Nonemergency Medical Transportation (NEMT) Services (Overview)
Overview
Minnesota Health Care Programs (MHCP) covers nonemergency and emergency medical transportation services. (Select the links in the Covered Services section for service-specific coverage policies and billing procedures.)
Nonemergency Medical Transportation Services (NEMT)
NEMT provides Medical Assistance (MA) members with the safest, most appropriate and cost-effective mode of transportation to get to and from nonemergency medical service appointments. Members can arrange NEMT as one-way or round trips. Medical necessity determines which of the following types or levels of transport and ancillary services the member is certified to receive for transport to and from covered medical services:
The local agency (Modes 1 through 3) or the MHCP medical review agent (KEPRO for Mode 4) completes the transport level certification.
The MHCP medical review agent (KEPRO for Modes 5 and 7) or mental health crisis teams and some medical providers in specific situations (Mode 6) complete the transport level certification.
Members who qualify for local agency-administered NEMT may need the driver’s help up to, into, or in the residence, medical facility or pickup location. This includes assistance to or from the appropriate medical appointment desk.
All NEMT transport services include reimbursement in the rates for all activities of the transport driver needed to ensure the safe loading, unloading and transport of the rider. This may include but is not limited to any of the following:
Emergency Medical Transportation
Ambulance transportation services is the transport of a member whose medical condition or diagnosis requires medically necessary services before and during transport. This includes air and ground, emergency and nonemergency ambulance services.
Eligible Providers
Eligible providers must meet the following:
Refer to the Provider Enrollment webpage for general enrollment requirements. Refer to the Provider Basics, Provider Requirements, and Access Services sections for nonparticipating provider information.
Provider Type Home Page Links
See the MHCP provider types webpage to search for information and resources for the provider type specific to the services you provide.
Eligible Members
To be eligible to receive NEMT services, the member must meet one of the following criteria:
Members enrolled in a managed care organization (MCO) must contact the appropriate MCO for the process and procedures for obtaining transportation services.
MinnesotaCare members enrolled in a managed care plan with dates of service on and after January 1, 2017, will only receive or be reimbursed for personal mileage (mode 1), unassisted transport— out-of-state airfare only (mode 3), and out-of-state transport and ancillary services (lodging, meals, parking or tolls) through the local county or tribal agencies. All other NEMT transports are accessed through the health plan.
Transportation to services provided for a waiver program is the responsibility of the waiver program. For member transportation to waiver program services, see HCBS Waiver Services and Elderly Waiver (EW) and Alternate Care (AC) Program sections in the manual.
Refer to these sections for specific policies about eligible members:
A person who is certified for state-administered NEMT transport services must contact the provider to schedule transport for ramp or lift-equipped, protected, or stretcher transports. If certified for state-administered NEMT assisted transport or the local agency administered NEMT transports, the person must obtain transport through the local county or tribal agency.
Covered Services
MHCP covers NEMT services when provided for an eligible MHCP member to or from the site of an MHCP-covered medical service and either of the following apply:
Refer to these sections for specific covered service policies:
Arranging Transportation
Members can arrange for transportation as one-way or round trip within the 30- or 60-mile limit criteria (30 miles for a trip to a primary care provider or 60 miles for a trip to a specialty care provider). The school district is responsible for transportation when the services to or from which the member is being transported are part of an individualized education program (IEP).
It is preferable to submit requests for transportation up to five days before the member needs public transportation and at least three days for all other modes of transportation to allow transport to be scheduled.
If a member lives within three-fourths of a mile of a public transit route and his or her appointment is within three-fourths of a mile of a public transit route, and it is an appropriate mode of transportation for them, then they must use public transportation.
After Hours Policy
Transportation after hours is for transportation that is before 7 a.m. and after 6 p.m., Monday through Friday and all day on weekends and holidays. After-hours transportation is a covered service under MHCP; however, MHCP does not require providers to provide transportation services outside of their business hours. NEMT providers may have hours that are different from those listed here.
One-time Transport Assessments and Upgrades
One-time assessment is for same-day service upgrade requests. The local county or tribal agency may authorize upgrade requests for county or tribal agency-level NEMT. The MHCP medical review agent may authorize requests for state-administered NEMT and Mode 4 of the Local Agency Administered NEMT. One-time assessments are completed when members with temporary conditions or sudden changes in condition require a higher level of transport service than they are currently approved to receive. Approve the one-time upgrade when the medical service is urgent, the member’s condition changes due to the treatment received immediately prior to transport, a medical provider who has seen or spoken with the person that day requests the medical service, or as required when a hospital discharges a member from their care.
