ACE-CCE Member Services Toolkit, Installment 5

Medicaid and All Kids cover non-emergency medical transportation (NEMT) in certain circumstances to ensure that clients can get to and from medical appointments. Transportation must be to a covered medical service; to the nearest available appropriate medical provider; and by the least expensive mode of transportation adequate to meet the individual's need on the date of transport, including public and commercial modes of transportation.

For various reasons, coordinating NEMT can be challenging for ACEs and CCEs. The purpose of this toolkit installment is to provide step-by-step guidelines for coordinating NEMT, to highlight key considerations, and to remind ACEs and CCEs of existing informational resources.

Most of the administrative functions for non-emergency medical transportation in Illinois’s Medicaid and All Kids programs are handled by First Transit, HFS’s prior authorization agent. Care coordinators are encouraged to develop strong and collaborative working relationships with First Transit.

Step 1. Identify Transportation Provider(s)
ACEs and CCEs may already have operational knowledge of transportation providers in their service area who are enrolled with Medicaid. If not, they can identify providers by calling First Transit at 1-877-725-0569. ACE and CCE members and providers may also be good sources of information about reliable transportation providers.

Plan the Trip

Once an appointment for a covered service is scheduled, the care coordinator will locate a transportation provider that is available to facilitate client travel to and from the appointment. First Transit is not a transportation provider and does not arrange transportation in most situations. Please note that authorization requests for dental appointments must be made at least seven days in advance.

Step 3. Request Prior

The care coordinator will call First Transit for preauthorization for non-emergency medical transportation.

Currently, First Transit requires member authorization (referred to by First Transit as “participant authorization”) before speaking to a care coordinator. This authorization may be a HIPAA release on file for each member or verbal authorization from the member. Additionally, ACEs and CCEs will receive instructions on how to maintain an up-to-date list of approved care coordinators on file with First Transit, which will minimize the need for formal releases or having the member on the call.

The care coordinator will provide member name, member RIN, details of appointment (including date, time, medical provider, medical provider address and telephone number, and reason for the appointment), level of transportation medically necessary for the member, and name of transportation provider.

First Transit will confirm member eligibility using the HFS eligibility file.

If the transportation request is authorized, First Transit will issue a Request Tracking Number (RTN).

Step 4. Finalize the Trip
The care coordinator will contact the transportation provider to relay the RTN and confirm the trip. The care coordinator should then communicate to the member the details of the trip, including instructions for what to do if he or she is unable to keep the scheduled appointment. Appointments must be canceled with sufficient prior notification to the medical provider and the transportation provider.

ACEs and CCEs are responsible for arranging NEMT services.

If ACEs and CCEs have difficulty finding available transportation providers, they should explore creative solutions. For example, the ACE or CCE could enroll itself as a provider and provide transportation to its own members. Also, family and friends of members may enroll as “private auto” providers. The reimbursement rate is $0.23 per mile that the member is in the car. Private auto enrollment information is available at NETSPAP.com.

Step 3 (Request Prior Authorization) will soon be automated by PassPORT, First Transit’s online prior authorization portal. A Request Tracking Number will be generated when the trip is entered and will be listed as pending until the trip is adjudicated (authorized or denied). The care coordinator will need to check back in the PassPORT system to monitor progress of the request. Additional detail about PassPORT will be forthcoming.

Please remember that some requests take more time to process than others because First Transit may need additional documentation to validate the trip request. The care coordinator should initiate this process as soon as the participant has a scheduled medical appointment.

Because transportation services can be critical to accessing care, ACEs and CCEs were provided with an overview of the prior authorization program in 2014.

Several Provider Notices have been issued regarding NEMT processes and procedures.

As savvy readers of the Member Services Toolkit know, provider handbooks are a rich source of information about covered services. The provider handbook for transportation services is intended for the transportation providers, but it also provides insight into how those providers operate and as such may be valuable tool for care coordinators.

Issued by the Illinois Department of Healthcare and Family Services
March 2015