Welcome to the LogistiCare seminar Arranging non …...What is not urgent care? • Immediate or...

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Welcome to the LogistiCare seminar

Arranging non-emergency medical transportation

(NEMT) services for the WI SE Region MCO

Members


This presentation is located at the website below

https://facilityinfo.logisticare.com/wifacility

1. That website has this entire webinar, and

2. Documents you can download including

ForwardHealth updates for members and

providers, the standing order form and answers to

questions that healthcare facilities and Medicaid

members frequently ask about accessing non-

emergency Medicaid transportation.



What is LogistiCare (LGTC)?

1. LGTC is a transportation management company with

operations centers nationwide.

2. Our WI Operations Center is located at:

2335 City View Drive, Suite 200

Madison, WI 53718

(866) 907-5194 phone

(866) 907-5195 fax


What does LGTC do?

1. LGTC screens requests for non-emergency medical transportation (NEMT) for Medicaid and BadgerCare Plus and HMO members on behalf of DHS.

2. We help to determine whether the member qualifies for NEMT services, and if so, the most appropriate level of transportation for the member.

3. We then schedule and assign the transport to the appropriate NEMT service Provider based on the member’s medical and mobility needs.

4. LGTC also contracts and monitors the service delivery provider to ensure the quality of transportation companies that perform the NEMT service.


What is NEMT?

NEMT is any covered transportation to a Medicaid covered

service. However there are exceptions:

• Transportation initiated by dialing 911

• Non-emergency ambulance transport of a vent patient from

home, or from one hospital to another with patient on IV

medication

• Transport of a hospital inpatient from a hospital to a medical

test and return to the hospital

• Transport of a member to the /Developmentally Disabled/MR

training center


What changes Occur in September ?

1. DHS has contracted with LGTC to manage NEMT services

for members who have no other means of transportation

2. Members and healthcare facilities will contact LGTC, not the

transportation provider or the county, to request NEMT

services

3. LGTC will contract with and oversee the transportation

providers who will provide the NEMT, and report to DHS.


Which members are affected by the

implementation?

1. The new WI SE MCO implementation for non-emergency medical transportation will affect the members enrolled in the following HMO programs in the following Counties:

• Medicaid and BadgerCare Plus members who are enrolled in an HMO in Milwaukee, Waukesha, Washington, Ozaukee, Kenosha, and Racine counties will receive their NEMT services through LogistiCare.

2. Note: The following members will continue to receive transportation services through LGTC management system:

• Wisconsin Medicaid.

• Family-Planning Only Services.

• BadgerCare Plus Standard Plan

• BadgerCare Plus Benchmark Plan.

• Tuberculosis-Only Services.

• Express Enrollment for Pregnant Woman.

• Members enrolled in state-contracted managed care organizations (MCOs) who receive NEMT services on a fee-for-service basis.


Members Not Affected by the

Implementation

The WI SE MCO NEMT management system will not affect

members who reside in a nursing home.

Members who reside in a nursing home will receive

transportation by contacting the Transportation Provider of choice

through private commercial agreement.


Members Not Eligible for NEMT

NEMT services are not covered for members enrolled in:

1. BadgerCare Plus Core Plan or BadgerCare Plus Basic Plan. However, Core and Basic Plan members may also be enrolled in Family-Planning Only Services and may receive NEMT to covered family planning services only.

2. Wisconsin Well Woman Program.

3. Wisconsin Chronic Disease Program.

4. Qualified Medicare Beneficiary Only.

5. Qualifying Individual 1.

6. Qualified disabled working individuals.

7. SeniorCare.

8. Alien emergency services.

9. Specified Low-Income Medicare Beneficiary.

10. FamilyCare.


What are the “criteria” for NEMT?

1. The member has no other means of transportation

2. The “type” of transportation is covered,

3. Transportation is to receive a Medicaid covered

service


What “types” of NEMT are covered?

1. Bus/Mass Transit

• The member lives within ¼ mile of a bus stop

• The medical facility is within ¼ mile of a bus stop

• The member can walk ¼ mile

• The member understands common signs and directions

• Bus passes can be obtained by calling LGTC

2. Ambulatory: • The member can walk unassisted from doorway to curb

• The member can walk unassisted from the vehicle to the facility

3. Wheelchair can transfer • Member can transfer from the wheelchair to the seat of an

ambulatory vehicle

• The member’s wheelchair folds and can be placed in the rear of the vehicle


What “types” of NEMT are covered?

