Wisconsin Hospitals FAQ Question: What will change on July 1 for ForwardHealth members who are eligible i for non-emergency medical transportation (NEMT) services? Answer: The Department of Health Services (Department) has contracted with LogistiCare to manage NEMT services for members who have no other means of transportation. As a result, ForwardHealth members and Wisconsin healthcare facilities will no longer contact a private transportation provider or their county to request NEMT services. Beginning on July 1, ForwardHealth members and Wisconsin healthcare facilities will contact LogistiCare directly for all their Medicaid transportation. Question: What is LogistiCare? Answer: LogistiCare is a transportation management company with operations centers nationwide. The Wisconsin operations center is located at 2335 City View Drive, Suite 200, Madison, WI 53718. Question: What will LogistiCare do concerning rides for eligible members with no other means of transportation? Answer: LogistiCare will receive all requests for Medicaid transportation at their Wisconsin call center. LogistiCare will provide eligibility screening for all Medicaid transportation requests on behalf of the Department. LogistiCare will essentially perform the same transportation request screening function that the counties previously performed. For example, LogistiCare will help to determine whether the member qualifies for NEMT, and if so, they will determine the most appropriate level of transportation for the member. LogistiCare will then schedule and route the NEMT trip based on the member s medical and mobility needs. LogistiCare will credential, contract with, and pay local Wisconsin transportation companies who provide Medicaid NEMT service. Question: What is non-emergency medical transportation for ForwardHealth members? Answer: NEMT is any covered transportation to a Medicaid covered service. For example, a discharge from the hospital, or transport to a Medicaid enrolled physician to receive a medically covered service, or transportation for a medical treatment like dialysis. Certain services will not be handled by LogistiCare under Wisconsin policy. For example, the following services will not be covered by LogistiCare: Transportation to a any non-medicaid covered services such as AA meetings or medically unsupervised weight reduction classes All transportation initiated by dialing 911 Transportation for nursing home residents (Nursing home facilities will continue to provide transportation for their residents.) Non-emergency ambulance transportation of a vent patient from home, or from one hospital to another when the patient is on IV medication. 1
Transportation of a diagnosis-related group (DRG) patient from a hospital to a medical test and return to the hospital. Transportation of a member to the Developmentally Disabled/MR training center. Transportation costs to meet a member s personal choice of provider when a less expensive alternative is available. Transportation if the member or his/her family, neighbor, friend or relative can provide transportation without financial reimbursement, i.e., free transportation. Transportation for individuals whose eligibility is pending or for members in spend down status. Question: What are the criteria for Medicaid transportation eligibility? Answer: The member is currently enrolled in Wisconsin Medicaid or BadgerCare Plus program that is eligible to receive NEMT service. The member has no other means of transportation available to them, such as family, friends, or neighbors who can provide a ride without reimbursement. The service the member is going to or returning from is a Medicaid covered service. Question: Can hospital discharge planners arrange discharges by calling LogistiCare? Answer: Yes. Discharge planners can schedule discharges 24 x 7 by calling the LogistiCare reservation line at 866-907-1493. Question: If the hospital emergency department requests a discharge in the middle of the night will LogistiCare be able to provide transportation to the person s home? What if the member is an HMO patient, will the HMO be able to provide transportation during the middle of the night? Answer: Yes, off hours transportation will be available. This transportation service includes all members enrolled in HMOs with the exception of those members enrolled in an HMO in Milwaukee, Waukesha, Ozaukee, Kenosha, Racine or Washington counties. Question: After the discharge has been called in, when will transport arrive? Answer: Under contract with the Wisconsin Department of Health Services, LogistiCare will have a no more than three hours to have transportation at the location of the discharging hospital. Question: How much advanced notice does LogistiCare require? Answer: There is no advanced notice requirement for hospital discharges and other urgent care nonemergency medical transports. Those types of requests are taken 24 x 7. Routine and standing order trip requests require two business days advance notice. For example, a member could call LogistiCare on a Monday to schedule routine transport to a Wednesday appointment with a physician, or a social worker in a free-standing or hospital-based dialysis clinic could call or fax in a request for three months worth of regularly reoccurring standing order transport for every Tuesday, Thursday and Saturday for an ESRD patient. Question: What kinds of non-emergency medical transportation are available? Answer: Six types. 