Urgent care is care for any illness or severe condition which, under reasonable standards of medical practice, would be diagnosed and treated within a 24-hour period and if left untreated, could rapidly become a crisis or emergency. Transportation requests for urgent care include any calls for transportation services when the person indicates his or her medical provider has told him or her to come to the provider’s office or to obtain other medical treatment or services that same day or within a 24-hour period.
Complete the same-day NEMT upgrade using the assessment process to ensure the proper level of transport is established and provided based on medical necessity. Same-day, after hours, weekend and holiday transport services depend on the transportation provider’s availability.
Spenddown
Non-emergency medical transportation (NEMT) and the related ancillary service charges ARE NOT applied to an existing spenddown obligation of a member. Members with a spenddown obligation are eligible for NEMT and related ancillary services to get them to and from their medical appointments. MHCP will reimburse for transports and ancillary services to the local agencies or enrolled NEMT provider.
Responsible Person
NEMT services may be provided for the member and, when necessary, one responsible person. The responsible person is included in the reimbursement for ground transports.
A responsible person is an adult or emancipated minor who is needed to make medical decisions, learn about the member’s medical care or is necessary to allow the member to receive a covered medical service.
In most situations, the responsible person must be transported with the MHCP member to receive payment or reimbursement for the NEMT services. An eligible responsible person includes, but is not limited to one of the following:
Family Members Transported Without the Member
MHCP covers transportation of responsible persons and one or more siblings from a single location separately from the member when necessary to enable family therapy services as established in the member’s plan of care to be completed. For example, the responsible person, sibling or spouse of a child or parent living in a residential facility may be required to attend therapy sessions or complete therapy services. Such cases do not require the member receiving care to be included in the transport. Use the member’s MHCP ID number when billing.
Transportation of an “Unaccompanied Minor”
The Department of Human Services (DHS) requires a parent or legal guardian to sign a parental authorization to allow any minor less than 18 years of age to receive nonemergency medical transportation services to medical, dental or therapy appointments without being accompanied by a parent or legal guardian.
The transportation coordinator must receive the signed parental authorization before scheduling any transportation for a minor traveling without a parent or legal guardian. The signed authorization is valid for one year from the date the transportation coordinator receives the signed form.
Transports of minors 17 years old and under require parental consent for transport if the parent or legal guardian is unable to accompany the minor. The local agency or transportation coordinator should keep the signed parental authorization form in their records.
Note: For minors receiving family planning services, they cannot be required to have a responsible person accompany them to or from the family planning services and cannot be required to provide any type of release from a parent or legal guardian.
Follow these steps for transporting a minor:
Parent or Guardian Authorization Form
Information in the local agency-established “Unaccompanied Minor Transport” form should include but is not limited to the following information:
Use of Public Transit
The county or tribe will negotiate agreements with public transportation systems wherever possible and will use public transportation systems when appropriate for the member.
Members who are able to travel by public transport must use public transport. The transportation coordinator determines the type of ticket or pass for the member by determining how many rides the member requires during a fixed period. Members whose needs are met by public transit may receive a monthly public transit pass. Any member who is eligible for one public transit trip for a medically necessary covered service may select to receive a transit pass for that month. Members who do not have any transportation needs in any given month, or who have received a transit pass from another program administered by a county or tribe, are not eligible for a transit pass that month. Counties or tribes cannot require members to select a monthly transit pass if public transit does not meet the member’s needs. Members who receive a monthly transit pass are not eligible for other modes of transportation, unless an unexpected need arises that the member cannot access through public transit.
Public Transit Procedure
Follow these requirements for public transit:
Possible exceptions for public transit include the following:
Consider a public transportation exclusion if the member has an underlying medical condition, an extenuating circumstance that makes this option inadequate, or an Americans with Disabilities Act (ADA) transit certification confirming public transit exclusion is on file.
You may issue a ticket or pass for one adult caregiver to accompany a member who is under 18 years old to authorized appointments.
If an adult member states that he or she requires an additional passenger who is not a PCA, send a statement of medical necessity to the member’s treating medical or mental health professional to determine the medical necessity of an additional passenger before scheduling transportation.
Special Considerations for Public Transit
If a member can use public transit routes (bus and light rail) that are on a published schedule, the member must pay the posted fare.
If a member lives within three-fourths of a mile of a public transit route and his or her appointment is within three-fourths of a mile of a public transit route, and it is an appropriate mode of transportation for them, then they must use public transportation.
If the member is able to use community dial-a-ride that is open to all members of the public, MHCP will reimburse the scheduled rate.
