HCBS Provider Training MyCare Ohio WAIVER TRANSPORTATION

Transcription

1 HCBS Provider Training MyCare Ohio WAIVER TRANSPORTATION

2 Summary Home and Community Based Services Waivers Waiver Transportation Opt-In vs. Opt-Out Member Waiver vs. Non-waiver Eligible Member Non-medical vs. Non-emergency Medical Transportation Services Access2Care Opt-In or Opt-Out with Waiver Services Opt-In or Opt-Out, Non-Waiver, Not living in a Nursing Facility Opt-In or Opt-Out, Non-Waiver, Living in a Nursing Facility Stretcher Services Opt-Out with Advantage by Buckeye for Medicare Services for 2015 Case Scenario Examples Important Contacts 2

3 Home and Community Based Services Waivers Home and community-based waivers are programs of in-home and community care that help eligible members remain at home instead of being in a nursing home, hospital or facility. 3

4 Home and Community Based Waiver Services Adult Day Health Services Alternative Meals Service Assisted Living Services Choices Home Care Attendant Chore Services Community Transition Emergency Response Services Enhanced Community Living Home Care Attendant Home Delivered Meals Homemaker Services Home Medical Equipment Home Modification Maintenance & Repair Independent Living Assistance Out of Home Respite Services Personal Care Services Pest Control Nutritional Consultation Social Work Counseling Waiver Nursing Services Waiver Transportation 4

5 Waiver Transportation Waiver transportation will be determined on a case by case basis. Waiver transportation will be authorized by the Waiver Services Coordinator/ Buckeye Care Manager and included in the member s All Services Plan in order to be approved for payment. Waiver transportation services must be provided by a transportation provider certified by the Ohio Department of Aging (ODA) or Ohio Department of Medicaid (ODM) to render this waiver service. ***Buckeye utilizes a network of Preferred Providers for waiver transportation services. For more information on how to become a Preferred Provider, please contact your Provider Network Specialist. 5

6 What is an Opt IN vs. Opt OUT Member? Opt-In Members are dually eligible individuals eligible for MyCare Ohio and selecting Buckeye (or other MyCare MCP) for BOTH Medicare and Medicaid. Buckeye will pay as primary and secondary for these members. Opt-Out Members are dually eligible individuals eligible for MyCare Ohio enrolled with Buckeye (or other MyCare MCP) for Medicaid ONLY. Buckeye will pay secondary for these members. These members have opted out of integrated Medicare and Medicaid. 6

7 Waiver Eligible MyCare Members Waiver eligible members have met the conditions of participation for enrollment into the waiver program within MyCare Ohio. These members are eligible to receive waiver transportation services on their All Services Plan approved by their Waiver Services Coordinator or Buckeye Care Manager. 7

8 Non-Waiver Eligible MyCare Members Non-waiver, Community Well members have not met the conditions of participation for enrollment into the waiver program within MyCare Ohio. These members may be eligible for certain transportation benefits based on whether they are wheel-chair bound or living in a nursing facility. 8

9 Non-Medical Transportation Service "Non-medical transportation service" means a service that transports a consumer from one place to another for a nonmedical purpose through the use of a provider's vehicle and driver. Examples of places to which the service may transport a consumer are a grocery store, a senior center, or a government office. ***Non-medical transportation services are only available to waiver eligible members. 9

10 Non-Emergency Medical Transportation Service "Non-emergency medical transportation service" means a service that transports a consumer from one place to another for a non-emergency medical purpose through the use of a provider's vehicle and driver. Examples of places to which the service may transport a consumer are a doctor's office or a pharmacy. 10

11 Access2Care Access2Care is Buckeye Health Plan s contracted transportation broker for non-emergency transportation services. For more information about becoming a provider with Access2Care, please call or visit 11

12 Opt-In or Opt-Out with Waiver Services Waiver eligible member, age 60 and over contacts their Area Agency on Aging (AAA) Waiver Services Coordinator to request transportation. Waiver eligible member, age 59 and under contacts their Buckeye Care Manager to request transportation. Services are approved by the Waiver Services Coordinator /Buckeye Care Manager and arranged with a contracted Preferred Transportation Network Provider and included on the member s All Services Plan. Authorization is created and notification is sent to the provider via fax/ . 12

13 Opt-In or Opt-Out, Non-Waiver Eligible, Not living in a Nursing Facility Ambulatory (non-wheelchair) - No transportation benefit. Transportation would need to be arranged through their county NET transportation services, operated at the local CDJFS Office. Wheelchair bound Member should contact Access2Care for transportation arrangements 48 hour notice required (for Medicaid reimbursable appointments only) 13

