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Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services

Revised: 05-22-2018

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Documentation
  • Noncovered Services
  • Authorization Requirements
  • Billing
  • Legal References
  • Overview

    Local county or tribal agency nonemergency medical transportation (NEMT) service is transportation provided for eligible Minnesota Health Care Programs (MHCP) recipients by local county and tribal agencies to allow the recipients access to receive covered medical services or to attend MHCP service-related appeal hearings. Recipients eligible for fee-for-service (FFS) NEMT and related ancillary services must contact their county of residence (COR) local agency for policies and procedures to obtain service or service reimbursements.

    The local county or tribal agency must inform the recipients of their transportation options and requirements to correctly access those services. Information to recipients must include but is not limited to the following:

  • • Scheduling process
  • • Types of transports available
  • • Transport level of service determination process
  • • Reimbursements including the rural urban commuting area (RUCA), documentation, and billing for reimbursement within the timeframes for the recipients or the transportation providers to bill the local agency for reimbursement.
  • • How long it takes the local agency to reimburse the recipient or the transportation providers.
  • Medical Transportation Management’s Minnesota Nonemergency Transportation (MTM-MNET) coordinates local agency NEMT for some counties through a host county contract. Hennepin County is the host county for the contract for local agency NEMT coordination in these counties: Anoka, Benton, Chisago, Dakota, Hennepin, Isanti, Mille Lacs, Pine (added March 1, 2018), Ramsey, Sherburne, Stearns, Washington and Wright. FFS recipients who live in these counties must contact MTM MNET at 866-467-1724 for local agency NEMT and related ancillary services.

    For all other counties, contact the local county or tribal agency for NEMT transport and ancillary service processes and procedures.

    Local agency NEMT transport services include the following:

  • • Mode 1 – Personal mileage reimbursements
  • • Mode 2 – Volunteer driver mileage reimbursements (curb-to-curb)
  • • Mode 3 – Unassisted transport (curb-to-curb) may include taxi, bus, light rail, other commercial carriers and airfare
  • • Mode 4 – Assisted transport (door-to-door and door-through-door) may include taxi, bus, light rail, other commercial carriers
  • Local agency NEMT transportation services provided by the NEMT provider include the following:

  • • Helping the recipient to and from the vehicle when necessary
  • • Includes curb-to-curb, door-to-door, door-through-door assistance
  • • Helping the recipient to safely enter and exit the vehicle when needed
  • • Verifying the recipient is safely secured in the vehicle
  • • Helping to secure the recipient when necessary
  • Ancillary Access Services
    Local county and tribal agencies administer reimbursement of related travel expenses when necessary to allow recipients to obtain a covered health service.

    Ancillary access services available to eligible recipients include:

  • • Lodging
  • • Meals
  • • Parking and tolls
  • Refer to the Access Services Ancillary to Transportation section for more information.

    Eligible Providers

    The county or tribal agency uses transportation providers or private automobile to provide transportation services to FFS recipients. Contact the local county or tribal agency for their transportation service enrollment or contracting information and requirements.

    Examples of local agency NEMT providers include the following:

  • • Personal vehicle
  • • Volunteer drivers
  • • Bus, light rail
  • • Taxi and dial-a-ride services
  • • Airplane
  • County and Tribal Agencies
    All NEMT providers must comply with the operating standards for vehicles and drivers according to Minnesota Statutes 174.29 and 174.30. Publicly operated transit systems, volunteers, and not-for-hire vehicles are exempt from the requirement.

    Provider Type Home Page Links
    Review related webpages for the latest news and additions, forms, and quick links.

    Eligible Recipients

    Fee-for-service MHCP recipients enrolled in the following programs are eligible to receive transportation services:

  • Emergency Medical Assistance (EMA)
  • Medical Assistance (MA)
  • • State-only funded MA benefits due to residing in an Institution for Mental Disease (IMD)
  • MinnesotaCare for recipients under the age of 21 or pregnant woman
  • Minnesota Family Planning Program (MFPP)
  • • Refugee Medical Assistance (RMA)
  • For recipients enrolled in a managed care organization (MCO), or transportation services provided through a waiver program, refer to Eligible Recipients in the Nonemergency Medical Transportation (NEMT) Services (Overview) section.

    MinnesotaCare members enrolled in a managed care plan with dates of service on and after January 1, 2017, will only receive or be reimbursed for personal mileage (mode 1), unassisted transport— out-of-state airfare only (mode 3), and out-of-state transport and ancillary services (lodging, meals, parking or tolls) through the local county or tribal agencies. All other NEMT transports are accessed through the health plan.

    Recipients must contact MNET or their local county or tribal agency for policies and procedures for scheduling or obtaining local agency NEMT-related ancillary services or reimbursements.

    Covered Services

    Refer to Covered Services in the Nonemergency Medical Transportation (NEMT) Services (Overview) section for general service coverage requirements.

