Missouri Facility Resources

Along with the driver credentialing process and training, each vehicle operated by a TP must undergo an initial 45 point vehicle inspection by a LGTC Field Monitor before that vehicle can be used to transport MO HealthNet NEMT participants. Once approved, each vehicle is regularly re-inspected. Wheelchair and stretcher vehicles receive more in-depth inspections with regards to the special equipment needed for transport. Once inspected, a LGTC window decal is applied to the vehicle. This provides for a quick visual identification of a LGTC approved vehicle.

Yes. There are four circumstances in which the participant may be transported beyond the travel distance standards above:

1. If the participant has a previous history of other than routine medical care with the qualified, enrolled medical service provider for a special condition or illness.
2. If the participant has been referred by a Primary Care Provider (PCP) to a qualified, enrolled medical service provider for a special condition or illness.
3. If there is not a routine or specialty care appointment available within thirty (30) calendar days to a qualified, enrolled medical service provider within the travel standards.
4. A participant may be transported to the following MO HealthNet services without regard to the travel distance standards if the participant:
   • Is scheduled for an appointment arranged by the Family Support Division (FSD) eligibility specialist for a Medical Review Determination (MRD) to determine continued eligibility.
   • Is locked into a medical service provider by the state agency. LGTC must first receive prior authorization from the state for lock-in trips that exceed the travel.
   • Has chosen to receive a covered service free of charge from the VA or Shriners Hospitals. LGTC must first verify that each transport to be provided to free care meets all criteria including, but not limited to participant eligibility and MO HealthNet covered service.

The level of service describes the type of transportation service needed to transport the participant. A participant can travel by one of several levels of service based on his/her medical needs and mobility.

Gas Reimbursement

• Participant has a vehicle (or access to vehicle of friend, neighbor or family member)
• Vehicle is operable (and is available at the time of the participant’s medical appointment)
• Participant is physically able to drive the vehicle (or friend, neighbor, family member is)
• Participant routinely uses the car for non-medical trips (e.g., to go to the store, laundry, church or to visits friends and family)
• However, participant can’t drive him/herself to the medical appointment unless financial assistance is provided (i.e., gas or mileage reimbursement).

Bus Pass/Mass Transit

• The participant lives within 3 blocks of a bus stop
• The medical facility is within 3 blocks of a bus stop
• The participant can walk 3 blocks
• The participant understands common signs and directions
• Bus passes can be obtained by calling LGTC

Ambulatory

• The participant can walk unassisted from doorway of residence to the curb
• The participant can walk unassisted from the vehicle to the medical facility

Wheelchair can transfer

• The participant can transfer from the wheelchair to the seat of an ambulatory vehicle
• The participant’s wheelchair folds and can be placed in the rear of the vehicle

Wheelchair

• The participant is confined to wheelchair
• The participant cannot transfer from the wheelchair to the seat of an ambulatory vehicle
• The participant requires a lift-equipped wheelchair van

Stretcher

• The participant is confined to bed
• The participant cannot sit up or sit in a wheelchair
• The member does not require medical monitoring during transport

Non-emergency BLS

• MRSA – patient with total isolation precautions at destination
• Oxygen not self- administered by patient
• Aspiration precautions – suction standby needed
• Plain IV TKO [Isotonic]
• Sedated with IV or IM including narcotics within last 30 minutes
• Clamped central line
• Post- surgical positioning or movement precautions
• 5150 hold
• Pulse oximetry monitoring

Non-Emergency ALS

• IV requiring titration and continuous monitoring during transport [meds per local protocols]
• Cardiac monitoring
• Trach with deep suctioning
• Chest tube to gravity

No.

A participant may request a preferred provider. LGTC will attempt to schedule transport with the preferred provider but cannot guarantee the assignment because we cannot guarantee that the provider will be available for the specific trip.

Participants may see any MO HealthNet enrolled provider. However, for transportation, MO HealthNet’s policy is that NEMT will be authorized to a qualified, enrolled medical service provider, within MO HealthNet’s travel distance standards.

Their “preference” will be taken into consideration but cannot be guaranteed.

A participant may request not to ride with a specific provider. Modivcare will investigate any incident causing such a request.

No. Children under the age of seventeen (17) years of age must be accompanied to medical appointments. Emancipated minors may be transported without a parent/guardian with them.

Yes. Hospital discharge requests shall be honored within 3 hours of the time the request is made. Requests for other urgent care transports shall be honored as soon as reasonably possible.

