Welcome to the LogistiCare seminar on arranging … › Portals › 213...1. LGTC screens requests for non-emergency transportation (NEMT) from people on Medicaid or dually enrolled

Welcome to the LogistiCare seminar on arranging non-emergency transportation (NEMT) services for

people living in Wayne, Oakland and Macomb counties who are on Medicaid or dually enrolled

Medicaid/Children's Special Health Care Services (CSHCS) and who have no other way to get a ride

LOGISTICARE | www.logisticare.com | Confidential and Proprietary

2

You need not take notes. There’s a website with all of the material we’ll go over today.

http://mifacility.logisticare.com has1. All of the material we will review with you

today 2. A list of frequently asked questions3. Documents you can download including

standing order and medical necessity forms, and answers to questions that healthcare facilities frequently ask about non-emergency Medicaid transportation.

http://mifacility.logisticare.com/


3

What is LogistiCare (LGTC)?

1. LGTC is a transportation management company – a broker - with operations centers nationwide.

2. LGTC has operated in MI since 2007 under contract with MI Community Choice Medicaid & Medicare.

3. LGTC has opened its MI Operations Center at: The Omni Officentre26877 Northwestern Hwy, Suite 211 Southfield, MI 48037-0070


4

What does LGTC do?

1. LGTC screens requests for non-emergency transportation (NEMT) from people on Medicaid or dually enrolled Medicaid/CSHCS or from their families or healthcare providers, on behalf of the MI Dept. of Community Health.

2. LGTC helps to determine whether the person qualifies for NEMT and if so the most appropriate level of transportation for the beneficiary.

3. LGTC schedules and routes non- emergency transportation based on the beneficiaries medical and mobility needs.

4. LGTC credentials, contracts with and pays local transportation companies to perform the non- emergency transportation.


5

What is NEMT?

1. NEMT is any transportation that is not initiated by dialing 911 and does not require an “immediate” response to take a member to the emergency room for evaluation of a new or suddenly worsening condition that threatens life or limb

2. NEMT does not include air ambulance or extended transplant housing


6

What is changing January 1st?

1. MI DCH has contracted with LGTC to manage NEMT services for beneficiaries who have no other means of transportation.

2. Beneficiaries and healthcare facilities will contact LGTC, not the transportation provider or the county DHS office, to arrange NEMT services.

3. LGTC will contract with and oversee the transportation providers who will provide the NEMT, and report to MI DCH.

4. If a beneficiary is not using an enrolled provider currently, please call 1-866-569-1902, the LogistiCare Reservation line, to arrange NEMT


7

Announcement from Michigan DCH

The Michigan Department of Community Health (MDCH) has contracted with LogistiCare Solutions, LLC (LogistiCare) to arrange and manage non-emergency medical transportation (NEMT) services to eligible Medicaid beneficiaries and beneficiaries dually eligible for Children’s Special Health Care Services (CSHCS) who have no other means of transportation.

LogistiCare will arrange and manage NEMT services in Wayne, Oakland, and Macomb Counties.

Effective January 1, 2011 all NEMT services as described above must be pre-arranged through LogistiCare.

Medicaid NEMT services are necessary to ensure that Medicaid beneficiaries who need transportation to and from any Medicaid covered service receive these services in a manner that is both professional and courteous and via a mode of transportation that is both reasonable and cost effective. The goal of MDCH is to provide efficient and effective transportation options in order to improve access to healthcare services.

LogistiCare will maintain a network of transportation providers that will provide the actual transportation services. LogistiCare will determine the appropriate mode of transportation and request an appropriate vehicle from one of the network providers to transport beneficiaries.

By this letter, we are introducing LogistiCare to medical facilities whose patients may utilize Medicaid NEMT services and may therefore have a need to interact with LogistiCare. In the coming weeks LogistiCare will distribute NEMT program and contact information to medical facilities. In addition, LogistiCare will begin compiling the information needed to pre-load beneficiary trip information into its reservation system. Your facility may be asked to provide or confirm trip reservation details.

