Virginia Facility Resources

The level of service describes the type of service required to transport a member. A member can travel by one of several levels of service based on the medical necessity and plan coverage.

Facilities and Medicaid members do not have the freedom of choice to choose the transportation provider. A request can be made and will be noted by Modivcare; however, Modivcare reserves the right to utilize a different transportation provider consistent with the transportation needs of the member.

No, attendants are for the safety of members while riding the vehicle only. However, the member can have an escort ride for free. Please see definition of escort listed above. When the transportation reservation is called in make sure and tell the customer service representative you have an escort riding as well.

Ambulance, as defined by Code of Virginia §32.1-111.1, means any vehicle, vessel or craft that holds a valid permit issued by the Virginia Department of Health, Office of Emergency Medical Services (OEMS) and that is specially constructed, equipped, maintained and operated, and intended to be used for emergency medical care and the transportation of patients who are sick, injured, wounded, or otherwise incapacitated or helpless. The word “ambulance” may not appear on any vehicle, vessel or aircraft that does not hold a valid EMS vehicle permit. Modivcare only facilitates non-emergency ambulance transportation.

An escort is a family member, friend or facility employee who accompanies a member for the entire trip and stays with the member at the destination. Modivcare is not responsible for providing escorts.

Stretcher-van services means transportation is provided to an individual who cannot be transported in a taxi/sedan (ambulatory) or wheelchair van, but does not need the medical services of an ambulance. Stretcher-van service does not provide emergency medical transport and does not include any medical monitoring, medical aid, medical care or medical treatment during transport.

A wheelchair van is a motorized vehicle equipped specifically with certified wheelchair lifts or other equipment designed to carry persons in wheelchairs, or other mobility devices. Wheelchair van services can only be used in non-emergency situations and are limited to use by members who can sit upright, to members without acute medical problems that require them to remain in a horizontal position and by members who use a mobility device.

Yes, all Medicaid paid services are subject to verification or service authorization prior to transport.

Out-of-state transportation is allowed to the extent that it is general practice for the member in a particular locality to use services in a bordering state. Examples are travel from Scott County, Virginia to Kingsport, Tennessee or travel from Tazewell County, Virginia to Bluefield, West Virginia, Duffield, Virginia to Durham, NC, from Fairfax County to the District of Columbia or other similar near-by locations in bordering states. All other out-of-state transports are arranged by the Department of Medical Assistance Services (DMAS).

Please refer to the Attendant Pre-Assessment Checklist (APAC) found on this website on the download navigator.

Facilities who would like to arrange a standing order appointment for Medicaid members should contact a Utilization Review/Facility Representative, or submit by fax a Transportation Request Form at least five (5) days in advance. The phone number is 866-679-6330 and fax number is 866-907-1491. Depending on the situation the five (5) days notice may be waived to two (2) days.

The Utilization Review/Facility Department is available 8:00 AM – 5:00 PM, Monday – Friday.

Hospitals contact the Facility Line at 866-679-6330 and select the appropriate prompt. Modivcare has three hours to assign the trip to a provider and pick up the member. The three hour time frame starts with the call to Modivcare. All hospital discharges should be arranged by hospital staff. The patient/member should not make the transportation request for the discharge. Modivcare will need to verify the discharge with hospital staff.

Call the Modivcare reservations line at 866-386-8331 at least seven (7) days before the scheduled medical appointment. This allows for proper delivery of the bus tokens, tickets, swipe cards or passes. Please tell the customer service representative the member will be using public transportation.

You will find the Gas Reimbursement Trip Log on this website on the download navigator. Please make sure and contact Modivcare BEFORE transporting to receive prior approval and trip number for reimbursement. The trip number is required for reimbursement.

Prior to the Medicaid covered service, you will need to call Modivcare to schedule the transportation. When scheduling gas reimbursement trips, you will need the name of the person who will be transporting the member as well as their telephone number and mailing address.

Transportation should be scheduled five (5) business days in advance of the appointment. The day of the appointment is not being included in this calculation. Please have the member’s name, Medicaid number, name and address to the pick-up facility, or residence, as well as the destination facility, available when making a reservation. Transportation reservations may be taken with less than a 5-day notice if they are of an urgent nature, which will be verified with the physician’s office.

In order to be reimbursed, a Gas Reimbursement Trip Log will need to be completed. The physician’s office must sign the trip log. The payee will mail the completed signed trip log to Modivcare’s Claims Department for processing. You still need to call Modivcare before the trip(s) is made to get a trip number for the trip log. If you fail to call in ahead of time you will not receive reimbursement.

Notify Modivcare immediately by dialing 866-679-6330 or the “Ride Assist” line for your area.

Yes.