4. Wheelchair

• The member is confined to the wheelchair

• The member cannot transfer from the wheelchair to the seat of an ambulatory vehicle

• The member requires a lift-equipped wheelchair van

• No Medical Necessity Form is required

5. Stretcher

• The member cannot walk and is confined to bed

• The member cannot sit up or sit in a wheelchair

• The member does not require medical monitoring during transport

• No Medical Necessity Form is required

6. Mileage, meals and lodging may be covered

• Eligibility Requirements Apply


Examples of covered NEMT

1. A discharge from the hospital to Home

2. Member Home Residence to a Medicaid enrolled Medical Provider to receive a covered service

3. Member Home Residence for a medical treatment like dialysis


Examples of Non-covered NEMT

1. Transport to 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 services to

their residents

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

provider

4. Transport if the member or his/her family, neighbor, friend or

relative can provide transportation for free.

5. Transport for individuals whose eligibility is pending or for

members in “spend down” status (QMB)

6. Transportation of Medical Equipment – Wheelchairs

7. Transportation of a non-medically necessary family member


Must LGTC be contacted? How?

LGTC must be contacted for demand response routine, urgent, or standing order NEMT service

1. Routine NEMT

• Members, their families or medical providers call 866-907-1493, the Reservation number to schedule a routine trip

• A routine trip is an occasional, episodic trip to a Medicaid covered service. For example, a trip to the doctor on Thursday

• Schedule routine trips two business days in advance

• English, Spanish and Hmong language choices

• TTY Line: 866-288-3133 is the reservation number for the deaf/hearing impaired.

• Members reservations begin Monday August 20 to reserve trips from September 1, and beyond

3. Urgent NEMT • Call 866-907-1493

• Requests for urgent NEMT services are taken 24 by 7.


What is an Urgent Care Transport?

1. An planned medical situation in which there is no immediate

threat to life or limb, but the member must be seen on the day

of the request and treatment cannot be delayed until the next

day.

2. Hospital discharges are considered as Urgent Care.

3. LGTC will verify with the medical provider of the medical

service that the need for urgent care exists.

4. Valid requests for urgent care transports shall be provided

within three (3) hours from the time of the request. Shorter

response are common.


What is not urgent care?

• Immediate or Emergent is transportation that is initiated by dialing 911.

• It is not Urgent Care if immediate response to take a member to the emergency room for evaluation of a new or suddenly worsening condition that threatens life or limb (e.g., any sudden life threatening medical situation, significant trauma, comas, shock, uncontrolled bleeding, respiratory distress, poisoning, drug overdose or any situation where immediate medical relief or treatment is necessary.)

• It is not transportation that someone forgot to schedule two business days in advance.


How is a Standing Order transport

Requested?

1. Call the Facility Dept. at 866-907-1497 to set up standing

order transport, or simply fax in a standing order request form

to 877-352-5629

• Standing Order NEMT means regularly occurring trips to a

Medicaid covered service (3 times per week for 3 months or

more duration) for members with no other way to get a ride

• Call the Facility Department at 866-907-1497 is the Facility

Department phone number

• The number is for the exclusive use of facilities

• Calls are accepted beginning Friday, August 17, after 7:00 AM

• You can call to set up or change a standing order

• You can call to request a routine trip for one of your patients



Requested?

2. The staff will request a Standing Order Request form be

completed - Get the form at:


3. The medical provider must fax the completed form to:

877-352-5629 (we don’t accept forms from members).

4. The Standing Order is entered in our system. It generates

trips for 3 months. Recertification is required.

5. Future trips are automatically generated according to

schedule. Refaxing is necessary only for changes to the

schedule or the member’s mobility changes

6. Regularly occurring trips for less than 3 days per week, just

are called in to the Reservation Line – 30 day limit



Standing Order Request Form for Appointments Occurring 3 Days or More per Week

The Facility Dept. phone is (866) 907-1497. Its fax is (877) 352-5629

Non-emergency medical transportation is not available for members who transport themselves or who reside in a nursing home.

