Medicaid non-emergency medical transportation (NEMT) and non Medicaid NEMT transport is an important benefit for beneficiaries who need to get to and from medical services but have no means of transportation. The Code of Federal Regulations requires States to ensure that eligible, qualified Medicaid beneficiaries have NEMT to take them to and from providers. However, every State’s Medicaid program is different. In addition, each State has the option of developing and implementing Medicaid waiver programs, which can provide coverage for additional transportation needs. Waiver program rules can also vary from State to State and even within the same State’s programs. Providers are responsible for knowing and abiding by the specific rules for each State where they furnish services, and for each of the programs for which they furnish services. The booklet cites State-specific examples to illustrate the rule discussed.
As an NEMT provider, be sure to know the specific Medicaid rules for NEMT and any general State licensing or certification requirements for vehicles and drivers in the States where you furnish services, as they can be different from State to State. Most States publish a provider transportation manual. I you need to review your states mandated regulations click here to view state Medicaid rules
Non Emergency Medical Transport (NEMT) Commercial Auto Insurance and other much needed coverage for companies in every state is available using the easy contact form below or call (855) 910-9321 .
For help in the following states use the form above. Arizona-AZ, California-CA, Colorado-CO, Connecticut-CT, Delaware-DE, Florida-FL, Idaho-ID, Illinois-IL, Kentucky-KY, Louisiana-LA, Maine-ME, Maryland-MD, Massachusetts-MA, Michigan-MI, Minnesota-MN, Missouri-MO, Montana-MT, Nevada-NV, New Hampshire-NH, New Mexico-NM, New York-NY, North Dakota-ND, Oklahoma-OK, Oregon-OR, Rhode Island-RI, South Dakota-SD, Texas-TX, Utah-UT, Vermont-VT, Washington-WA, West Virginia-WV, Wisconsin-WI, Wyoming-WY.
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Depending on the State, there may be special criteria drivers must meet before they transport Medicaid beneficiaries.
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First, they must have the appropriate, current licenses for the types of vehicles they drive when transporting others. For example, States may require a chauffeur’s license (or equivalent) for taxis and vans.
Second, a State may have qualifications for drivers that exceed the minimum to ensure that Medicaid beneficiaries receive a high quality of transportation. Standards might include limiting the number of points drivers can have against their license, certifying the health of a driver, carrying vehicle liability insurance, or having a criminal background check.
Drivers should be required to treat beneficiaries with courtesy and respect. The State, the broker, or the transportation company should monitor any complaints made by beneficiaries related to access and quality including any complaints received about the driver’s behavior—and hold drivers accountable. In several States, two of the more frequent complaints about transportation providers concern the timeliness of the driver and the driver not showing up. Other top complaints include problems with the driver’s behavior and “other stakeholders.”
It is important for NEMT transportation providers to remember that there may also be specific vehicle documentation and maintenance requirements. States may, for example, require providers to have documented proof the vehicle belongs to the correct entity and the identification number matches the ownership papers; the vehicle is legally licensed; the vehicle license plate is on the correct vehicle; and the vehicle is in good condition, safe for transport, and receives regular maintenance. In addition, the State may require proof the vehicle has the current State required commercial auto liability insurance.
§ 457.1206 Non-emergency medical transportation PAHPs.
(a) For purposes of this section Non-Emergency Medical Transportation (NEMT) Prepaid Ambulatory Health Plan (PAHP) means an entity that provides only NEMT services to enrollees under contract with the State, and on the basis of prepaid capitation payments, or other payment arrangements that do not use State plan payment rates.
(b) The following requirements and options apply to NEMT PAHPs, NEMT PAHP contracts, and States in connection with NEMT PAHPs, to the same extent that they apply to PAHPs, PAHP contracts, and States in connection with PAHPs.
(1) All contract provisions in § 457.1201 except those set forth in § 457.1201(h) (related to physician incentive plans) § 457.1201(l) (related to mental health parity).
(2) The information requirements in § 457.1207.
(3) The provision against provider discrimination in § 457.1208.
(4) The State responsibility provisions in §§ 457.1212 and 457.1214, and § 438.62(a) of this chapter, as cross-referenced in § 457.1216.
(5) The provisions on enrollee rights and protections in §§ 457.1220, 457.1222, 457.1224, and 457.1226.
(6) The PAHP standards in § 438.206(b)(1) of this chapter, as cross-referenced by §§ 457.1230(a), 457.1230(d), and 457.1233(a), (b) and (d).
(7) An enrollee’s right to a State review under sub-part K of this part.
(8) Prohibitions against affiliations with individuals debarred or excluded by Federal agencies in § 438.610 of this chapter, as cross referenced by § 457.1285. * https://www.law.cornell.edu/cfr/text/42/457.1206
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