Yes, waivered services would be covered by regular Medicaid and medical benefits would be covered by a managed care program. When you call Modivcare for transportation arrangements, transportation will be set up accordingly.

Yes. DMAS has a User’s Guide on their website. The User’s Guide can be accessed at http://www.dmas.virginia.gov/downloads/pdfs/tr-UserGuide_MedTransp.pdf.

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

Examples of such trips are dialysis, wound care, chemotherapy, radiation, and doctor appointments deemed “urgent” by the physician. Modivcare will verify the urgency with the physician’s office.

Ambulatory is defined as capable of walking, not bedridden and has the ability to transfer from a wheelchair to a vehicle without assistance, must be able to stand and pivot without assistance.

Medically necessary transportation is defined as the mode of transportation available that is most appropriate to the needs of the member. Covered non-emergency Medicaid transportation services include non-emergency ambulance, stretcher van, wheelchair van, fixed-route public transportation, gas reimbursement and taxi (including sedans and mini-vans).

Modivcare manages different levels of service in all of Virginia Medicaid’s Managed Care and regular Medicaid programs. Please see level of service table listed below for levels of service provided to each program. All transports must be prearranged and confirmed by Modivcare.

The member will use the same “Ride Assist” phone number listed above. Once their appointment is finished, the member or someone at the medical facility will call the “Ride Assist” phone number and request transportation to be sent to pick up the member. The transportation provider will be dispatched and will have up to 60 minutes to pick up the member.

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

Standing Orders are reoccurring trips for treatment that are scheduled at least three days per week for a period of three months or more to programs such as Supported Employment, Psychosocial Rehabilitation, Adult Daycare, and Dialysis.

An attendant accompanies a member or a group of members during transport only. The attendant is on the vehicle to ensure the safe operation of the vehicle and the safety of the members. An attendant is an employee of the company that provides transportation services for a member. A transportation attendant is not a personal assistant, an escort, a parent, caretaker, relative or friend. An attendant is not a medical professional, and does not offer professional medical services. A transportation attendant shall be provided for a member or a group of members when it is necessary for the safety of the member(s), to ensure timeliness of the trip and to reduce behavioral problems en route.

Urgent reservations are defined as a reservation for an unscheduled episodic situation in which there is no threat to life or limb, but the member must be seen with less than a five (5)-day notice. Urgent care reservations are not for routine appointments or appointments where the caller failed to notify Modivcare to arrange transportation.

Non-emergency Medicaid transportation is any transportation that is not initiated by dialing 911 and does not require immediate response to take a member to the emergency department for evaluation for a new or suddenly worsening condition that threatens life or limb. Transportation reservations may be taken with less than a 5-day notice if they are of an urgent nature, which will be verified with the physician’s office.

The “Ride Assist” phone numbers are listed below:

Virginia Medicaid

Optima Family Care

Other Healthcare

Medicaid Transportation services are identified as non-emergency, medically necessary, transportation provided to eligible members to ensure reasonable access to and from Medicaid and FAMIS covered services.

Gas Reimbursement is a program to reimburse a member’s friend, neighbor or relative at a rate of $0.40 per mile from the member’s residence to the Medicaid paid service and the return trip home.

Minors 13 to 17 may travel alone; however, a Consent and Acknowledgement of Responsibility Form must be on file. For transporting minors under the age of 13 please contact the Utilization Department for policy.

If a member’s transportation is more than 15 minutes late, call the appropriate “Ride Assist” line.

The check will be issued three (3) to four (4) weeks after Modivcare’s receipt of the Gas Reimbursement Trip Log.

You will find the Attendant Care Eligibility Assessment Form on this website on the download navigator.

Please refer to the Consent and Acknowledgement of Responsibility Form found on this website on the download navigator.

Instructions and the Transportation Request Form that can be used for standing orders or a single trip are located on the Download navigation section of this website.

All changes to a standing order must be made by a facility representative. Changes must be made with Modivcare who will then contact the assigned transportation provider. Do not make changes with the transportation provider or driver directly. The new Transportation Request Form should be faxed to 866- 907-1491.

Requests for an attendant will be accepted from a qualified assessor, such as the member, member’s parent or guardian, the member’s case manager or social worker.

At the time of the request, an Attendant Care Eligibility Assessment form must be completed and faxed to Modivcare’s Utilization Review/Facility Department at 866-907-1491.

The Consent and Acknowledgement Form must be signed by the parent or legal guardian of the minor.

Please call Modivcare’s Transportation Coordinator at 804-236-1570 or toll free at 866-810-8305 Ext. 608.

The Transportation Request Form must be completed by a Facility representative. Example: dialysis clinician, social worker, case manager or other healthcare professional.