1. Bus/Mass Transit provided that 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 and provided the member understands common signs and directions. Bus passes can be obtained by calling LogistiCare. 2
2. Common carrier transportation for members who can walk unassisted from doorway to curb, and can walk unassisted from the vehicle to the medical facility. 3. Common carrier transportation for those in a wheelchair who can transfer from their wheelchair to the seat of a common carrier vehicle and whose wheelchair can fold up and be placed in the rear of the vehicle. 4. Specialized Medical Vehicle (SMV) transport for members who are confined to wheelchair and cannot transfer from the wheelchair to the seat of an ambulatory vehicle. These members require a lift-equipped wheelchair van with appropriate seatbelt and securements for both member and wheelchair. In a change from current practice, no certificate of need or medical necessity form is required by LogistiCare to substantiate need for transport by either wheelchair or stretcher (gurney). 5. Stretcher transportation for those members who cannot walk, sit up or sit in a wheelchair. These members are confined to a bed. They do not require medical monitoring during transport but do require transport by stretcher. Again, no certificate or need or medical necessity form is required. 6. Mileage, meals and lodging is also covered and can be obtained by calling LogistiCare. Question: How will LogistiCare determine which type of transportation to assign? Answer: Upon receiving all incoming telephone transportation requests, LogistiCare will ask questions to assess the member s mobility and any special needs. Based on the answers to those questions LogistiCare will determine whether common carrier, SMV, or stretcher service best meets the member s mobility and medical needs. Question: What kinds of questions will LogistiCare ask to determine whether common carrier, SMV, or stretcher service best meets the member s mobility and medical needs? Answer: LogistiCare will ask a range of questions. Following are a few examples. Are you (is the Member) able to walk or do you (do they) require the use of a wheelchair or stretcher? If they are in a wheelchair or stretcher: WHEELCHAIR Is the wheelchair manual or electric? o MANUAL Are you (Is the Member) able to transfer without assistance? Is there a ramp at the residence? If yes, Is it in the front or back? If there s no ramp, Are there any steps? If yes, How many? Question: According to the contract with the Department of Health Services, what are some examples of call center performance standards LogistiCare must abide by? Answer: Callers may never receive a busy signal. The Department requires that 90 percent of all calls should be answered by a live operator within 180 seconds as measured on an average daily basis. Dropped calls may not exceed seven percent on an average daily basis. Live agents must be staffed during all operational hours. Written responses to inquiries or complaints must be provided within five business days. Question: Is LogistiCare held to any overall quality standards? Answer: Yes, LogistiCare must develop and maintain an ongoing assurance plan to support the provision of high-quality services. This plan and subsequent reports are required to be submitted to the Department on an ongoing and regular basis. 3
Question: What standards or reporting will LogistiCare have to provide to the Wisconsin Department of Health Services? Answer: LogistiCare will be required to regularly report on such subjects as, transportation providers and drivers, accident and moving violations, member complaints, telecommunications systems reports, and an annual fiscal audit report. Question: Does the Department require LogistiCare to provide NEMT services to a hospital for Medicaid and BadgerCare Plus members who are residents of a nursing home? Answer: No. The new NEMT management system will not affect members who reside in a nursing home. Members who reside in a nursing home will receive transportation through their resident nursing home. Question: Does the Department require LogistiCare