Medi-Cal's Non-Medical Transportation Benefit - The Stronger Families .

MEDI-CAL’S NON-MEDICAL TRANSPORTATION (NMT) BENEFIT Brigid Sweeney, MPA, MSc Maternal and Child Health Access August 13, 2018

POLL 1: DO YOU KNOW WHAT MEDI-CAL’S NON-MEDICAL TRANSPORTATION BENEFIT IS? a) Yes b) No c) Maybe

WHAT IS NON-MEDICAL TRANSPORTATION (NMT)? Transportation to and from: a doctor’s visit, a pharmacy to pick up prescriptions, medical supplier to pick up medical equipment or devices, to visit your baby in the NICU, or to receive any other Medi-Cal-covered service, including mental health and dental services. Please note: Medi-Cal HMOs must also provide this transportation for “carved out services” that they don’t cover directly, such as mental health, dental and substance abuse services.

POLL 2: DO YOU KNOW THE DIFFERENCE BETWEEN NON-MEDICAL TRANSPORTATION (NMT) AND NON EMERGENCY MEDICAL TRANSPORTATION (NEMT)? a) Yes b) No c) I don’t know

HOW IS NON-MEDICAL TRANSPORT DIFFERENT FROM NON-EMERGENCY MEDICAL TRANSPORT OR EMERGENCY MEDICAL TRANSPORT? “Non-medical” transportation DIFFERS FROM both non-emergency medical transportation AND emergency medical transportation. Non-medical transport (NMT) is for visits to the doctor, dentist, pharmacy, and other Medi-Cal covered services where the beneficiary is able to travel in a standard vehicle and does not need assistance getting to and from the car. Does NOT require a prescription! Non-emergency MEDICAL transport (NEMT) includes the transportation of sick, injured, convalescent, infirm or otherwise incapacitated beneficiaries by ambulance, litter vans, or wheelchair vans. The beneficiary requires door to door service. Requires a prescription from medical provider. Emergency medical transport (EMT) is transportation for an emergency that requires an ambulance or an air-lift.

THIS IS IMPORTANT! NMT, NEMT and EMT are all VERY DIFFERENT! This webinar is ONLY ABOUT NMT.

POLL 3: WHAT’S THE MAIN DIFFERENCE BETWEEN NMT AND NEMT? a) The letter E b) Requiring door to door assistance from the driver c) Requiring a prescription from the provider for transport d) I don’t know e) Both B and C

CORRECT ANSWER e.) Both B and C Door to door assistance from the driver and Requiring a prescription from your medical provider for transport are KEY DIFFERENCES between NMT and NEMT.

WHO IS ELIGIBLE FOR THIS BENEFIT? All Medi-Cal beneficiaries, regardless of whether the person is in a health plan or “regular” (fee-for-service) Medi-Cal, who lack other transportation to reach a Medi-Cal covered service, and who do not require medical assistance with transport. The beneficiary will need to attest to having no other means of transportation to medical services. This includes women in all categories of pregnancy-related aid codes.

POLL 4: WHICH SCENARIO(S) MEETS THE CRITERIA FOR NON-MEDICAL TRANSPORTATION (NMT)? CHOOSE ALL THAT APPLY. a.) My client has a doctor’s appointment and is able to get to and from the vehicle on their own. b.) My client is in a wheelchair and will need assistance from the driver. c.) My client wants to visit her baby in the NICU. She is able to walk on her own.

CORRECT ANSWER Both A and C a.) My client has a doctor’s appointment and is able to get to and from the vehicle on their own. c.) My client wants to visit her baby in the NICU. She is able to walk on her own.

WHAT ABOUT BENEFICIARIES WITH RESTRICTED MEDI-CAL WHO ARE NOT PREGNANT? Beneficiaries on restricted aid codes will be able to use Non-Medical Transportation for any Medi-Cal Covered Services that are covered by their restricted Medi-Cal Examples include: Dialysis Dental emergency What about emergency services? Trick question! Those services would include Emergency transport by ambulance or air ambulance.

WHAT TYPE OF TRANSPORTATION IS COVERED? Round trip rides for a beneficiary to obtain covered Medi-Cal services by: a ride service, taxicab, bus tokens or passes, train tickets, and similar

ARE THERE LIMITATIONS? RESTRICTIONS? No! Distance? Time? How many rides? NO! No limitation! They are eligible for this benefit as long the person continues to be eligible for Medi-Cal and they lack other transportation to a medically necessary service covered by Medi-Cal.

CAN PARENTS OR CARETAKERS ALSO TAKE THE TRANSPORTATION? Yes! Examples include: One attendant or caretaker can accompany an elderly person One parent/guardian or caretaker can accompany their child

ARE TEENS ALLOWED TO USE THE TRANSPORT BENEFIT ON THEIR OWN? Yes Parents can authorize teens to use this transport on their own ahead of time SOME plans will allow parents to provide consent for their teens to travel alone – either over the phone or with a consent form. Not all plans allow this, however. All Plan Letter seems to give plans the freedom to choose whether they will allow for this. For teens in health plans who are accessing sensitive services or family planning services, the teen should be allowed to arrange transport or have their medical provider arrange it for them. NOT ALL PLANS ALLOW THIS. If anyone is told this is not allowed, they should file a grievance with the health plan WITHOUT their parents’ consent.

HOW DOES THIS WORK FOR TEEN ACCESSING SENSITIVE SERVICES THROUGH MINOR CONSENT MEDI-CAL? Transportation must be provided WITHOUT the parents’ consent for the following: Services related to pregnancy, family planning, sexual assault (children of ANY age under 21) Service related sexually transmitted diseases or outpatient mental health or substance use disorders. (children ages 12 through 20) Minor Consent Fact Sheet: nor%20Consent%207-18%20Final.pdf For teens enrolled in Minor Consent Medi-Cal, they would always be FFS. The teens or their providers would follow the FFS process for accessing NMT.

