Alaska Medicaid Travel

Transcription

1 Alaska Medicaid Travel Transportation & Accommodation Services Presented by Kristina Walters Division of Health Care Services September 2012

2 Slide 2 Overview of Transportation and Accommodation Services Medicaid-Covered Transportation Transportation requiring travel to another community Ground transportation within the recipient s community of residence Emergency transportation

3 Travel to Another Community Alaska Medicaid covers both in-state and out-of-state travel to another community for medical services that are not available locally. September 28,

4 Slide 4 Travel Services Types of Transportation and Accommodation Services Air Ferry Bus Taxi Wheel Chair Accessible Van Hotel and Meals

5 Slide 5 Service Authorization (SA) Requirements Must be eligible for Medicaid during travel dates INELIGIBLE MEDICAID ELIGIBILITY CODES 19WD-Waiver Determination 21GJ- CAMA 25DE Disability or Blindness Exam unless travel is need to received this exam 66 Qualified Disabled & Working Individuals (QDWI) 67 Qualified Medicare Beneficiaries (QMB) 68 & 78 Special Low Income Medicare Beneficiary (SLMB & SLMB PLUS) SA must be requested by the referring or receiving health care provider or community health aide (CHA/P) Services must be medically necessary and covered by Alaska Medicaid

6 Slide 6 Service Authorization Requirements (cont.) Travel is approved to the nearest enrolled facility or provider that can render necessary services. Indian Health Services (IHS) beneficiaries may travel to the nearest IHS facility

7 Slide 7 Service Authorization Requirements (cont.) Travel is approved for the length of time necessary to meet the health care need Travel must be approved before the travel occurs An escort will be approved for minors and may be approved for adults when medically necessary

8 Slide 8 How to Obtain a Service Authorization Step 1 Step 2 The health care provider determines travel is necessary for the recipient to receive medical care The referring or receiving health care provider or CHA/P contacts Xerox to obtain a SA Xerox Service Authorization Request , option 5 or (toll-free in Alaska), option 1, 2. 8:00a.m. 5:00p.m., Monday Friday 8:00a.m. 5:00p.m., Saturday 12:00p.m. 4:00p.m., Sunday

9 Steps to Obtain a Service Authorization, (cont.) Step 3 The requesting provider communicates the medical appointment dates/times and reason for travel (diagnoses and services to be performed) & who is traveling. Step 4 Upon approval, the requesting provider will be given a SA number and travel/ accommodation details. Step 5 The requesting provider completes and gives the recipient the hotel/meal and taxi vouchers needed. September

10 Slide 10 Travel Reservations Air or Ferry The recipient or escort contacts the Medicaid Travel Office (MTO) to make reservations Mon-Sun 7:00 AM 7:00 PM Alaska time MTO issues an electronic ticket

11 Travel Reservations Hotel The recipient or escort contacts an enrolled hotel to make reservation To obtain a list of enrolled hotels Recipients may contact the Recipient Helpline at Providers may contact Provider Inquiry at (option 1) or (option 1, 1) The recipient must give the hotel the Transportation Authorization and Invoice (AK-04) voucher as a form of payment September

12 Travel Reservations Hotel (cont.) The recipient is expected to share a hotel room with the escort The reimbursement rate is $89 per day One unit of lodging is one night s stay Hotels may require a credit card or cash for a deposit September

13 Travel Reservations Meals Meals are provided at an enrolled hotel with an enrolled on-site restaurant Meals reimbursement is limited to $36 per day One unit of meals equals three consecutive meals Meals authorized per person per unit of lodging The escort is expected to share food for recipients under two years of age September

14 Taxi Recipient will need a taxi voucher for each one-way trip Example: Airport to hotel Hotel to medical appointment Medical appointment to airport Recommend recipient knows enrolled taxi companies prior to travel September

15 Slide 15 Authorization for Escorts Escorts are Defined by the State of Alaska in 7 AAC as a person who accompanies the patient to or from a source of medical care Who is Eligible for An Escort? Children Adults Under the age of 18 years If Medically necessary including but not limited to: Elderly Wheelchair bound Blind Cognitively impaired Physically disabled

16 Slide 16 Authorization for Escorts (cont.) The escort must be: Physically and mentally able to assist the recipient At least 18 years of age Escorts are not compensated for their time by Alaska Medicaid Authorization for travel, lodging and meals: During time medical evaluation and treatment are being provided

17 Common Travel Circumstances Travel from remote villages to a Hub to receive medical care Travel to a larger community to receive more in-depth health care Travel for pregnant women to await delivery September

18 Slide 18 Ground Transportation in the Recipients Community of Residence - Overview EPSDT or Well Child Transportation For recipients under 21 and/or pregnant Local Ground Transportation Used for all recipients who do not meet the EPSDT requirement

19 Well Child or EPSDT Transportation September

20 Slide 20 Requirements for EPSDT Transportation Recipient must be eligible for Medicaid with an eligibility code allowing transportation Under 21 years of age and/or receiving pregnant women s Medicaid The travel request must be made prior to the date of travel

21 Slide 21 Requirements for EPSDT Transportation, (cont.) EPSDT Transportation is Used for the Following Services Well child exams to include immunizations Flu-shots Preventive for dental and/or eye care Any referrals for medical, dental, counseling, or therapy Prenatal care and post-partum follow-up Picking up prescriptions related to an EPSDT appointment WIC appointments

22 Slide 22 Authorization of an Escort for EPSDT Transportation Who is Eligible for An Escort? Children Adults Under the age of 18 years If Medically necessary including but not limited to: Wheelchair bound Blind Cognitively impaired Physically disabled Escorts will be authorized to ride with the recipient in the taxi or given a bus pass for the month. Escorts are not reimbursed for their time.