to provide NEMT services for Medicaid and BadgerCare Plus members discharged from a hospital back to the member s nursing home? Answer: No. The new NEMT management system will not affect members who reside in a nursing home. Members who reside in a nursing home will receive transportation through their resident nursing home. Question: Does the Department require LogistiCare to provide NEMT services for Medicaid and BadgerCare Plus members who are not residents of a nursing home but who are discharged from a hospital to a nursing home (or to another Medicaid-enrolled provider) for temporary rehabilitation services? Answer: Yes. Question: If a child is inpatient, and hospital staff need to get the parent(s) or guardian transported to the hospital in order to learn cares (e.g., trach cares, g-tube feedings) will their transportation be covered by LogistiCare? Answer: Yes. Wisconsin Medicaid typically covered this limited activity and LogistiCare will too. Question: If a patient s ride fell through the morning of the appointment (e.g., their car breaks down and no one can get them to the hospital), will LogistiCare be able to help them if it is less than 2 business days advance notice? Answer: If it s not urgent care transportation per se, then no. However, if the physician at the hospital insists the appointment must occur that day and is impossible to reschedule, then our Medical Director will ask to speak directly with the physician before making the decision. Question: If LogistiCare determines that a member requesting transportation to a hospital does not qualify for NEMT services, will LogistiCare let the hospital know that and the reasons for denying the request? Answer: If the request came from the hospital, then yes. If the request came from the member, then LogistiCare will inform the member. Question: If a Medicaid or BadgerCare Plus member from northern Wisconsin needs to see a specialist in southern Wisconsin and qualifies for NEMT food and lodging services, how will they get that help? 4
Answer: It will occur exactly as Wisconsin policy requires. If providing funds up front is allowed and is required, then LogistiCare will do that in the amount(s) allowed by current Wisconsin policy. If the member plans to request reimbursement after the fact, then LogistiCare will provide it upon receiving the receipt(s) in the amount(s) allowed under current Wisconsin policy. Question: Will LogistiCare continue to require the certificate of need, signed by a physician or physician s assistant, to substantiate the need for specialized motor vehicle service? Answer: No. Question: Does LogistiCare provide webinars and on-line information about accessing non-emergency medical transportation? Answer: Yes. Webinars are available weekdays other than Fridays through late June. The webinar invitation is attached. Webinars are designed primarily for healthcare facility staff. In addition, the webinar presentation plus a variety of downloadable documents including ForwardHealth updates for members and providers, the standing order form for requesting regularly reoccurring NEMT services, and answers to questions that members and/or healthcare facilities frequently ask about non-emergency Medicaid transportation are all available at https://facilityinfo.logisticare.com/wifacility End Notes: i The new non-emergency medical transportation management system will affect most Medicaid and BadgerCare Plus members except those: Residing in a nursing home, or Enrolled in the BadgerCare Plus Core Plan, the BadgerCare Plus Basic Plan, SeniorCare, FamilyCare, or Receiving services through an HMO in Milwaukee, Waukesha, Ozaukee, Kenosha, Racine or Washington county. Specifically, the new management system will affect most of the members enrolled in the following programs: 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-forservice basis (e.g., Children Come First). Medicaid and BadgerCare Plus members who are enrolled in an HMO other than in Milwaukee, Waukesha, Washington, Ozaukee, Kenosha, and Racine counties will receive their NEMT services through LogistiCare. Non-emergency medical transportation are not covered for those Medicaid and BadgerCare Plus members enrolled in: 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. Wisconsin Well Woman Program. Wisconsin Chronic Disease Program. Qualified Medicare Beneficiary Only. Qualifying Individual 1. Qualified disabled working individuals. SeniorCare. Alien emergency services. Specified Low-Income Medicare Beneficiary. FamilyCare. 5
Again, LogistiCare will not be responsible for NEMT services for Wisconsin Medicaid or BadgerCare Plus members who are enrolled in an HMO in Milwaukee, Waukesha, Washington, Ozaukee, Kenosha, and Racine counties. ROH \ C \ WI \ DHS \ Draft FAQs for WI hospitals 05-27-11.doc 6