Molina Healthcare Dual Options Transportation Benefit 2014
Eligibility Dual Options (MMP) is the name of Molina s Medicare-Medicaid and will be an option for consumers in the Central, West Central, and Southwest regions. Southwest: Butler, Warren, Clinton, Clermont, and Hamilton West Central: Greene, Clark, and Montgomery Central: Franklin, Madison, Union, Delaware, and Pickaway Consumers are eligible to join a MyCare Ohio managed care plan if: They are receiving full benefits from both Medicare and Medicaid They are 18 years of age or older They reside in a MyCare Ohio service region 2
Duals Emergent Transportation Transportation falls within two categories, Emergent and Non-Emergent. Emergency transportation (ambulance), provided through the "911" emergency response system, will be covered when medically necessary. Emergency services are services for a medical problem that is so serious it must be treated right away by a provider. An emergency medical condition is defined as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in any of the following: Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy Serious impairment to bodily functions Serious dysfunction of any bodily organ or part 3
Duals Non-Emergent Transportation "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. Over 30 Miles Logisticare Non-emergent Transportation NET Program Under 30 Miles Waiver Nursing Facility Transportation 4
Duals Non-Emergent Transportation Over 30 Miles Molina Healthcare of Ohio provides non-emergent medical transportation for our members for distances greater than 30 miles. Transportation can be scheduled on a recurring basis ahead of time. If one of your patients is in need of this service, please have them contact Logisticare or our Member Services Department to see if they qualify. Note: It is important to have your patient(s) call three (2) days in advance of the appointment to schedule the transportation. One additional passenger or escort is allowed to accompany the member if there is space availability. Logisticare: (888) 475-5423; TTD/TTY (866)288-3133 Member Services Duals: (855) 665-4623 5
Duals Non-Emergent Transportation Under 30 Miles What Happens if a member needs transportation services and the distance is less than 30 miles? Depending on the level of care of the member, 1 of three options will be offered. Waiver Transportation Transportation for Members in a Nursing Facility County NET Program 6
Waiver Transportation During the transition of care period, supplemental transportation will continue to be an inclusive benefit for members on the following waivers of origin: Transitions II Aging Carve-Out Waiver Ohio Home Care Waiver PASSPORT Waiver When the transition of care period is over, all waiver eligible members will be enrolled in Molina Healthcare s combined waiver. At this point waiver transportation will be determined on a case by case basis. Waiver transportation will require prior authorization. 7
Transportation for Members Residing in a Nursing Facility Transportation is a carved out medical benefit for members living in a skilled nursing facility (SNF). SNF s may continue to use their current vendor during the transition of care period. Once the transition of care is over, SNF s will be required to use a vendor contracted with Molina Healthcare. Transportation will be billed by, and directly reimbursed to the transportation vendor and will require a prior authorization. 8
Non-Emergency Transportation (NET) Program Molina is not currently offering a supplemental non-emergent transportation other than for SNF residents, members on a waiver or for distances greater than 30 miles. Members may still get help with transportation for certain services through the local County Department of Job and Family Services Non-Emergency Transportation (NET) program. Call your County Department of Job and Family Services for questions or assistance with NET services. 9
How Do Members Get Care? Transportation specialists are available to assist you 24 hours a day, seven days a week. Please call (877) 659-8407 to arrange transportation or if you have questions. For hearing impaired TTY/Ohio Relay, call (800) 750-0750 or 7-1-1 for assistance. Please call no later than 48 hours in advance of your appointment. Logisticare: (888) 475-5423; TTD/TTY (866)288-3133 10
Frequently Used Phone Numbers DEPARTMENT NUMBER Case Management (855) 322-4079 (follow phone prompts) Claims Reconsideration (855) 322-4079 / fax (800) 499-3406 Claims Inquiry Customer Service (855) 322-4079 (follow phone prompts) Community Outreach (855) 665-4623 Fraud, Waste, and Abuse Tip Line (866) 606-3889/ fax (888) 665-0860 Member Eligibility Ohio Medicaid (800) 686-1516 Member Services Duals (855) 665-4623/fax: (855) 266-5462 Member Services Medicare (866) 472-4584 Pharmacy (Medicare/Duals) (855) 322-4079 / fax: (888) 858-3090 Prior Authorization (Inpatient) (855) 322-4079 Prior Authorization (Outpatient) (855) 322-4079 Provider Services (855) 322-4079 / fax: (866) 713-1893 Provider Services Web Portal Help Desk (866) 449-6848 Utilization Management (855) 322-4079 / fax: (866) 449-6843 24 Hour Nurse Advise Line (888) 275-8750 / TTY: (866) 735-2929 Behavioral Health (855) 322-4079 / fax(866) 553-9262 Member Services 8 a.m. to 8 p.m. Monday - Friday Provider Services 8 a.m. to 6 p.m. Monday - Friday 11