Organ Transplant Donor
MA may reimburse the costs of the appropriate level of NEMT transport and ancillary services to get the MA organ transplant donor from his or her location to Minnesota and back to the initial location. This ONLY includes transport and ancillary services for organ transplant donors from locations WITHIN the United States.
The member is responsible for obtaining the documentation necessary to give to the local agency for MA to provide and reimburse transport and ancillary services properly. The member gets the information or documentation from his or her managed care organization (MCO).
Service Animals
Under the Americans with Disabilities Act (ADA), a service animal is any dog that is individually trained to do work or perform tasks for the benefit of a person with a disability, including a physical, sensory, psychiatric, intellectual or other mental disability. Other species of animals whether wild or domestic, trained or untrained, are not service animals for the purpose of this definition. In addition to dogs, the ADA allows miniature horses to be service animals if they have been individually trained to do work or perform tasks for the benefit of the person with a disability.
Transportation Coordinators may ask two questions:
The transportation coordinator cannot require documentation (for example, proof of certification, training or licensure) if the animal is a service animal.
A service animal must be under the control of its handler and have a harness, leash, or other tether, unless the handler is unable to use because of a disability or such use would interfere with the animal’s safe, effective performance of work or tasks. If this is the case, the service animal must be otherwise under the handler’s control by way of voice control, signals or other effective means.
An NEMT provider may ask a person to remove a service animal from the vehicle if the animal is out of control and the animal’s handler does not take effective action to control it, or if the animal is not trained.
If the person with a disability has an emotional support, comfort or companion animal that is not also trained to be a service animal, the person can request a reasonable accommodation to travel with the animal. As a condition of providing the reasonable accommodation, the NEMT provider can require that the animal be leashed or under the control of the person with a disability at all times. If the person with a disability fails to exercise control of the emotional support, comfort or companion animal, the transportation company can refuse to transport the animal or require that the animal be in a kennel while in transport.
Recurring Trips
A recurring trip is when an MHCP member needs transportation to appointments with sequential dates and times on a daily, weekly, or bi-weekly basis for an extended period. MHCP members may schedule recurring trips for up to 30 days at a time in most cases. Members may schedule for more than 30 days in advance for the following conditions or services (including but not limited to):
Transport for Repair of Medical Equipment
MHCP covers transportation for medical equipment repair only when the member and medical equipment are transported together.
Transportation to an Opioid Treatment Program
As of July 1, 2015, providers and drivers must be chosen on a random basis, when feasible, for all NEMT transportation to Opioid Treatment Program clinics.
Pharmacy Transports
Allow pharmacy-only transports when transport is the only option available based on pharmacy requirements or absence of other means to obtain the prescription(s). Members must use all means to obtain pharmacy items, which includes, but is not limited to the following:
If pharmacy-only transport is required, the following apply:
Hospital Discharges
Members being discharged from a hospital after hours, including weekends and holidays, may need a higher mode of services. Hospital staff may initiate a one-time assessment for this purpose. Hospital staff must first determine if the person has a current level of transport service established for NEMT. If the person has a local county or tribal agency NEMT level of transport established, does not require a greater level of service for discharge and the transport level providers are available, inform the person that he or she may call the county or tribe directly to schedule the transport.
If the member’s medical needs require a higher level of transport or the member’s current transport level providers are not available, hospital staff must review the member’s conditions and establish the appropriate level of transport based on the person’s current medical needs.
The discharge provider must also contact the MHCP state-administered NEMT transport medical review agent within seven business days of the transport to have the level-of-service (LOS) assessment finalized when state-administered NEMT was necessary. The medical review agent will not review or certify the transport if they do not receive the information within seven business days. The provider or member may then contact the transportation provider to schedule transport.
New Arrival Refugee Transportation
MHCP covers nonemergency transportation for all refugees to receive medical services within the first 90 days of their arrival.
The refugee-screening clinic or assigned caseworker is responsible for submitting all MHCP nonemergency transportation requests to a transportation coordinator within the refugee’s first 90 days of arrival.
The transportation coordinator will check MN–ITS to verify if eligibility has been established before scheduling transportation. Follow this process:
Multiple Trip Legs
Each complete round trip will include multiple segments by one or multiple transportation providers.
Example: Member is picked up at point A and transported to point B service provider. The transportation provider then transports the member from point B service provider to point C service provider and then to final destination A. This is three trip legs or units.