As part of the contract agreement with MDCH, LogistiCare is a HIPAA Business Associate of MDCH and is authorized to receive beneficiary private health information. MDCH requests that you assist in the implementation of this program and release requested information to LogistiCare. Your cooperation and timely assistance will help to ensure a smooth implementation of the new NEMT brokerage program and help to ensure that your patients arrive at their scheduled appointments safely and on time.


8

Which beneficiaries are affected?

1. People living in Wayne, Oakland and Macomb counties who are on Medicaid or dually enrolled Medicaid/Children's Special Health Care Services (CSHCS) and who have no other way to get a ride

2. Beneficiaries living in those counties who do participate with a Medicaid Managed Care Plans should call their HMO for transport. However if they need NEMT services for dental, substance abuse and community mental health services and have no other means of transport they should contact LGTC.


9

What are the “criteria” for NEMT?

1. The beneficiary has no other means of transportation

2. The “type” of transportation is covered and is to a Medicaid/CSHCS covered service

3. The service the beneficiary is going to is a covered Medicaid/CSHCS covered service


10

What “types” of NEMT are covered?

1. Ambulatory• Ambulatory includes Mass Transit provided the

beneficiary is able to understand common signs and directions

• No Medical Needs Form is needed• Bus passes are obtained by calling LGTC2. Wheelchair\medivan• A Medical Needs Form is required• The form can be faxed to medical providers and other

healthcare facilities and is also available online at http://mifacility.logisticare.com

3. Mileage, meals and lodging is also covered and can be obtained by calling LGTC


11

Examples of NEMT to or from a covered service

1. A discharge from the hospital

2. Transport to a Medicaid/CSHCS enrolled physician to receive a medically covered service

3. Transport for a medical treatment like dialysis


12

Examples of non-covered NEMT

1. Transport to a non-covered services (e.g., AA meetings, medically unsupervised weight reduction)

2. Transport for nursing home residents. Long term care facilities are expected to provide transportation for services outside their facilities

3. Transportation costs to meet a beneficiary’s personal choice of provider

4. Transport if the beneficiary or his/her family, neighbors, friends or relatives can provide transportation. MI DCH rules state they are expected to continue to do so.

5. Transport beyond 18 months, without documented prior authorization, for methadone treatment


13

Must we contact LGTC for all ambulatory and wheelchair trips we arrange for our beneficiaries?

1. Yes, you must call LGTC

2. For Medicaid beneficiaries covered in the agreement between MI DCH and LGTC - and for Medicaid Managed Care beneficiaries needing dental, substance abuse or mental health services - LGTC must be contacted to arrange all non- emergency ambulatory or wheelchair/medivan transports


14

How do we request routine transport from LGTC?

A routine trip is an occasional, episodic trip to a Medicaid covered service, e.g., a trip to the doctor on Thursday

1. 866-569-1902 is the reservation number. Beneficiaries, their families/care givers or medical providers call the reservation number to reserve a routine trip

2. 866-288-3133 is the reservation number for the deaf or hearing impaired.

3. 866-569-1908 is the Healthcare Facility Dept. number for the exclusive use of healthcare facility staff. Call to speak to the staff specialist we have assigned to your facility to request a routine trip for one of your beneficiaries, or to set up or change a standing order. Hospital discharge planners can call this number to schedule a discharge.


15

How do we request standing order transport?

Standing order transport for ambulatory, wheelchair or medivan transport means regularly reoccurring trips to a Medicaid covered service, e.g., 3 times per week to dialysis

1. 866-569-1908 is the Healthcare Facility Dept. number. 2. When a beneficiary, beneficiary’s representative or

medical provider calls to request standing order transport one of our specialists will set up the first week’s worth of trips

3. Then our specialist will contact the medical provider to ask that a Standing Order Request form be completed

4. If the beneficiary requires wheelchair or medivan transport, then our specialist will ask the medical provider to have the Medical Needs Form completed


16

How do we request standing order transport?