HOW DO BENEFICIARIES ACCESS THIS NMT BENEFIT? It depends on whether someone is enrolled in a: Medi-Cal Health Plan (HMO) OR Medi-Cal Fee-for-Service (FFS)

HOW DO MEDI-CAL HEALTH PLAN MEMBERS ACCESS THE NMT BENEFIT? In Los Angeles, these are the best numbers for each plan: Anthem Blue Cross: (877) 931-4755 Care First: (877) 433-2178 Health Net: (800) 675-6110 Kaiser: (844) 299-6230 LA Care: (866) 529-2141 Molina: (844) 292-2688 Plan members should be able to get non-medical transportation by calling Member Services. Follow this link for a list of all Medi-Cal Health Plans in the state of California: hPlanDir.aspx and click on the plan member’s county to find the health plan’s contact number

HOW DO FEE-FOR-SERVICE BENEFICIARIES ACCESS THIS BENEFIT IN LOS ANGELES? Providers/advocates should send all inquiries to DHCS-Benefits@dhcs.ca.gov. Include info about the client’s request for transport and the level of urgency. Please DO NOT include the client’s name, address or Medi-Cal number until the state sends an encrypted message requesting info. This process WILL CHANGE. We will keep everyone posted with updated fact sheets!

HOW DO FEE-FOR SERVICE BENEFICIARIES ACCESS THIS BENEFIT IN ALL OTHER COUNTIES? Providers and advocates (OUTSIDE of Los Angeles county) should contact the county first. To find the email contact for your county, please visit nclaiming%20counties%20-%20contact%20listing.pdf If the county contact says they do not provide non-medical transportation, send an email explaining your client’s problem accessing transportation to DHCS- Benefits@dhcs.ca.gov.

WHERE WILL THE NMT PROVIDERS FOR FFS BENEFICIARIES BE POSTED? EVENTUALLY the NMT Providers should be posted here: http://www.dhcs.ca.gov /services/medical/Pages/Transportatio n.aspx

POLL 5: WHICH OF THE FOLLOWING IS NOT COVERED BY THE NON-MEDICAL TRANSPORTATION BENEFIT? a) Trip to the pharmacy to pick up a Medi-Cal covered prescription b) Mental health provider appointments c) Dental appointments d) All of the above e) None of the above

CORRECT ANSWER e. None of the above Trip to the pharmacy to pick up a Medi-Cal covered prescription Mental health provider appointments Dental appointments Are ALL COVERED by the Non-Medical Transportation Benefit

POTENTIAL BARRIERS TO ACCESSING NON-MEDICAL TRANSPORTATION (NMT)

HEALTH PLAN MEMBERS MAY EXPERIENCE THE FOLLOWING: Each health plan requires advance notice for non-urgent transportation – ranging from 24 hours notice to 7 business days. Some plans were requiring providers to fill out request forms for NMT. This is required for NEMT, which is causing confusion. NOT REQUIRED FOR NMT!!!! Some plans may say that transport over county lines or over a certain distance may require plan/provider approval or at least be verified. Some plans may be confused about what Medi-Cal actually covers and therefore may be confused about what is actually included in the transportation benefit. For example, if the plan representative doesn’t know that full dental coverage has been restored for adults. Whether the beneficiary is in Medi-Cal Managed Care or FFS, all Medi-Cal covered services allow for access to this transportation benefit. The plans ALSO have to cover the transportation to carved out services such as dental and mental health services.

WHAT IF YOUR CLIENTS EXPERIENCE PROBLEMS ACCESSING NMT? Health Plan Email Rene.Mollow@dhcs.ca.gov with a cc: to Laurie.Weaver@dhcs.ca.gov File a grievance with the plan Ask for a state hearing with this online form or by calling 800-952-5253 After going through the plan grievance process, you can file a complaint with DMHC by calling 888-466-2219 or by filling out the online form. Fee-For-Service Ask for a state hearing with this online form or by calling 800-952-5253

ACCESSING TRANSPORT THROUGH CALIFORNIA CHILDREN’S SERVICES (CCS) Transportation: If it is hard for you to get your child to medical care provided by CCS, the Nurse Case Manager can help. In some cases, CCS may be able to arrange the ride you need. Maintenance and Transportation (for parents when their child in the hospital): Sometimes CCS can help families in need with rides, parking, food, and/or lodging nearby. For more information contact: 1-800-288-4584 http://publichealth.lacounty.gov/cms/ccs.htm

WHAT IF CLIENTS ARE STILL HAVING PROBLEMS? Advocates should contact: If the state is not assisting please contact MCHA’s Brigid Sweeney at 213-749-4261 or BrigidS@mchaccess.org Consumers should contact: Health Consumer Center (Los Angeles) 818-492-5270 Health Consumer Alliance (other counties) 888-804-3536

LACPECHVC REFERRALS WORKGROUP’S NEW TRANSPORTATION RESOURCE

THANK YOU! QUESTIONS? Brigid Sweeney BrigidS@mchaccess.org Tel: 213.749.4261 Ext. 342 www.mchaccess.org

Non-emergency MEDICAL transport (NEMT) includes the transportation of sick, injured, convalescent, infirm or otherwise incapacitated beneficiaries by ambulance, litter vans, or wheelchair vans. The beneficiary requires door to door service. Requires a prescription from medical provider. Emergency medical transport (EMT) is transportation for an .