Non-Medical Transportation For HARP enrollees in NYC. December 2015
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1 Non-Medical Transportation For HARP enrollees in NYC December 2015
2 General Designation Information REMINDER: There has been new guidance regarding the BH HCBS Non-Medical Transportation. To provide this service you must be or become a Medicaid transportation provider If you are NOT a Medicaid transportation vendor, you will be unable to provide Non-Medical Transportation In order to become certified by Medicaid, you must complete a New York State Medicaid Enrollment form at index.aspx 2
3 Non-Medical Transportation Services In addition to any medical transportation furnished under 42 CFR (a) in the State Plan, Non-Medical Transportation may be available to individuals receiving BH HCBS in HARPs and HIV SNPs Non-Medical Transportation will be paid Fee For Service (FFS), the same way regular Medicaid transportation is paid. Regular Medicaid transportation covers trips to and from Medicaid-covered medical appointments There are two types of Non-Medical Transportation: Trips to and from BH HCBS that are included in the Plan of Care (POC) Trips to and from non-hcbs destinations (e.g. job interview) that are time-limited/non-routine (with a start and end date) and specifically tied to a goal related to recovery from mental health or substance use disorders in the individual s POC (see the guidance manual for examples of qualifying trips) $2,000 cost cap per individual per year excludes public transportation and transportation to and from BH HCBS in the POC 3
4 Examples of Non-HCBS Locations Specifically Related to Goals in POC All goals are to be met within a specific timeframe. Requests for transportation to a service associated with the goal that are submitted outside the specified timeframe will not be considered. Non-Medical Transportation cannot be used for routine transportation to and from a job or school. For example, a participant may be transported to a job interview, but not to work on a daily basis. Similarly, a participant may be transported to a college fair, but not to classes on a regular basis. The frequency of these trips should be included in the plan of care with a specific timeframe defined including a start and end date. 4
5 Non-Medical Transportation Grid Health Home Care Managers are responsible for completing the NYS Behavioral Health Home and Community Based Services (BH HCBS) Plan for Transportation Grid (Grid) based on the BH HCBS and goals in an individual s POC The Grid is only to be completed if an individual requires Non-Medicaid Transportation, and this grid should NOT include regular Medicaid transportation (i.e. trips to Medicaid-covered medical appointments) The care manager will send the completed Grid to the Managed Care Organization (MCO) along with the POC As soon as the POC is approved, the MCO is responsible for forwarding the Grid to the transportation manager (e.g. LogistiCare) to ensure that individuals non-medical trips (NMT) can be authorized. Note that the transportation manager also coordinates the transportation for other Medicaid covered transportation If the services or goals within the POC require NMT change, then the Grid needs to be re-submitted by the care manager to the MCO and from the MCO to the transportation manager 5
6 Non-Medical Transportation Grid 6
7 Which Mode of Transportation is Necessary? The same, appropriate mode of transportation used by the participant for standard medical trips should be used for non-medical transportation trips, and vice versa Assessing the most cost effective and medically appropriate mode of transportation. Medical Justification 2015 Form: Requires a medical professional to provide the mobility-related reason why the enrollee requires a specific mode of transportation Reasons for decreased mobility could be that the enrollee is wheelchair-bound, underwent recent surgery to a limb, is blind, or has an unstable gate. Must be signed by a medical professional and sent to the transportation manager Reviewed, approved and filed by the transportation manager Audited by the Department and transportation manager Many individuals will already have this form on file if they are already receiving regular Medicaid transportation This form is not needed for public transit 7
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10 Where to send completed grids LogistiCare Solutions, LLC Fax to (877) Attn: HARP CARE PLAN GRID 10
11 Guidance for Non-Medical Transportation The Guidance for Behavioral Health Home and Community Based Non-Medical Transportation Services for Adults in HARPs and HARP Eligibles in SNPs can be found at the following link: The guidance document includes: Definition of Non-Medical Transportation Roles for Health Home Care Managers, MCOs and Transportation Managers Guidelines for Non-Medical Transportation 11
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