5. When both forms are required only the Medical Needs Form needs to be signed

6. Both forms are located online at http://mifacility.logisticare.com or our specialist can fax the form(s) to the medical provider

7. The medical provider then will fax the completed form(s) to 866-569-1910. That’s the Healthcare Facility Dept.’s fax number. Now there’s no need to phone in future trip requests for the beneficiary

8. To request regularly reoccurring trips for less than 3 days per week, just call and our staff will schedule a month’s worth or trips at a time

http://mifacility.logisticare.com/


17

How far in advance must we contact LGTC?

1. Call two business days in advance, by noon, for “Routine” or “Standing order” trip requests

2. The two days includes the day of the call but not the day of the appointment

3. For example, call on Monday by noon for an appointment on Wednesday

4. Call 24 by 7 for “Urgent” trip requests


18

Ride Assistance and Operations Center

1. 866-569-1903 is the “Where’s My Ride?” telephone number that case managers, social workers, medical providers and beneficiaries (or their families/care givers) call concerning a service issue. For example, if transportation is late dropping off or picking up the patient.


19

How do I know whether to request ambulatory or wheelchair/medivan transport?

1. LGTC will ask questions to assess the beneficiary’s mobility and any special needs

2. Based on the answers to those questions LGTC will determine whether ambulatory or wheelchair/medivan service best meets the beneficiary’s mobility and medical needs

3. If wheelchair or medivan transport is requested then LGTC will have to verify that with the medical provider. LGTC will request the name, address and telephone number of the doctor/physician


20

Standing Order Form

1. It is used to request reoccurring transport, e.g., three (3) or more days/week for three (3) or more months

2. Every quarter our Healthcare Facility representative will contact you to see if standing order should continue

3. Standing Order Form: shown next


21

Standing Order Request Form for Appointments Occurring 3 Days or More per WeekFacility Department - Phone: (866) 569-1908 – Fax (866) 569-1910

Beneficiary’s Name: __________________________ DOB: ____-____-____ Gender: M__ F__ Medicaid #: _________________ Beneficiary’s Insurance Type: _______________ (if applicable) Beneficiary’s Insurance #:_______________________ (if

applicable)Appointment Days: ( ) Sun ( ) Mon ( ) Tue ( ) Wed ( ) Thurs ( ) Fri ( ) SatName of parent/guardian (if applicable): ________________________________________________________________________

Start date: ___________ ( ) Ambulatory ( ) W/C Medivan-can transfer ( ) W/C Medivan-requires lift ( ) Needs escortRequested by: ________________________________Relation: __________________________ Phone: ( ) _____-________Patient Condition: ______________________________________ Facility Medicaid Provider #: ___________________________Treatment Type: __________________________ Procedure Code(s): _________/_________ Medicaid Billing Code: _________Can beneficiary Sign Driver’s Log? Yes: ___ No: ___ If no, is beneficiary inability to sign permanent? Yes: ___ No: ___

Please explain if beneficiary inability is permanent: _____________________________________________________________________

Pick Up: Check if it’s the person’s home ( ) or a facility ( ). If a facility, please name it: ________________________________Pick up street address: ________________________________________________________ Bldg: _________ Apt: __________City: _________________________ State: ______ Zip: __________ Phone: ( ) _____-________ Cell: ( ) _____-________Directions: ______________________________________________________________________________________________Appointment Time: ________ AM / PM Suggested Pick Up Time from Home: ________ AM / PM

Drop Off Information:Drop Off At (Facility Name): _______________________________ Contact Name: ____________________________________Street address: ______________________________________________________________ Bldg: _________ Apt: __________City: _________________________ State: ______ Zip: __________ Phone: ( ) _____-________ Cell: ( ) _____-________Directions: ___________________________________________________ Physician Name: _____________________________Return Pick Up Time: ________ AM / PM Please specify if trip is: One-way trip: ( ) or Round trip: ( )AuthorizationWhen will patient’s authorization expire? (e.g., ongoing, 90 days, etc):

_________________________________________________Days Treatment Needed: ____________________________ Length of Time per Treatment: ____________________________

I am requesting non-emergency Medicaid transportation for the beneficiary named above only for those days when the beneficiary will receive a Medicaid-payable treatment at the facility named above. I affirm that the information entered above is accurate.