14 Opt-In or Opt-Out, Non-Waiver Eligible, Not living in a Nursing Facility Transportation greater than 30 miles Access2Care will manage the Authorization process and coordinate the trip with the nearest in-network transportation provider. For non-emergent transportation, approval is needed by the Care Manager and scheduling is done through Access2Care

15 Opt-In or Opt-Out, Non-Waiver Eligible, Living in a Nursing Facility Wheelchair Services with Medicaid Facility should contact Access2Care for transportation arrangements 48 hour notice required. No Authorization required. ***Once an Opt-In or Opt-Out member eligible for waiver services enters a nursing facility, their waiver services are put on hold and therefore, these members are treated as non-waiver eligible. 15

16 Stretcher Services Stretcher Services/Opt-In - If member is Opt-In, requests for stretcher services should be requested through Buckeye s MyCare Medical Management Stretcher Services/Opt-Out - If member is Opt-Out, facility should contact the member s Medicare provider. ***Medical Management does not arrange transport for any members. The nursing facility/care manager would select an ambulance provider and the ambulance provider contacts Buckeye Medical Management for authorization. 16

17 Opt-Out with Advantage by Buckeye for Medicare Services for one-way trips per year to plan-approved locations under Advantage by Buckeye. Member should contact Access2Care for transportation arrangements 48 hour notice required. No Authorization required. ***MyCare Ohio members with Advantage by Buckeye for Medicare Services are considered Opt-Out. 17

18 Scenarios Scenario A: Opt-in waiver member age 52 years requires dialysis treatment three times each week at a community health center. Member calls the Buckeye care manager to arrange for transportation. Transportation is coordinated with a contracted Preferred Transportation Network Provider and service is added to the member s All Services Plan.. Scenario B: Opt-out member living in a nursing facility requires stretcher services. The nursing facility contacts the member s Medicare provider to request stretcher services. Scenario C: Opt-in member living in a nursing facility needs to see an orthopedic surgeon for a follow-up appointment two weeks following knee replacement surgery. The nursing facility contacts Access2Care for transportation arrangements. Scenario D: Opt-out non-waiver member is ambulatory and living in a community senior high rise apartment. The member has an appointment with her primary care doctor. She calls her county department of Job & Family Services to request transportation through the NET program. 18

19 Important Contacts Non-Emergency Transportation Contact Information (arranged through county departments of Job and Family Services) Cuyahoga CDJFS 1641 Payne Ave. Cleveland, OH (216) Voice Dialysis, Chemotherapy, Radiation appointments (216) Voice Less than 5 appointments in a month (216) Voice 5 or more appointments needed in a month Geauga CDJFS Ravenwood Dr. P.O. Box 309 Chardon, OH (440) ext Voice (800) ext Toll Free 19

20 Important Contacts Non-Emergency Transportation Contact Information (arranged through county departments of Job and Family Services) Lake CDJFS 177 Main Street Painesville, OH (440) Lorain CDJFS North Ridge Rd. Elyria, OH (440) Medina CDJFS 232 Northland Dr. Medina, OH (330) ext

21 Important Contacts Non-Emergency Transportation Contact Information (arranged through county departments of Job and Family Services) Fulton CDJFS 604 S. Shoop Ave., Ste. 200, Wauseon, OH (419) , (800) Lucas CDJFS 3210 Monroe St., Toledo, OH

22 Important Contacts Non-Emergency Transportation Contact Information (arranged through county departments of Job and Family Services) Ottawa CDJFS 8043 W. St. Rte. 163, Ste. 200, Oak Harbor, OH (419) Wood CDJFS 1928 E. Gypsy Lane Rd., P.O. Box 679, Bowling Green, OH (419) Service/Intake (888) Toll Free Call and ask to be forwarded to NET Plus Transportation; must be ten days prior to the appointment 22

23 Important Contacts Non-Emergency Transportation Contact Information (arranged through county departments of Job and Family Services) Clark CDJFS 1345 Lagonda Ave., Springfield, OH , (800) Greene CDJFS 541 Ledbetter Rd., Xenia, OH (937) , (800) Montgomery CDJFS 1111 S. Edwin C. Moses Blvd., Dayton, OH (937)

24 Additional Questions? Please contact your regional HCBS Provider Network Specialist: Northeast Region (Cuyahoga, Geauga, Lake, Lorain and Medina counties) Anne Marie Hillton x24367 Northwest Region (Fulton, Lucas, Ottawa and Wood counties) Laura Anaple x24816 West Central Region (Clark, Greene and Montgomery counties) Rena York x

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