Member’s Name: _________________________ DOB: ___-___-____ Gender: M_ F_ ForwardHealth #_______________________

Name of parent/guardian (if applicable): ____________________________________________________ Phone ( ) ____- _____ Appointment Days: ( )Sunday ( )Monday ( )Tuesday ( )Wednesday ( )Thursday ( )Friday ( )Saturday

Start date: _______ Requested by: ______________________ Relation to the member: ___________ Phone ( ) ____- _____

Level of Service: ( ) Bus. Bus stops are within ¼ mile of residence & ¼ mile of the medical provider. Member can walk ¼ mile.

( ) Ambulatory. Member can walk from doorway of residence to the curb.

( ) Wheelchair can transfer: Member can transfer to & sit in the seat of ambulatory vehicle. Wheelchair folds.

( ) Wheelchair: Member is permanently confined to wheelchair & requires a lift-equipped wheelchair van.

( ) Stretcher: Member confined to bed & cannot sit up. Does not require medical monitoring during transport.

Patient Condition: _________________________________________________ Facility NPI #: ___________________________

Treatment Type: __________________________________________________ Procedure Code(s): _______________________

Can the member sign the Driver’s Log? Yes: ___ No: ___ If no, is member’s inability to sign permanent? Yes: ___ No: ___ Please explain if member’s inability is permanent: ______________________________________________________________

Transportation Provider currently transporting member: ____________________________ Phone ( ) ______-________

Pick Up: Check if it’s the person’s home ( ) or a facility ( ). If a facility, please name it: ________________________________

Please confirm the member’s pickup address with the member as some members change residence frequently.

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 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: ( )

Authorization: I request non-emergency medical transportation for the named member only for those days when the member will receive a covered service at the named facility. I affirm that the information above is accurate, and that I am a physician, physician's assistant, nurse midwife, or nurse practitioner.

Signature: _________________________________________________________________________ Date: ____-____- _____ Please print your name: __________________________________________________________ Phone: ( ) _____- ______

For LGTC use only: Recertified: ______ Terminated: _______ Date: ___________ By: _________________________________

Reason for recertifying/terminating the standing order: ____________________________________________________________

PLEASE FAX THE COMPLETED FORM TO WISCONSIN FACILITY DEPT at (877) 352-5629


Requested?

2. On-Line Order Entry Method

• https://facility.logisticare.com/

• The Facility Services Website (FSW) processes Wisconsin

healthcare facilities NEMT requests for their Medicaid service

enrollees. This eliminates the need to call in or fax these

requests

• TO USE THE WEBSITE:

• A medical facility, must register with our Facilities Department.

• Must complete the Medical Practitioner Electronic Data Interchange (EDI)

Form.


https://facility.logisticare.com/https://facility.logisticare.com/


How far in advance must we call?

1. Reservations are accepted two business days in advance

for “Routine” or “Standing order” trip requests

• The two days includes the day of the call but not the day of

the appointment

• For example, call on Monday for an appointment on

Wednesday

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


Ride Assistance: “Where’s My Ride?”

1. The “Where’s My Ride?” Line is available whenever a concern regarding a Member’s service requires adjustment, notice, or to report an incident concerning service.

• For example, transportation is late dropping off or picking up the member, if a LGTC staff is rude on the phone, if the vehicle appears to be in poor condition or if the member complains about the driver’s service.


How do I know which type of

transportation to request?

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

2. Based on the answers to those questions LGTC will determine whether ambulatory, wheelchair can transfer, wheelchair or stretcher service best meets the member’s mobility and medical needs

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


How soon will transport arrive?

1. For “Urgent” transports within 3 hours

2. For “Routine” or “Standing Order” transports at the scheduled

pick-up time or within a 15 minute “window.”

3. If the member says he/she will call for pickup after their

medical appointment (referred to as a “Will Call” return) then

the driver will arrive within 60 minutes of when LGTC

receives the call.


What are the LGTC service hours?

1. Routine Reservations and Standing Order Reservations:

Monday to Friday from 7:00 a.m. until 6:00 p.m.

2. “Urgent” Reservations: 24 by 7

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


Who is in LGTC’s transportation provider

network?

1. LGTC is contracting with local transportation providers and

will use current companies operating in the six county area.

2. Provided must meet compliance standards regarding

insurance, drivers and vehicles

3. “Preference” may be taken into consideration but cannot be

guaranteed

4. Contact the LGTC if you questions as to which transportation

provider will be used in your area, or if there are member

with “special” needs (e.g., bariatric special needs)


Questions - Discussion

Questions?

Welcome to the LogistiCare seminar Arranging non …...What is not urgent care? • Immediate or...

Documents

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