Transportation between Two Similar or Same Facilities or Locations
MHCP covers transportation between two hospitals, two long-term care facilities, or two medical or residential facilities or other similar or same facilities or locations when a medically necessary health service that is part of the member’s plan of care is not available at the originating facility.
The following requirements apply:
Inclement Weather
NEMT providers must consider the safety of the member first when deciding whether to transport or to provide or use a specific level of service during times of inclement weather. Ensure that members receive proper notice if transportation is not possible due to the inclement weather situation.
The NEMT provider must notify members if they are not able to complete transportation services due to inclement weather.
Note: Give special consideration to urgent requests (could include but not limited to dialysis, electro-current therapy, chemotherapy and radiation).
Cancelled Transports Due to Inclement Weather
Either the NEMT provider or the member can notify the transportation coordinator that a transport is being canceled. NEMT providers make every effort to complete all trips during inclement weather or unusual traffic conditions whenever it is safe to do so.
NEMT providers must return members they took to an appointment to an appropriate location before inclement weather limits their ability to transport them safely. If the original NEMT provider cannot accommodate the return ride, the transportation coordinator will locate another NEMT provider that is able to provide the return ride. If no NEMT provider is available to provide the service, the transportation coordinator should help the member locate lodging and explain the reimbursement policy for lodging and meals.
Reconsideration Procedure
A reconsideration of a level-of-service (LOS) determination follows this procedure:
* Statement of medical necessity: The statement of medical necessity must indicate the medical necessity for the person to be present at the medical facility. The transportation coordinator will contact the person for information required to send to the treating provider requesting a statement of medical necessity for the transport, ancillary services or medical provider destination. Once the transportation coordinator receives the medical necessity information, the coordinator reviews it for approval of transportation and ancillary services costs. Approval is not guaranteed.
Cancelling Scheduled Transports
The member must make every attempt to cancel scheduled transports in a timely manner so transport vehicles are not sent to pick-up a member unnecessarily resulting in “no show” situations. Members must cancel transports as soon as the member determines they will not be able to make the appointment. Failure to proper cancel transports in a timely manner could result in limited future transport services being available.
Noncovered Services
MHCP does not cover the services listed below as medical transportation service costs for fee-for-service (FFS) (this list is not all-inclusive):
Excluded Costs Related to Transportation
MHCP excludes the costs listed in this section as medical transportation service costs for FFS. MHCP does not reimburse for these services and the provider cannot bill the member for them:
Authorization Requirements
Types of transports requiring authorization
Types of Transports | Descriptions |
Transports exceeding 30- and 60-mile limits | Local county human services or tribal agencies are responsible for authorization of NEMT services when a MHCP-covered medical service can only be received at a location more than 30 miles from the member’s home or residence for primary care and more than 60 miles from the member’s home or residence for specialty care. This does not include authorization for any protected transport (mode 6) services. |
Out-of-state nonemergency transportation | Does not include origination or destination points located in neighboring states when the county of the neighboring state is contiguous to Minnesota. |
Nonemergency stretcher services | All NEMT stretcher transports, including nursing facility residents, must be certified through the MHCP NEMT medical review agent. |
Refer to the following for service specific authorization requirements:
Refer to the Authorization section for general authorization requirements.
Out-of-State Medical Services
Local county and tribal agencies and state-administered NEMT providers considering requests for out-of-state medical transportation must obtain proof of authorization for out-of-state medical services from the member or responsible person. The MHCP medical review agent completes FFS authorization for out-of-state medical services. Referral by the managed care organization is required for members enrolled in a managed care plan. Refer to the Out-of-state Services authorization requirement section of the MHCP Provider Manual for more information.
Billing
Refer to Billing Policy for general MHCP billing policies and the following sections for service specific billing procedures:
MHCP-enrolled state-administered NEMT and ambulance providers bill MHCP directly for FFS transport services.
Local agency-administered NEMT transportation providers do not bill MHCP for service reimbursements. Contact the local county or tribal agency for reimbursement processes. Bill according to the following:
Retroactive Local Agency or State-Administered NEMT Certification
All requests to backdate the level of service based on a retroactive MHCP determination or for a person who is already an eligible MHCP member require completion of the level-of-service transport or ancillary services assessment. The DHS medical review agent must mail the denial letter following the level-of-service determination and mails an approval letter, if requested.
The member will need to have a retroactive level-of-service assessment completed for the following:
All cost reimbursements must be within the eligibility period and include appropriate documentation that would otherwise be required.
Documentation Requirements
Retain transportation records for five years from the date the service is first billed to MHCP.