23 Slide 23 Steps to Obtaining an Authorization for EPSDT Transportation Step 1 After the medical appointment is scheduled the recipient or the recipient s health care provider can make the travel request. Anchorage recipients Contact HCS at All other recipients Contact their local Public Health Center Step 2 Requestor will provide the recipient's name, Medicaid ID #, date & time of appointment, pickup location & drop off location. Step 3 1 of 2 modes of transportation will be approved Bus pass for the entire month to cover multiple appointments. Taxi service for the individual appointment

24 Local Ground Transportation September

25 Slide 25 Requirements for Local Ground Transportation The recipient is eligible for Medicaid with an eligibility code allowing transportation. The appointment must be a covered Medicaid service. The appointment must be medically necessary. This service is only available to recipients that have no other transportation available to them.

26 Slide 26 Steps to Obtaining an Authorization for Local Ground Transportation Step 1 The health care provider determines that the recipient needs assistance with transportation to their appointment. Step 2 The health care provider contacts Xerox to obtain a service authorization Step 3 The contacting provider conveys the needed medical service and clinical information to support medical necessity.

27 Slide 27 Steps to Obtaining an Authorization for Local Ground Transportation, (cont.) Step 4 The health care provider will be asked to verify if the recipient has other means of transportation available to them. Step 5 Once SA is approved, the health care provider will supply the travel voucher for taxi or wheel chair van voucher. Step 6 The recipient will contact their enrolled taxi/wheel chair van provider to arrange the pick up for their appointment.

28 Slide 28 Recipient Travel Concerns? Recipients may contact the Medicaid Recipient Helpline for travel concerns: Recipient Helpline

29 What is the Transportation Authorization and Invoice Form? This invoice/voucher is also known as the AK-04 form provided by Xerox. This voucher is completed by the health care provider who has obtained the Service Authorization. Transportation and accommodation providers will need a voucher to be paid for services rendered. The recipient carries these during the travel. September

30 Slide 30 AK-04 Transportation Authorization and Invoice Form, (cont.) Hotel and Meal vouchers will be authorized the same number of units. Taxi vouchers should only have 1 unit per recipient and escort. Services will not be reimbursed if services are not prior approved. The recipient will need additional vouchers in cases of travel extensions.

31 Slide 31

32 Transportation Authorization Form Completion - Step A Slide 32

33 Transportation Authorization Form Completion - Step B Slide 33

34 Transportation Authorization Form Completion - Step C Slide 34

35 Transportation Authorization & Invoice Form Provider Completion Slide 35

36 Common Travel Problematic Areas Provider unable to receive reimbursement due to incomplete or incorrect Travel Voucher Lack of availability of enrolled hotels Untimely travel SA extension September

37 Emergency Transportation Overview Medical condition, including labor and delivery, manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in: Placing the patient's health in serious jeopardy Serious impairment to bodily functions Serious dysfunction of any bodily organ or part September

38 Slide 38 Regulatory Requirements Regulation 7AAC Emergency Transportation Services Alaska Medicaid will pay for medically necessary emergency ground or air transportation to the nearest facility that provides emergency care or to the nearest IHS facility. Alaska Medicaid will not reimburse emergency transportation services to return the recipient to a residence.

39 Emergency Transportation Air Ambulance Alaska Medicaid will pay for air ambulance services only if: The recipient is being transferred to a higher level of care and The patient is accompanied by appropriately credentialed medical personnel. Alaska Medicaid will not reimburse for an escort. Prior authorization is to be obtained retroactively A recipient traveling to the same or lower level of care are reimbursed for lift-off fee at the point of patient pickup only September

40 Denial of Services Recipients are notified by mail when services are denied. The notification informs the recipient of their right to a fair hearing. Fair hearing requests can be made to: Xerox Attn: Fair Hearing Representative PO Box Anchorage, AK Phone: or Fax: September 28,

41 Resources Provides the necessary information you will need for successful billing. Includes access to Medicaid Billing Manuals and fee schedules. Provider Inquiry: , option 1 or option 1, 1 Eligibility Verification System Prior Authorization Unit (Travel & MRI only) , option 4 or , option1, 2 Kristina Walters, Medical Assistance Administrator II Alaska Medicaid/ State of Alaska Kristina.Walters@alaska.gov or September

42 Questions Thank you SEPTEMBER