Welcome to the LogistiCare seminar on arranging non-emergency medical transportation (NEMT) services for Medicaid and BadgerCare Plus members, except

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1 Welcome to the LogistiCare seminar on arranging non-emergency medical transportation (NEMT) services for Medicaid and BadgerCare Plus members, except those residing in a nursing home, or enrolled in the BadgerCare Plus Core Plan, the BadgerCare Plus Basic Plan, SeniorCare, or FamilyCare.

2 You need not take notes. There s a website with all of the material we ll go over today That website has all of the material we will review, and 2. Documents you can download including ForwardHealth updates for members and providers, the standing order form and answers to questions that healthcare facilities frequently ask about nonemergency Medicaid transportation. LOGISTICARE Confidential and Proprietary 2

3 What is LogistiCare (LGTC)? 1. LGTC is a transportation management company a broker - with operations centers nationwide. 2. Our WI Operations Center is located at: 2335 City View Drive, Suite 200 Madison, WI (866) phone (866) fax LOGISTICARE Confidential and Proprietary 3

4 What does LGTC do? 1. LGTC screens requests for non-emergency medical transportation (NEMT) for Medicaid and BadgerCare Plus members from members, their families or healthcare providers, on behalf of DHS. 2. We help to determine whether the member qualifies for NEMT, and if so, the most appropriate level of transportation for the member. 3. We then schedule and route the NEMT trip based on the member s medical and mobility needs. 4. LGTC also credentials, contracts with and pays local WI transportation companies to perform the NEMT. LOGISTICARE Confidential and Proprietary 4

5 What is NEMT? 1. NEMT is any covered transportation to a Medicaid covered service. However there are exceptions: Transportation initiated by dialing 911 Non-emergency ambulance transport of a vent patient from home, or from one hospital to another with patient on IV medication Transport of a diagnosis-related group (DRG) patient from a hospital to a medical test and return to the hospital Transport of a member to the /Developmentally Disabled/MR training center LOGISTICARE Confidential and Proprietary 5

6 What changes July 1? 1. DHS has contracted with LGTC to manage NEMT services for members who have no other means of transportation 2. Members and healthcare facilities will contact LGTC, not the transportation provider or the county, to request NEMT services 3. LGTC will contract with and oversee the transportation providers who will provide the NEMT, and report to DHS. LOGISTICARE Confidential and Proprietary 6

7 Which members are affected by the implementation? 1. The new non-emergency medical transportation management system will affect most of the members enrolled in the following programs: Wisconsin Medicaid. Family-Planning Only Services. BadgerCare Plus Standard Plan BadgerCare Plus Benchmark Plan. Tuberculosis-Only Services. Express Enrollment for Pregnant Woman. Members enrolled in state-contracted managed care organizations (MCOs) who receive NEMT services on a fee-for-service basis (e.g., Children Come First). Medicaid and BadgerCare Plus members enrolled in an HMO will receive their NEMT services through LogistiCare. 2. Please note that due to recent policy change, the following members will be affected by the new transportation management system: Wisconsin Medicaid or BadgerCare Plus members who are enrolled in an HMO in Milwaukee, Waukesha, Washington, Ozaukee, Kenosha, and Racine counties. LOGISTICARE Confidential and Proprietary 7

8 Members Not Affected by the Implementation 1. The new NEMT management system will not affect members who reside in a nursing home. Members who reside in a nursing home will receive transportation as they currently do. LOGISTICARE Confidential and Proprietary 8

9 Members Not Eligible for NEMT NEMT services are not covered for members enrolled in: 1. BadgerCare Plus Core Plan or BadgerCare Plus Basic Plan. However, Core and Basic Plan members may also be enrolled in Family-Planning Only Services and may receive NEMT to covered family planning services. 2. Wisconsin Well Woman Program. 3. Wisconsin Chronic Disease Program. 4. Qualified Medicare Beneficiary Only. 5. Qualifying Individual Qualified disabled working individuals. 7. SeniorCare. 8. Alien emergency services. 9. Specified Low-Income Medicare Beneficiary. 10. FamilyCare. LOGISTICARE Confidential and Proprietary 9

10 What are the criteria for NEMT? 1. The member has no other means of transportation, 2. The type of transportation is covered, and 3. The service the member is going to is a Medicaid covered service LOGISTICARE Confidential and Proprietary 10

11 What types of NEMT are covered? 1. Bus/Mass Transit The member lives within ¼ mile of a bus stop The medical facility is within ¼ mile of a bus stop The member can walk ¼ mile The member understands common signs and directions Bus passes can be obtained by calling LGTC 2. Ambulatory: The member can walk unassisted from doorway to curb The member can walk unassisted from the vehicle to the facility 3. Wheelchair can transfer Member can transfer from the wheelchair to the seat of an ambulatory vehicle The member s wheelchair folds and can be placed in the rear of the vehicle LOGISTICARE Confidential and Proprietary 11