Trips for participant travel out of state are booked with Modivcare, using the same process that other trips are booked as long as they are to a MO HealthNet enrolled covered, reimbursable service. Trips to “border states” do not require prior authorization by MO HealthNet but trips to non-border states do.

All Modivcare approved TPs are required to meet a rigorous credentialing process. This process mandates that all drivers must have a current driver’s license, a clean driving record (including the Missouri State Highway Patrol Request for Criminal Record Check and the Family Care Safety Registry), and tested negative on a stringent drug test. Once all this information is received, Modivcare’s Compliance Department will review it to make sure the driver meets all the standards set forth by the State of Missouri. The driver is then either approved or denied to transport participants for Modivcare. Once approved to transport MO HealthNet participants, each driver must possess a national certification for Defensive Driving, First Aid and CPR, and Passenger Assistance Sensitivity Certifications. Modivcare offers a certification program to each provider through the National Safety Council and CTAA.

A copy of the Standing Order Request Form is located at this web site and can be downloaded for your convenience. Alternately, the Modivcare Healthcare Facility Dept. staff can fax the form to you.

Call the Facility Dept. at 866-269-5942 to change or update a standing order.

Hospitals contact the Reservation Line at 866-269-5927 and select the discharge prompt. Dedicated call takers are assigned to handle discharges. Discharges must be called in by a doctor, nurse or social worker. Once the discharge is arranged, the transportation provider has three (3) hours to respond and pick-up the participant. A completed medical needs form is required when an upgrade in the mode of transportation from ambulatory or wheelchair to stretcher is requested for discharges.

10 minutes from the scheduled pick-up time.

Except for hospital discharges and urgent trips, all reservation requests for routine NEMT must be pre-arranged with 5 days’ prior notice. The five days includes the day of the call but not the day of the appointment. For example, call on Monday for an appointment on Saturday. See chart below. LGTC does honor trip requests from participants eligible for Gas Reimbursement with less than 5 days’ notice. However, every Gas Reimbursement trip must be pre-authorized by LGTC.

If a pick up time had not previously been scheduled, then the driver will arrive within 60 minutes of when the participant called.

Cancellations should be called in 2 or more hours before the scheduled pick-up time.

No, although Modivcare may call the medical provider to confirm that need.

No.

Modivcare maintains a Facility Department dedicated to handling the needs of those healthcare facilities that serve Medicaid participants who have no other way to get a ride, and who require regularly reoccurring non-emergency medical transport (NEMT). For example, transport three days each week to and from dialysis. A dedicated staff and phone number is available to book transportation requests from these facilities on behalf of the participants they serve. The phone number is 866-269-5942. It is suggested that you fax your trip requests in to save time on the phone and make most efficient use of your time. The fax number is 866-269-8875 . You will find instructions and forms for arranging trips included in the answers below.

No.

Yes. The limit is 3 trip legs. A trip to and from a physician’s office is two trip legs. The first takes the participant to the physician’s office. The second trip leg returns the participant to his/her residence. A participant is limited to three (3) trips legs in any one day. More than three trip legs per day must be prior authorized by LGTC.

MO HealthNet standards require that if a request for NEMT falls under one or more of the denial criteria listed below, then LGTC must deny the request:

• The participant is not eligible for NEMT on the date of service.
• The participant does not have a medical need that requires NEMT.
• The medical service for which NEMT is requested is not a covered medical service.
• The participant has access to free transportation.
• Transportation to the medical service for which NEMT is requested is covered under another program.
• The medical appointment is not scheduled or was not kept.
• The trip was not requested timely and the request cannot be accommodated because of this.
• Additional documentation was requested and was not received timely.
• The participant refuses the appropriate mode of transportation.
• The participant refuses the NEMT provider assigned to the trip and another appropriate NEMT provider is not available.
• The participant refuses to cooperate in determining status of MO HealthNet eligibility.
• The participant is found to be ineligible for NEMT based on the documented information that cannot be otherwise confirmed.
• The participant exhibits uncooperative behavior or misuses/abuses NEMT services.
• The participant is not ready to board NEMT transport ten (10) minutes after the scheduled pick up time.

Sudden life threatening medical situations, significant trauma, comas, shock, uncontrolled bleeding, respiratory distress, poisoning, drug overdose and any situation where immediate medical relief or treatment is necessary.

Examples of such trips are doctor appointments deemed urgent by the physician, and hospital discharges.