Doctor’s or Certified Professional’s Signature: _________________________ Date: ___________ Phone: (


22

The Medical Needs Form (MNF)

1. For wheelchair\Medivan trips – actually any mode of transport above ambulatory - MI DCH requires submission of the Medical Needs Form to substantiate need for non- ambulatory transport

2. The Medical Needs Form must be signed by a physician, physician assistant (PA), or a nurse practitioner

3. The MNF is displayed next


23

Michigan Non-Emergency Transportation Services Medical Necessity FormFacility Department: Telephone 866-569-1908; Fax 866-569-1910Dear Physician or Advanced Practice Nurse: This office has received a request for transportation to a Medicaid covered service for the

individual identified below. Please review the functional abilities and limitations and provide supporting information as necessary.Beneficiary’s Name: ___________________________________________________________________ Medicaid #

____________________________Date of Birth ______ / ______ / ______Current Status (Circle):

Independent Ambulation Yes NoUses walker or cane Yes NoWalking difficulty Yes NoAble to transfer from wheelchair without assistance Yes No Requires assistance of trained personnel for safety Yes NoConfined to wheelchair Yes NoAlert Yes NoConfused Yes NoDisoriented Yes NoComes into your facility: Alone Yes NoWith assistance Yes No(if Yes) Type of assistance ___________________________________________________________ Assisted by someone Yes No(if Yes) Who? ______________________________________________________________________Diagnosis: Is diagnosis permanent Yes NoGive number of months that treatment for the diagnosis will be required: ____ # months, or For lifetimeChronic ongoing illness Yes NoEstimated number of office or clinic visits: Will this

Yes, When ______________ times per week month

quarter Other (Please specify) change?

No (Date)

Other Comments_________________________________________________________________________________________Recent Hospitalizations: Dates______________________________________________________________________________Patient can travel by: (please circle) Bus (an ambulatory or wheelchair-bound patient able to make it to bus stop alone) Yes NoAmbulatory van or car/taxi (patient is able to make it to the vehicle alone) Yes NoAmbulatory van or car/taxi (patient unable to make it to the vehicle alone) Yes NoWheelchair lift-equipped van (patient is able to make it to the curb alone) Yes NoWheelchair lift-equipped van (patient unable to make it to the vehicle alone) Yes No

As a licensed physician, PA or nurse practitioner I acknowledge that transportation must only be provided to treatments covered by Medicaid. I attest that to the best of my knowledge the information above is correct.

Signature________________________Print name ____________________ _________ Signature Printed name Date


24

How soon will transport arrive?

1. For “Urgent” transports within 3 hours2. For “Routine” or “Standing Order”

transports at the scheduled pick-up time or within a 15 minute “window”

3. For “Will Call” returns after treatment – that is, when the beneficiary was not sure what time the appointment would end – within 60 minutes of when LGTC receives the call that the appointment has concluded and the beneficiary is ready to return to his/her residence


25

What are the LGTC service hours?

1. Routine Reservations and Standing Order Reservations: Monday to Friday from 8:00 a.m. until 5:00 p.m.

2. “Urgent” Reservations: 24 by 7

3. Ride Assist/Where’s My Ride?: 24 by 7


26

Will claims be paid even if NEMT is not arranged through LGTC?

1. No, however MDCH will continue to reimburse for CSHCS only beneficiaries, transplant housing and fixed wing air ambulance


27

Who is in LGTC’s transportation provider network?

1. LGTC is contracting with transportation providers presently and plans to use as many of the current companies as possible provided they meet state compliance standards regarding insurance, drivers and vehicles

2. “Preference” may be taken into consideration but cannot be guaranteed

3. Contact Mike Pardikes, our Director of Operations, at 866-791-4107 if you have questions as to who will be used in your area or if you have beneficiary “special” needs that need to be discussed, e.g., bariatric special needs


28

Questions - Discussion

1. What are your questions?2. Remember the website for

healthcare facilities at http://mifacility.logisticare.com