12 What types of NEMT are covered? 4. Wheelchair The member is permanently confined to wheelchair The member cannot transfer from the wheelchair to the seat of an ambulatory vehicle The member requires a lift-equipped wheelchair van No Medical Necessity Form is required 5. Stretcher The member is confined to bed The member cannot sit up or sit in a wheelchair The member does not require medical monitoring during transport No Medical Necessity Form is required 6. Mileage, meals and lodging is also covered and can be obtained by calling LGTC LOGISTICARE Confidential and Proprietary 12

13 Examples of covered NEMT 1. A discharge from the hospital 2. Transport to a Medicaid enrolled physician to receive a medically covered service 3. Transport for a medical treatment like dialysis LOGISTICARE Confidential and Proprietary 13

14 Examples of non-covered NEMT 1. Transport to a non-covered services (e.g., AA meetings, medically unsupervised weight reduction) 2. Transport for nursing home residents. Long term care facilities are expected to provide transportation for services outside their facilities 3. Transportation costs to meet a member s personal choice of provider 4. Transport if the member or his/her family, neighbor, friend or relative can provide transportation. 5. Transport to a VA hospital 6. Transport for individuals whose eligibility is pending or for members in spend down status LOGISTICARE Confidential and Proprietary 14

15 Must LGTC be contacted? How? 1. Yes, contact LGTC for routine, urgent or standing order NEMT 2. Routine NEMT Members, their families or medical providers call , the Reservation number to schedule a routine trip A routine trip is an occasional, episodic trip to a Medicaid covered service. For example, a trip to the doctor on Thursday Schedule routine trips two business days in advance English, Spanish and Hmong language choices is the reservation number for the deaf/hearing impaired. Members can begin calling on Friday, June 17 to request trips for July 1 and beyond 3. Urgent NEMT Call Requests for urgent NEMT services are taken 24 by 7. LOGISTICARE Confidential and Proprietary 15

16 What is urgent care? 1. It s an unscheduled episodic situation in which there is no immediate threat to life or limb, but the member must be seen on the day of the request and treatment cannot be delayed until the next day. 2. Hospital discharges are considered as urgent care. 3. LGTC may verify with the direct provider of medical service that the need for urgent care exists. 4. Valid requests for urgent care transport shall be honored within three (3) hours of the time the request is made. LOGISTICARE Confidential and Proprietary 16

17 What is not urgent care? 1. Urgent care is not transportation that is initiated by dialing It is not transport that requires an immediate response to take a member to the emergency room for evaluation of a new or suddenly worsening condition that threatens life or limb (e.g., any sudden life threatening medical situation, significant trauma, comas, shock, uncontrolled bleeding, respiratory distress, poisoning, drug overdose or any situation where immediate medical relief or treatment is necessary.) 3. It is not transport that someone forgot to schedule two business days in advance. LOGISTICARE Confidential and Proprietary 17

18 How do we request standing order transport? 1. Call the Facility Dept. at to set up standing order transport or simply fax in a standing order request form to Standing Order NEMT means regularly reoccurring trips to a Medicaid covered service (3 times per week for 3 months or more duration) for members with no other way to get a ride For example, 3 times per week to dialysis is the Facility Dept. phone number The number is for the exclusive use of facilities You can call to set up or change a standing order You can also call to request a routine trip for one of your patients LOGISTICARE Confidential and Proprietary 18

19 How do we request standing order transport? 3. When standing order transport is requested the Facility Dept. staff will set up the first week s trips 4. Then our staff will ask that a Standing Order Request form be completed Get the form at LOGISTICARE Confidential and Proprietary 19

20 How do we request standing order transport? 5. The medical provider then will fax the completed form to (we don t accept forms from members) 6. Now there s no need to phone in future trip requests for the member, or fax another standing order form unless the member s mobility changes 7. Our Facility Department is available starting Monday, May 2 to take faxes from healthcare providers for standing order NEMT for members 8. To request regularly reoccurring trips for less than 3 days per week, just call the reservation line and our staff will schedule a month s worth or trips at a time LOGISTICARE Confidential and Proprietary 20

21 How far in advance must we call? 1. Call two business days in advance, by noon, for Routine or Standing order trip requests 2. The two days includes the day of the call but not the day of the appointment 3. For example, call on Monday by noon for an appointment on Wednesday 4. Call 24 by 7 for Urgent trip requests LOGISTICARE Confidential and Proprietary 21

22 Ride Assistance: Where s My Ride? is the Where s My Ride? telephone number that a member, family member, social worker, case manager or other medical provider can call concerning a service issue. For example, if transportation is late dropping off or picking up the member. LOGISTICARE Confidential and Proprietary 22