    Refer to Multiple Riders in the Transportation Overview section for information on transporting multiple MHCP recipients at the same time from a single pick-up (origination) location for dates of service on or prior to June 30, 2017. Effective with dates of service on and after July 1, 2017, the proration of multiple rider NEMT transports no longer applies.

    Also see One-time Transport Assessments and Upgrades in the Transportation Overview section.

    Local agency NEMT is a covered service when nonemergency transportation services are provided for the following:

  • • To enable a recipient to obtain a covered health service. Transport is limited to a provider within 30 miles of the recipient’s home or residence for primary care and 60 miles from the home or residence for specialty care. (Refer to the NEMT Authorization Requirements table for mileage exceeding the 30-mile and 60-mile limits.)
  • • To enable eligible MHCP recipients to attend MHCP-related appeal hearings
  • • To provide a ride to MHCP covered services from origination (pick-up) location to destination (drop-off) location by the most direct route
  • • The most appropriate and cost-effective level of transport to meet the needs of the recipient
  • • The recipient and, when necessary, one responsible person who is needed to make medical decisions, learn about the recipient’s medical care services, or is otherwise necessary to allow the recipient to get to or receive a covered medically necessary service. This includes, but is not limited to, a family member, relative, authorized representative or legal guardian
  • • When transporting one responsible person or one or more siblings from a single location separately from the recipient is necessary to enable family therapy services established in the recipient’s plan of care to be completed. This includes when a child or parent is in a residential facility and a responsible person, sibling(s) or spouse is required to attend to complete therapy service. The recipient receiving care does not need to be included in the transport.
  • • When an additional attendant is needed to enable the transport of a recipient
  • Nursing Facility (NF) Recipients Approved for State-Administered NEMT Statewide

    MA recipients residing in, or being admitted to or discharged from a licensed nursing facility automatically qualify for state-administered NEMT-level transportation for all non-stretcher state-administered NEMT transport level trips. These people do not need a LOS certification through KEPRO. The local county human services agency updates the recipient’s living arrangement code and must indicate the recipient resides in a nursing facility. The recipient living arrangement must be one of the following for the provider to receive reimbursement for state-administered NEMT transports (verify these living arrangement codes through the recipient Eligibility Request in MN–ITS):

  • • 41 – NFI (Nursing Facility I) Medicare certified
  • • 42 – NFII (Nursing Facility II) non-Medicare certified
  • • 44 – Short Term Stay NFI
  • • 45 – Short Term Stay NFII
  • Exception: NEMT transport to nursing facility on date of discharge from the hospital
    Local agency administered NEMT transports for an MHCP recipient to a nursing facility on the date of discharge from a hospital are eligible for reimbursement if the county has not updated the recipient’s living arrangement three months after the month of admission. See documentation requirements later in this section.

    Electroconvulsive therapy, dialysis and outpatient procedures with sedation
    Recipients who receive electroconvulsive therapy (ECT), dialysis, or outpatient procedures with sedation are eligible for local agency NEMT to and from the service. Recipients may require a higher mode of NEMT transport for the return trip. This could include a state-administered mode or level of transport. Refer to the State-Administered NEMT Transportation Services section for Authorization Requirements. Refer to Transportation Upgrade in the State-Administered NEMT Transportation Services section for covered services.

    Personal mileage reimbursement
    Personal mileage is the least costly method of transport and is reimbursed by the local county or tribal agency. Recipients who have a vehicle must use personal mileage and are not eligible for other modes of transport.

    Personal mileage reimbursement cannot be denied based on a minimal distance driven to obtain the MHCP covered medical service. The mileage to and from the eligible service by the most direct route is reimbursable. The local agency may hold personal mileage reimbursement until a reasonable amount has been accrued before generating a payment. The local county or tribal agency may deny personal mileage that exceeds the 30 or 60 mile limits when not authorized, coordinated or delivered according to local agency policies and procedures.

    Refer to the following exceptions from the use of the personal mileage requirement:

  • • Recipient has a medical condition that prevents the safe operation of a motor vehicle
  • • A qualified medical professional must provide documentation
  • • Exclusion may be time limited
  • • The transportation coordinator (county or tribal local agency, or entity hired to act on behalf of the county or tribe) may consider other reasonable exclusions for a vehicle being unavailable for use
  • • Recipient must provide supporting documentation
  • • Exclusion may be time limited
  • Personal mileage reimbursement requirements include, but may not be limited to the following:

  • • Personal mileage requirements apply to the client and people who have a relationship (vested interest) to the recipient. This includes, but is not limited to family, friends, relatives, neighbors, personal care assistants (PCA), home health aides (HHA), other personal attendants, corporate foster care staff or county social worker.
  • • The recipient must complete and submit personal mileage trip-log sheets for reimbursement. The local agency establishes trip-log submission deadlines. Trip logs must include the following:
  • • Recipient name and MHCP ID number
  • • Date of service
  • • Name of medical provider or facility
  • • Address of residence (trip origination location) and medical provider or facility (destination location)
  • • Verification of medical appointment. Acceptable verification may include a signature from the medical provider or facility or copy of the medical appointment explanation of benefits
  • MHCP covers corporate or business foster care provider mileage reimbursement when:

  • • Transportation reimbursement is not part of the per diem or negotiated rate paid to the corporate foster care provider
  • • The foster care provider has a vested interest to the recipient unless enrolled as an NEMT provider with the county or tribal agency. If enrolled with the local agency as an NEMT provider, the transport rate is negotiated by the county or tribal agency
  • Volunteer mileage reimbursement

    Local agency-recognized volunteer drivers must meet both of the following:

  • • Recognized as a volunteer driver by the county or tribal agency
  • • Available to transport all members of the community
  • Refer the volunteer driver or volunteer driver organization to the Minnesota Department of Revenue’s website and their Volunteer Mileage Reimbursement page for information related to volunteer driver reimbursement, possible tax implications and requirements for issuing Form 1099.

    For reimbursement of parking, meals and lodging, refer to the Access Services Ancillary to Transportation page.

    Documentation

    Trip documentation must be consistent with Minnesota Statutes 256B.0625, subdivision 17b which includes the following requirements:

  • • The record must be in English and must be legible according to the standard of a reasonable person
  • • The recipient's name must be on each page of the record and each entry in the record must document the following:
  • • The date on which the entry is made
  • • The date or dates the service is provided
  • • The printed last name, first name and middle initial of the driver
  • • The signature of the driver attesting to the following: "I certify that I have accurately reported in this record the trip miles I actually drove and the dates and times I actually drove them. I understand that misreporting the miles driven and hours worked is fraud for which I could face criminal prosecution or civil proceedings."
  • • The signature of the recipient or authorized party attesting to the following: "I certify that I received the reported transportation service" or the signature of the provider of medical services certifying that the recipient was delivered to the provider
  • • The address, or the description if the address is not available, of both the origin and destination, and the mileage for the most direct route from the origin to the destination
  • • The mode of transportation in which the service is provided
  • • The license plate number of the vehicle used to transport the recipient
  • • The time of the pickup and the time of the drop-off with "a.m." and "p.m." designations
  • • The name of the extra attendant when an extra attendant is used
  • • The electronic source documentation used to calculate driving directions and mileage
  • Documentation must also include the following:
  • • Provider’s NPI or UMPI number
  • • Recipient’s MHCP ID number
  • Noncovered Services

    Refer to Noncovered Services in the Nonemergency Medical Transportation (NEMT) Services (Overview) section.

    Transport provided by a PCA, HHA, corporate foster care, county social worker or case worker, etc., is not reimbursable if transportation is reimbursed by other program funds.

    Transport of an Emergency Medical Assistance (EMA) recipient for the purpose of obtaining routine or preventative medical care or services is not covered.

    Authorization Requirements

    Refer to Authorization for general authorization requirements. Refer to the Authorization section in the Nonemergency Medical Transportation (NEMT) Services (Overview) for more specific information. Local county or tribal agencies may require authorization for the transportation services they provide or reimburse.

    Out-of-State Medical Services

    Refer to the Nonemergency Medical Transportation (NEMT) Services (Overview) section for out-of-state medical services.

    Billing

    Refer to Billing in the Nonemergency Medical Transportation (NEMT) Services (Overview) section for billing policy information. Refer to the MN–ITS User Guide for specific billing instructions.

    Local agency administered NEMT providers do not bill MHCP for service reimbursements. Contact the local county or tribal agency for reimbursement processes.

    County or Tribal Agencies
    Local county and tribal agencies may reimburse the recipient or the provider directly for costs incurred. Reimbursement is the lesser of the recipient’s or provider’s submitted charge and the MHCP calculated allowable. The calculated allowable is the maximum amount MHCP will reimburse the local agency.

    For more information about the NEMT billing process, procedure codes, modifiers and payment rates refer to the Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Informationsection.

    For the ancillary access services billing process, refer to the Ancillary Access Service Procedure Codes, Modifiers and Payment Rates web page.

    Legal References

    Laws of Minnesota 2014, chapter 312, article 24, section 28 NEMT provider requirement
    Laws of Minnesota 2014, chapter 312, article 24, section 45
    Waiver Applications for Nonemergency Medical Transportation Service Providers
    Minnesota Statutes 174
    (Department of Transportation)
    Minnesota Statutes 174.29-174.30
    (Coordination of Special Transportation Service)
    Minnesota Statutes 256B.0625
    , subd.17 (Transportation costs)
    Minnesota Statutes 256B.0625
    , subd.17a (Payment for ambulance services)
    Minnesota Statutes 256B.0625
    , subd.18 (Bus or taxicab transportation)
    Minnesota Statutes 256B.0625
    , subd.18a (Access to medical services)
    Minnesota Rules 8840.5925
    (Vehicle Equipment)
    Minnesota Rules 9505.0315
    (Medical Transportation)
    Minnesota Rules 9505.0445
    (Payment Rates)

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