Travel policies are in place to determine the appropriateness of participants travelling outside the standard distance. In order to assist participants in accessing appropriate care, you may receive calls from Modivcare to verify the reason the participant must travel beyond the standard distance. Standard distances are shown on the next page. The standards are based on whether the county of residence is categorized as urban, basic, or rural. The following lists the counties meeting each category:

Urban – Clay, Greene, Jackson, Jefferson, St. Charles, St. Louis, and St. Louis City

Basic – Boone, Buchanan, Cape Girardeau, Cass, Christian, Cole, Franklin, Jasper, Johnson, Lincoln, Newton, Platte, Pulaski, St. Francois, and Taney

Rural – all other counties

Modivcare maintains a staff to resolve any issues when a transportation provider is late or fails to show at the scheduled time. A dedicated phone line is available to call to find out the status of the ride. The line is called the “Where’s My Ride” line and the phone number to call is 866-269-5944.

Once their appointment is finished, they or someone at the medical provider’s office they visited will call the “Where’s My Ride” phone number at 866-269-5944 and request that transportation be sent to pick-up the participant. A transportation provider will be dispatched and will have 60 minutes to pick-up the participant.

Emergency ambulance trips are not arranged through LGTC. If an emergency ambulance trip is needed, 911 should be called.

Urgent/same day trips can be booked through LGTC 24 by 7. Such trips should be for true urgent conditions where a physician is requiring the participant be seen the same day or next day. All urgent/same day trips will be verified with the physician’s office for medical necessity. If it is a case where the trip was just not called in timely, then in those cases, the appointment should be rescheduled so that transportation can be booked providing the five days’ notice.

It is regularly reoccurring transportation for those participants who need transport 3 or more days per week for 3 or more month’s duration, e.g., a Monday, Wednesday and Friday dialysis patient. To eliminate the need to call the reservation line to schedule every one of those trips, a standing order process and has been created. This allows a facility to arrange 3 month’s worth of trips simply by filling out and faxing in the standing order form. At the end of those 3 months our Facility Department will call the healthcare facility and ask if the trip continues to be necessary. The facility will not have to submit a new standing order at that time unless the participant’s mobility has changed.

All transportation companies are required to attempt to contact the participant 24 hours in advance to inform the participant they will be the TP and the expected pick up time. In cases where TPs are not notifying the participants, the participant should call LGTC at 866-269-5944 .

Critical care transport would be inappropriate. This includes but is not limited to:

• Advanced airway management [including ventilator]
• Chest tube requiring suctioning
• Temporary pacemaker in place
• IV with medications, IV requiring titration and/or infusion pump
• With vasoactive, antiarrhythmic or anticoagulant
• Open central line or needs monitoring
• Critical care nursing skills needed during transport
• Pulmonary artery line in place
• Transcutaneous or transvenous pacing
• Must monitor/administer medications enroute
• Ventilator dependent during transport
• Intra-cranial pressure line
• Balloon pump – transport with hospital RN

Participants receiving MO HealthNet under a federally funded category or assistance.

Participants with these medical eligibility (ME) codes are not eligible for NEMT services, plus the other noted participants:

• 02 Blind Pension
• 08 Child Welfare Services-Foster Care
• 52 Division of Youth Services-General Revenue
• 55 Qualified Medicare Beneficiary (QMB)
• 57 Child Welfare Services -Foster Care-Adoption Subsidy
• 59 Presumptive Eligibility
• 64 Group Home Health Initiative Fund (State Placement)
• 65 Group Home Health Initiative Fund (Parent/Guardian Placement)
• 73 CHIP-children 150%+ -185% of the FPL
• 74 CHIP children 185+ -225% of the FPL
• 75 CHIP children 225%+ -300% of the FPL
• 80 Women’s Health Services – Uninsured Post Partum Women
• 82 Missouri RX
• 89 Women’s Health Services – Uninsured Adult
• Participants with access to free transportation.
• Participants enrolled in MO HealthNet managed care health plans.(Unless for specified DMH coverage in 2.5.5.)
• Participants who have access to NEMT through Medicare.
• Participants enrolled in the Hospice program.

On time or early – but not more than 30 minutes early.

On time. The driver can arrive 15 minutes early but participant isn’t required to board until the scheduled time.

The Standing Order Request Form should be faxed to the LGTC Facility Dept. at 866-269-8875.

All issues should be reported to LGTC through the WMR line referenced above. For reoccurring issues, the Modivcare Healthcare Manager may be contacted at 866-269-5942.

Social workers, case managers or other licensed/certified medical professionals. If a participant requests regularly reoccurring transportation for 3 or more days per week and 3 or more month’s duration, then the Facility Department will then contact the social worker or case manager to secure a Standing Order for the participant.