23 If I call to request NEMT, how do I know what mode or type of transportation to request when I call LGTC? 1. LGTC will ask questions to assess the member s mobility and any special needs 2. Based on the answers to those questions LGTC will determine whether ambulatory, wheelchair can transfer, wheelchair or stretcher service best meets the member s mobility and medical needs 3. If wheelchair or stretcher transport is requested then LGTC may have to verify that with the medical provider. LGTC may request the name, address and telephone number of the doctor/physician. LOGISTICARE Confidential and Proprietary 23

24 Standing Order Form 1. It is used to request reoccurring transport for 3 or more days a week for 3 or more months duration. 2. Every quarter our Facility staff will contact you by phone to see if standing order NEMT should continue. 3. LGTC cannot compel you to fill out the standing order request form on behalf of a member. However, many health care professionals do provide this and many of types of service and support for their patients. 4. If you elect to do this then please confirm the member s current residence (pick up address) before sending in the Standing Order form 5. Standing Order Form: shown next LOGISTICARE Confidential and Proprietary 24

25 Standing Order Request Form for Appointments Occurring 3 Days or More per Week The Facility Dept. phone is (866) Its fax is (877) Non-emergency medical transportation is not available for members who transport themselves or who reside in a nursing home. Member s Name: DOB: - - Gender: M_ F_ ForwardHealth # Name of parent/guardian (if applicable): Phone ( ) - Appointment Days: ( )Sunday ( )Monday ( )Tuesday ( )Wednesday ( )Thursday ( )Friday ( )Saturday Start date: Requested by: Relation to the member: Phone ( ) - Level of Service: ( ) Bus. Bus stops are within ¼ mile of residence & ¼ mile of the medical provider. Member can walk ¼ mile. ( ) Ambulatory. Member can walk from doorway of residence to the curb. ( ) Wheelchair can transfer: Member can transfer to & sit in the seat of ambulatory vehicle. Wheelchair folds. ( ) Wheelchair: Member is permanently confined to wheelchair & requires a lift-equipped wheelchair van. ( ) Stretcher: Member confined to bed & cannot sit up. Does not require medical monitoring during transport. Patient Condition: Facility NPI #: Treatment Type: Procedure Code(s): Can the member sign the Driver s Log? Yes: No: If no, is member s inability to sign permanent? Yes: No: Please explain if member s inability is permanent: Transportation Provider currently transporting member: Phone ( ) - Pick Up: Check if it s the person s home ( ) or a facility ( ). If a facility, please name it: Please confirm the member s pickup address with the member as some members change residence frequently. Pick up street address: Bldg: Apt: City: State: Zip: Phone: ( ) - Cell: ( ) - Directions: Appointment Time: AM / PM Suggested Pick Up Time from Home: AM / PM Drop Off At: Facility Name: Contact Name: Street address: Bldg: Apt: City: State: Zip: Phone: ( ) - Cell: ( ) - Directions: Physician Name: Return Pick Up Time: AM / PM Please specify if trip is: One-way trip: ( ) or Round trip: ( ) Authorization: I request non-emergency medical transportation for the named member only for those days when the member will receive a covered service at the named facility. I affirm that the information above is accurate, and that I am a physician, physician's assistant, nurse midwife, or nurse practitioner. Signature: Date: - - Please print your name: Phone: ( ) - For LGTC use only: Recertified: Terminated: Date: By: Reason for recertifying/terminating the standing order: PLEASE FAX THE COMPLETED FORM TO WISCONSIN FACILITY DEPT at (877) LOGISTICARE Confidential and Proprietary 25

26 How soon will transport arrive? 1. For Urgent transports within 3 hours 2. For Routine or Standing Order transports at the scheduled pick-up time or within a 15 minute window 3. If the member says he/she will call for pickup after their medical appointment (referred to as a Will Call return) then the driver will arrive within 60 minutes of when LGTC receives the call. LOGISTICARE Confidential and Proprietary 26

27 What are the LGTC service hours? 1. Routine Reservations and Standing Order Reservations: Monday to Friday from 7:00 a.m. until 6:00 p.m. 2. Urgent Reservations: 24 by 7 3. Ride Assist/Where s My Ride?: 24 by 7 LOGISTICARE Confidential and Proprietary 27

28 Will claims be paid even if NEMT is not arranged through LGTC? 1. No, the transportation provider will not be paid 2. NEMT must be pre-arranged through LGTC LOGISTICARE Confidential and Proprietary 28

29 Who is in LGTC s transportation provider network? 1. LGTC is contracting with transportation providers presently and plans to use as many of the current companies as possible provided they meet compliance standards regarding insurance, drivers and vehicles 2. Preference may be taken into consideration but cannot be guaranteed 3. Contact the Director of Operations at (866) extension 202 if you have questions as to which transportation provider will be used in your area, or if there are member special needs that need to be discussed, e.g., bariatric special needs LOGISTICARE Confidential and Proprietary 29

30 Questions - Discussion 1. What are your questions? 2. Remember the website for healthcare facilities at LOGISTICARE Confidential and Proprietary 30

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