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Transportation to and from providers is a critical component for Medicaid beneficiaries to obtain necessary health care.  Non-Emergency Medical Transportation (NEMT) services consist of arranging and/or paying for transportation.  When the beneficiary lacks both means and mode, the county is responsible for arranging transportation at a cost within allowable Medicaid regulations.  However, the obligation to provide transportation is not without qualifications.

 

Federal regulations require that the state assure necessary transportation (see 42 CFR 431.53).  Necessary means no other appropriate transportation resources are available to the beneficiary.

 

Medicaid only pays for transportation:

 

1.  By the least expensive mode available and appropriate for the beneficiary (see VIII.C.1),

 

2.  To the nearest appropriate medical provider (see VIII.B.),

 

3.  For a Medicaid-covered service (see VIII.A.) provided by an enrolled NC Medicaid provider.

                                                           

  

 

 

RUTHERFORD COUNTY DEPARTMENT OF SOCIAL SERVICES

 

 

CLIENT NON EMERGENCY MEDICAL TRANSPORTATION PLAN

(NEMT)

 

 

APRIL 1, 2012

 

 

 

 

 

 

(This document is intended to fulfill requirements according to

Adult Medicaid Manual MA-2910 - Medicaid Transportation and

Family and Children’s Medicaid MA-3550 – Medicaid Transportation)

 


RUTHERFORD COUNTY DEPARTMENT OF SOCIAL SERVICES

 

NON EMERGENCY MEDICAL TRANSPORTATION (NEMT) LOCAL POLICY

 

 

The Rutherford County Department of Social Services, as the local administrator of North Carolina’s Medicaid Program (Title XIX), has responsibility for assuring transportation for authorized Medicaid recipients to needed medical services.  The Rutherford County Department of Social Services (DSS) will follow all rules and regulations for Medicaid Transportation set forth by the North Carolina Department of Health and Human Services in the Adult Medicaid Manual and the Family and Children’s Medicaid Manual.  A copy of the Rutherford County DSS Medicaid Transportation Policy will be provided to the consumer on initial assessment and at each reassessment. 

 

 

BILLING:

 

Contracted providers, such as the Rutherford County Transit Authority (RCTA) and privately owned taxi companies, will request payment as stated in their contractual agreements with the Rutherford County Department of Social Services. 

 

Reimbursement requests submitted by consumers must be received by DSS no later than the fourth business day of the month following the month the expenses were incurred.  Reimbursement requests submitted after the fourth business day of the month will not be eligible for payment. 

 

Reimbursement requests submitted by consumers for months prior to the month in the current month’s billing cycle will not be paid; with the exception of Medicaid consumers who are approved for retroactive benefits.  These consumers will be assessed to determine eligibility for transportation expenses incurred during the retroactive period. 

 

 

PAYMENT RATES:

           

Transportation provided by the Rutherford County Transportation Authority (RCTA) and private taxi companies will be contracted on a yearly basis.  Payment will be based on the current contracted rate.

 

Mileage reimbursement rate to the recipient/FRP cannot exceed one half of the current IRS business rate.  Mileage reimbursement rate to non recipient/non FRP drivers cannot exceed the current IRS business rate. 

 

 

 

 

 

REQUIREMENTS/ RESPONSIBILITIES:

 

All consumers requesting Medicaid Transportation from the Rutherford County Department of Social Services must meet with the transportation coordinator to complete an assessment to determine eligibility for the service. 

 

  • No appointment is necessary and eligibility can be determined either in person or by phone.  The DSS office is located at 389 Fairground Road, Spindale, N.C. 28160.  The Medicaid Transportation Coordinator can be contacted by phone at 828-288-4022.

 

 

Consumers who are approved for Medicaid Transportation Assistance will be referred to the Rutherford County Transit Authority (RCTA) if appropriate to meet the consumer’s needs after all other transportation resources, including free and other community resources have been exhausted.  The RCTA is a contracting agency with the RCDSS.   

 

  • Consumers must contact RCTA directly to make a request by calling 828-287-6141.

 

  • RCTA must be given a minimum notice of three business days prior to the appointment date for in county appointments and five business days for out of county appointments. Requests for emergency/unexpected Medicaid transportation will be assessed on a case by case basis.    

 

  • Consumers who use the services of RCTA must abide by the rules and policies set forth by RCTA.

 

  • If RCTA cannot accommodate an appointment due to scheduling conflicts, distance etc. the consumer will make reasonable efforts to reschedule or arrange for the appointment/visit in order for RCTA to be able to provide the service.

 

  • In instances where reasonable efforts have been made for RCTA to provide the services without success the RCTA will contact the Medicaid Transportation Coordinator who will attempt to schedule the appointment with a private taxi service contracted by RCDSS.

 

If no contracted providers are able to provide medical transportation for the consumer, personal reimbursement will be approved.  Individuals, who are approved to receive personal reimbursements, will adhere to policy found under PAYMENT RATES stated above.    

 

Medicaid will not fund transportation to a provider at a significantly greater distance from the recipient’s residence solely because of personal preference if a suitable local source is available. 

           

  • If a physician deems another medical provider that is located at a greater distance is necessary, the consumer must present a written recommendation from the referring physician stating that the referred provider is the closest North Carolina Medicaid provider available for the specific treatment needed.

 

SAFETYAND RISK MANAGEMENT

 

DMV records of all drivers who transport Medicaid transportation consumers will be reviewed annually. 

 

  • All contractors, county employees, contractor employees and volunteers must meet all requirements outlined in MA-2910/3550 IX.B.-G. which deal with liability insurance, licensed operators, state inspections, alcohol and drug testing, background checks and driving records. 

 

Drivers who transport Medicaid transportation consumers must submit proof of liability insurance coverage to the RCDSS Medicaid Transportation coordinator.   

 

 

NO SHOWS

 

The recipient must be ready and at the designated place for pick up at the time required by the transportation vendor.  The recipient must call the number provided for trip requests to cancel scheduled transportation at least 24 hours in advance.  Cancellations made less than 24 hours in advance may count as one “no-show”, unless there was good cause for the cancellation.  A first missed trip without good cause will result in a telephone call, (by letter if the recipient cannot be reached by phone) that further missed trips may result in a suspension of transportation services for a period of thirty days.  A second missed trip within three months of the first missed trip will result in a telephone call (or letter if client cannot be reached by phone) warning that the next missed trip will result in a suspension of transportation services for a period of thirty days.  A third missed trip within three months of the first missed trip will result in a suspension notice informing the recipient that transportation services have been suspended for thirty days. 

 

*This is a moving three month period.  For example:  if you get a no show in January then (2) in February, you will be suspended for the month of March.  In April if you have a no show, then the (2) in February are still active and you will in turn be suspended for the month of May.   

 

CONDUCT POLICY

 

Any conduct which jeopardizes the safety of other passengers and/or the driver will result in suspension of transportations services.  Public transit systems and other NEMT vendors shall have conduct policies.  NEMT riders are subject to the conduct policies of the transportation vendors.  Violation of such conduct policies may result in suspension of transportation services in accordance with the vendor’s policy.    

 

 

FRAUD

 

Fraud will be handled by the Rutherford County DSS Program Integrity Caseworker.   Methods of seeking recovery may include:

 

  • Voluntary repayment from the client;
  • Recovery through court action.

 

 

 

This Local Medicaid Transportation Policy was accepted on ______________________

 

________________________________________                _______________________

DSS Director                                                                          Date

 

 

________________________________________                _______________________

DSS Medicaid Transportation Worker                                   Date