IDDSRAC Collaboration with Managed Care Subcommittee

Introduction Nonemergency medical transportation services provide transportation for a Medicaid beneficiary or their child to and from Medicaid-covered health care and dental services. NEMT services are for people who have no other way to get to their health care visits, including people enrolled in: • Medicaid • Children with Special Health Care Needs program (CSHCN) • Transportation for Indigent Cancer Patient (TICP) NEMT services are not for emergencies or transportation by stretcher or ambulance. If you need a nonemergency ride in an ambulance or by stretcher, call your health plan or the provider of the health care service you need the ambulance to access. If you need emergency transportation, call 911.

NEMT Services  NEMT services must be delivered in a manner that meets your needs, including accessibility.

•       Demand response transportation service, which provides curb-to-curb transportation to and from a health care service in an accessible passenger vehicle, bus, van, sedan, or ride-share vehicle.

•       Mass transit, which provides tickets or tokens to people to use to travel to allowable services.

•       Individual Transportation Participant (ITP) services, which provides mileage reimbursement to a designated driver, who can be the individual receiving the health care service, for trips to and from a health care service.

•       Meals and lodging for eligible overnight stays for people ages birth through 20 years.

•       Advanced funds for ride and travel-related expenses for people ages birth through 20 years. If an individual requires an attendant, the attendant is covered.

•       Airline fare when it is medically necessary and the most cost-efficient means of travel.

Setting up a Ride You should request NEMT services as early as possible, and at least two working days before you need a ride. The MCO, and its subcontractor, and HHSC must offer and arrange NEMT services to the individual and asapplicable, to his or her NEMT attendant. If an attendant is required, you must mention this when scheduling your ride. In certain circumstances you may request an NEMT service with less than 48 hours’ notice.

These circumstances include being picked up after being discharged from a hospital; trips to the pharmacy to pick up medication or approved medical supplies; and trips to receive treatment for urgent conditions. An urgent condition is a health condition that is not an emergency but is severe or painful enough to require treatment within 24 hours. (NB. Bold added for emphasis.) The MCO or HHSC may allow other exceptions to the 48-hour rule.

If your trip will take you out of town, call at least five working days before your appointment to schedule a ride.

Parental Accompaniment Children 17 years and younger who receive NEMT services must be accompanied by a parent or legal guardian, or by another responsible adult approved by the parent or legal guardian. Parents or legal guardians who cannot travel with their child should provide the documentation required by their health plan or HHSC to designate another adult to travel with their child. Exceptions to parental accompaniment requirements are granted for confidential appointments based on the type of appointment.

Children between the ages of 15-17 may travel without an adult with the written permission from a parent, guardian, or other responsible adult. If you have a reason for going to an appointment without your parent or without parental consent, please contact HHSC or your health plan’s designated transportation resource for information on your NEMT options.

FAQs

If I drive myself, can I be reimbursed for gas? Medicaid may be able to pay you or someone else who drives you to a health care service if your trip is approved before you travel. Payments are made by the mile at the HHSC-established mileage rate. To participate, drivers must sign up through the appropriate health plan or TMHP. Drivers must provide: • Copy of valid driver’s license • Copy of the driver’s Social Security card (the name must match the driver’s license) • Copy of the current vehicle insurance and registration for the vehicle that will be used for mileage reimbursement

If my trip request is denied, how can I appeal? You may ask your health plan or HHSC to conduct an internal review of the denied services. People with a health plan should follow their health plan’s process for submitting complaints and appeals. People without a Medicaid health plan should call 877-633-8747 (877-MED-TRIP).

You also have the right to request a fair hearing at any time. The request must be made through one of the following:

•       in writing via mail, fax, or email o The fax/email must be sent to the HHSC by entering the appeal in TIERS. The Fair and Fraud Hearings Department does not receive appeal requests directly.

•       verbally through: o calling 2-1-1, o speaking to your transportation provider or MCO, or o contacting your local HHSC Medicaid office; or

•       in person, by visiting your local HHSC Medicaid office. If the issue is not resolved you can contact the HHS Office of the Ombudsman.

You can contact them by calling 877-787-8999.  You can also send a fax to 888-780-8099 or write to: HHS Office of the Ombudsman P.O. Box 13247 Austin, Texas 78711-3247

Can I take an attendant when I use NEMT services? Yes, if approved by HHSC or the health plan. If you will be traveling with an attendant, please include this in your request for NEMT services.

How do I schedule an NEMT service? If you or your child is enrolled in a Medicaid health plan, contact your health plan’s designated transportation resource. This information can be found on the HHSC website for each MCO at https://www.hhs.texas.gov/services/health/medicaid-chip/programsservices/medical-transportation-program/health-plan-contact-information.  If you or your child is not enrolled in a Medicaid health plan, call the toll-free HHSC MTP hotline at 877-633-8747 (877-MED-TRIP).

To report fraud, waste, and abuse, call the Office of the Inspector General at 800-436-6184 or visit oig.hhsc.gov.