What trips are covered under adult Home and Community Based Services non-medical transportation?
Please refer to MCTAC's non-medical transporation webinar, held on January 9, 2017, which provided guidance on allowable vs. non-allowable trips. Resources from this webinar can be found here.
Is a Plan of Care required if the only BH HCBS the adult is receiving is Non-Medical Transportation (NMT)? What is an example of an appropriate NMT trip for an individual who is not receiving any other BH HCBS?
NMT is considered a BH HCBS, and therefore the HCBS requirements for Plans of Care must be met when NMT is utilized. However, the State does not expect that there will be many individuals for whom it will be appropriate to use NMT and not be engaged in other BH HCBS. An example of an appropriate NMT trip for an individual who is not receiving other BH HCBS is a trip to a job interview for an individual with an employment goal who is engaged in a Personalized Recovery Oriented Services (PROS) program and therefore is not eligible for the BH HCBS employment services.
Where is the adult Non-Medical Transportation (NMT) Grid accessed?
Do adult BH HCBS providers bill for Non-Medical Transportation (NMT)?
BH HCBS providers would only provide and bill NMT if they are enrolled Medicaid transportation providers and are assigned transportation by the transportation manager. Transportation is assigned via enrollee choice within the appropriate level of service or rotation when no choice is expressed. When billing for NMT, enrolled Medicaid transportation providers must receive prior authorization from the transportation manager and bill through eMedNY through the same billing process as fee-for-service Non-Emergency Medical Transportation (NEMT).
Can adult BH HCBS providers bill for mileage for staff trips related to an individual’s goal?
Non-Medical Transportation (NMT) is a BH HCBS and is separate from Staff Transportation which is a supplemental rate add-on for some BH HCBS. BH HCBS providers can bill for mileage for staff trips, as long as the mileage is tied to a service that was provided and it is a service that qualifies for Staff Transportation. The services that qualify are essentially all services, except NMT, respite services, and Psychosocial Rehabilitation or Family Support and Training if those services are provided to a group. Information about Staff Transportation is also available in the billing manual here.
What is the timeframe in which the MCO must confirm the proposed Non-Medical Transportation (NMT) is appropriate based on the approved POC/Level of Service Determination decision and send the Grid to the Transportation Manager?
If the NMT Grid is received with the level of service determination request, the MCO should forward the Grid to the Transportation Manager at the time of the approval of the level of service. If the Grid is received after the Level of Service approval, the MCO should review and make a decision regarding the appropriateness of the proposed NMT within the timeframe for Service Authorization Requests in Appendix F of the Medicaid Managed Care/Family Health Plus/HIV SNP Model Contract.