemergency Medical Transportation (NEMT) Services (Overview) in the MHCP Provider Manual. Also refer to the following the resources.

· Contact the appropriate MCO for process and procedures for transportation services requirements.

· For member transportation to waiver program services, refer to HCBS Waiver Services and Elderly Waiver (EW) and Alternate Care (AC) Program sections of the MHCP Provider Manual.

To be eligible for state-administered NEMT, a member must be impaired physically or mentally in a way that keeps him or her from safely accessing and using Local County or Tribal Agency Non Emergency Medical Transportation (NEMT) Services. The member must require a high level of driver assistance, which could include assistance inside the origination (pick-up) and destination (drop-off) locations. The member 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 member must obtain state-administered NEMT certification through the LOS assessment process from the state’s medical review agent (844-681-8144) before scheduling state-administered NEMT transport with the provider.

State-administered NEMT certified members are responsible for selecting and contacting a state-administered NEMT provider and scheduling their own state-administered NEMT rides. After the state’s medical review agent 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. Members may also use the MHCP Provider Directory to access a list of enrolled state-administered NEMT providers.

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

MA members 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 the state’s medical review agent. The local county human service agency updates the member’s living arrangement code and must indicate the member resides in a nursing facility. The member 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 “Verify eligibility” link in MN–ITS in the “What can I do here?” section):

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 member to a nursing facility on the date of discharge from a hospital are eligible for reimbursement if the county has not updated the member’s living arrangement three months after the month of admission. Refer to documentation requirements later in this section.

Covered Services

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

Ramp or Lift-Equipped Vehicle Transports
A member who needs a wheelchair-accessible vehicle (ramp or lift-equipped) is defined as an MA member 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 member 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 members 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 member is documented as a wheelchair user with wheelchair state-administered NEMT certification on the member 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 state’s medical review agent LOS process. State-administered NEMT certification is required for all stretcher transports and is based on the medical need of the member.

Transportation Upgrade

Electroconvulsive Therapy (ECT), Dialysis and Outpatient Procedures with Sedation
Members 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. The state’s medical review agent 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, refer to 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 NEMT Services Overview section for specific requirements.

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

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

The state medical review agent enters state-administered NEMT certifications into the Minnesota Department of Human Services (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 member 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 the medical review agent entered eligibility into the member’s eligibility file system.

If the member received state-administered NEMT transport while they were not eligible for MHCP, the member or their representative has 60 business days from the date of the eligibility determination on their copy of the LOS assessment to contact the MHCP medical review agent. The medical review agent can then review 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 must be consistent with Minnesota Statutes, 256B.0625, subdivision 17b which includes the following requirements:

As a condition for payment, NEMT providers must document each occurrence of a service provided to a recipient according to this subdivision. Providers must maintain records that identify individual trips with specific vehicles and drivers. Providers must retain transportation records for five years form when the service is first billed to MHCP. The documentation may be collected and maintained using electronic systems or software, or in paper form, and must be made available and produced upon request. Program funds may be subject to recovery by the commissioner pursuant to Minnesota Statutes 256B.064 if they are not correctly documented.

The record must be in English and legible according to the standard of a reasonable person; and include each of the following items:

1. The member’s name and MHCP ID number.

2. The date, or dates, the service is provided, if different than the date the entry was made.

3. Either the printed name of the provider sufficient to distinguish the driver of service or the driver’s UMPI number.

4. The date and the signature of the driver attesting that the record accurately represents the services provided and the actual miles driven; and acknowledging that misreporting information that results in ineligible or excessive payments may result in civil or criminal action.

5. The date and the signature of the recipient or authorized party attesting that transportation services were provided as indicated on the transportation trip record, or the signature of the medical services provider certifying that the member was transported to the medical services provider destination. In the event that both the medical services provider and the recipient, or authorized party, refuse or are unable to provide signatures, the driver must document on the transportation trip record that signatures were requested and not provided.

6. 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.

7. The name or number of the mode of transportation in which the service is provided.

8. The license plate number of the vehicle used to transport the member.

9. The time of the member pickup.

10. The time of the member drop-off.

11. The odometer reading of the vehicle used to transport the member at the time of pickup.

12. The odometer reading of the vehicle used to transport the member at the time of drop-off.

13. The name of the extra attendant when an extra attendant is used to provider special transportation service.

14. Documentation indicating the method that was used to determine the most direct route.

In determining whether the commissioner will seek recovery, the documentation requirements in this section apply retroactively to audit findings beginning on January 1, 2020, and to all audit findings thereafter.

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 under Nonemergency Medical Transportation (NEMT) Services (Overview) in the MHCP Provider Manual. 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.

Bill the appropriate level of service provided to meet the needs of the nursing facility or community member, 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 member at both ends of each trip leg. A “trip leg” is the transport of the member from the pick-up (origination) location to the drop-off (destination) location.

· Bill state-administered NEMT ramp or lift-equipped transport only when the member 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.

· The state medical review agent must approve or certify all state-administered NEMT stretcher transports through the LOS process, even when the member 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
the State-Administered Nonemergency Medical Transportation (NEMT) Trip Sheet (DHS 7047) (PDF) is obsolete. Refer to the Documentation information contained in this manual section for 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 (pickup) 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 for Stretcher Transport Attendants

Nonemergency stretcher transports that require an attendant are eligible for reimbursement and MHCP pays 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 transportation costs)
Minnesota Statutes, chapter 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, subdivision 14a (Level of Need Determination)
Minnesota Statutes, 256B.0625, subdivision 17 (Covered Services, Transportation costs)
Minnesota Statutes, 256B.0625, subdivision17b (Covered Services, Documentation Required)
Minnesota Statutes, 256B.0625, subdivision 18 (Covered Services, Public transit or taxicab transportation)
Minnesota Rules, 8840.5925 (Vehicle Equipment)
Minnesota Rules, 9505.0315 (Medical Transportation)
Minnesota Rules, 9505.0445, section R, (Payment Rates, Medical transportation services)
Minnesota Rules, 9505.2175, subpart. 4, (Medical transportation service records)