Trip documentation must be consistent with Minnesota Statutes, 256B.0625, Subd. 17b requirements:
Documentation must also include:
Definitions
Adult: A person over the age of 18 authorized to make transportation decisions for a minor.
ALS: Advanced Life Support.
Advanced life support, Level 1 (ALS1): Transportation by ground ambulance vehicle, and the provision of medically necessary supplies and services, including an ALS assessment by ALS personnel or the provision of at least one ALS intervention.
Advanced life support, Level 2 (ALS2):
Ambulance service: The transport of a member whose medical condition or diagnosis requires medically necessary services before and during transport.
Ancillary services: Health services, incidental to ambulance transportation services that may be medically necessary on an individual basis, but are not routinely used and are not included in the base rate for ambulance.
Attendant: An employee of a NEMT provider who meets all MnDOT driver certification requirements.
Basic life support (BLS): Transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services.
BLS emergency: When medically necessary, the provision of BLS services as described in the BLS definition, in the context of an emergency response.
Client: A person enrolled in MHCP using nonemergency medical transportation services.
Client reimbursement: client mileage reimbursement provided to clients who have their own transportation.
Common carrier transportation: The transport of a member by bus, taxicab, other commercial carrier, or by private automobile.
Day training and habilitation (DT&H) services: Refer to DT&H.
Level of service (LOS): Assessment necessary to determine what mode of state or local agency NEMT is appropriate and most cost effective for each member.
Local agency nonemergency medical transportation (NEMT): Transportation services coordinated, provided, or reimbursed by the county and tribe. This includes personal mileage and volunteer driver mileage reimbursement, unassisted and assisted transport levels.
Medical review agent: An organization that MHCP (DHS) contracts with for review of the specific types of state-administered NEMT service level certification requests.
Medical transportation: The transport of a member for the purpose of obtaining a covered service or transport of the member after the service is provided. The types of medical transportation are common carrier, special transportation and life support.
Minnesota Department of Transportation (MnDOT): The principal Minnesota state agency to develop, implement, administer, consolidate and coordinate state transportation policies, plans and programs (Minnesota Statutes 174).
Minnesota nonemergency transportation (MNET): The program that coordinates and provides all local county and tribal agency administered NEMT transport services through a host county contract (current host county is Hennepin) for Anoka, Benton, Chisago, Dakota, Hennepin, Isanti, Mille Lacs, Pine, Ramsey, Sherburne, Stearns, Washington and Wright counties.
Minor child: A person from birth through age 17.
NEMT coordinator: An entity made up of one or more county, tribe or contracted provider with the responsibility of coordinating the appropriate level of transportation services for the member.
No show: Member is not at pickup location when scheduled or member has cancelled a scheduled trip within the following:
Nonemergency medical transportation (NEMT): Local county or tribal administered and state-administered transportation services provided to enable MHCP members access to medically necessary covered services or to attend MHCP service related appeal hearings.
State-administered nonemergency medical transportation (NEMT): Transportation services administered and reimbursed directly to the MHCP enrolled providers by DHS for transport of MHCP-eligible members certified to use one of the state-administered levels of transport to get to and from an MHCP covered medical service. This includes ramp and lift-equipped, protected and stretcher transports.
Transportation coordinator: The local county or tribal agency (or their contracted entity) that reviews clients eligibility for NEMT and related ancillary services and completes a level-of-service (LOS) assessment for the transport services they coordinate, provide (using their contracted transportation providers), reimburse (the client or transportation provider), and bill to MHCP.
Trip or trip leg: The transport of the member from the pickup (origination) location to the drop-off (destination) location. This is the unit of billing.
Volunteer transport: A transportation program that provides transportation by volunteers using their own vehicles.
Legal References
Minnesota Statutes, 144E.10 (Ambulance Service Licensing)
Minnesota Statutes, 144E.16 (ambulance service Local Standards)
Minnesota Statutes, 174 (Department of Transportation requirements)
Minnesota Statutes, 174.29 (Coordination of Special Transportation Service)
Minnesota Statutes, 174.30 (Operating Standards for Special Transportation Service)
Minnesota Statutes, 256B.0625, subd. 17 (Transportation costs)
Minnesota Statutes, 256B.0625, subd. 17a (Payment for ambulance services)
Minnesota Statutes, 256B.0625, subd.17b (Covered Services, Documentation required)
Minnesota Statutes, 256B.0625, subd. 18 (Bus or taxicab transportation)
Minnesota Rules, 8840.5925 (Vehicle Equipment)
Minnesota Rules, 9505.0315 (Medical Transportation)
Minnesota Rules, 9505.0445 (Payment Rates)
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