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HOW TO REQUEST Non-Emergency Medical Transportation This a guide on how to use the transportation benefits offered by the HUSKY Health Program

Table of Contents Important Resources 3 What Is NEMT? 3 Who is Eligible for NEMT? 3 Transportation Options 4 Scheduling a Ride 5 Special Requirements 7 Approvals and Denials of Trip Requests 9 During Your Ride 10 How to File a Complaint 12 veyo.com 2

Important Resources Reservation Line 855-478-7350 Normal Hours of Operation Member Information Website 7:00 AM to 6:00 PM EST M-F ct.ridewithveyo.com What is NEMT? Non-Emergency Medical Transportation (NEMT) is a limited transportation benefit that is provided to eligible HUSKY Health Medicaid members who have no other way of getting to their medical, behavioral health or dental appointments. Who is eligible for NEMT? Veyo coordinates transportation for HUSKY A, C, D and limited benefit Medicaid members. You must be attending a covered medical appointment and have no other way of gettting there. Veyo only offers NEMT services to members that cannot drive themselves, and/or do not have a neighbor, friend, relative, or voluntary organization that can transport them to their appointment. veyo.com 3

You can go to any provider you choose within your local community (within 10 miles if you live in an urban area, within 20 miles if you live in a rural area). If you need to attend an appointment that is outside of your local community, have your medical, dental, or behavioral health provider complete a Closest Provider Certification Form to Veyo before your trip. The Closest Provider Certification can be found at: ct.ridewithveyo.com/forms If you do not have access to a computer, please call your healthcare provider and let them know that you need the form filled out and that it can be downloaded at ct.ridewithveyo.com/forms. Your healthcare provider must complete the form and email or fax it back to Veyo. The email and fax information can be found on the form. Rides are not provided to pick up prescriptions or medical equipment that does not need to be fitted. Transportation Options There are multiple kinds of transportation available: Bus Passes. If you live close enough to a bus stop and are able to ride the bus, a bus pass may be provided. veyo.com 4

Mileage Reimbursement. If a family member or friend has a car and is able to drive you to your appointment, they may be eligible to be reimbursed based on the total miles driven. If you are not able to ride the bus or get a ride, Veyo will schedule a ride for you with an appropriate vehicle based on your medical and transportation needs. This may be one of the following options: o Car/Vehicle or Rideshare Vehicle o Wheelchair Van o Ambulance o Another approved form of transportation Your doctor will need to fill out a Medically Appropriate Mode Form explaining why you are unable to take public transportation. This form can be found at: ct.ridewithveyo.com/forms. Scheduling a Ride You can request a ride by calling Veyo at 855-478-7350 Monday through Friday between 7:00 AM and 6:00 PM. For bus passes, please call at least 5 business days before your scheduled appointment. Additional time is needed for bus passes to be delivered to you. veyo.com 5

If you qualify for mileage reimbursement, a car, or a wheelchair vehicle, please call at least 2 business days before your scheduled appointment. The chart below gives you examples of when you would need to call to schedule a ride: Key information to keep in mind: Veyo s Call Center is open from 7:00 AM to 6:00 PM EST Monday through Friday for scheduling routine appointments The reservation phone line is 855-478-7350 Transportation for routine appointments can be scheduled up to 30 days in advance Repeating trips can be scheduled up to 180 days in advance If the trip request is received with less than 2 business days notice, and the appointment is not urgent, you may need to reschedule your appointment Requests for hospital discharges and urgent* trips will be scheduled immediately and are taken 24 hours a day, seven days a week. Please note: it may take up to 3 hours to arrange a ride for hospital discharge or urgent trips veyo.com 6

*An Urgent trip request is when a medical, dental, or behavioral health provider determines that you must receive services in less than 2 business days. When scheduling your trip, please keep in mind that the driver may drop you off at the healthcare facility right at your scheduled appointment time. If it is a large facility or you need to arrive before the appointment time, please make sure to factor this in when scheduling the trip. Can other people request transportation for a member? Yes. A relative, a caregiver, or a healthcare provider may call and schedule transportation on your behalf. What information will I need when I call to schedule a ride? When you call Veyo to schedule transportation, please be sure to have the following information available: Medicaid ID # First and Last Name Date of Birth Phone Number where you can be reached Pick-Up Address, Including Apartment Number Appointment Date Appointment Time Provider / Facility Name veyo.com 7

Address of Appointment, Including Office or Suite Number If Appointment Is Repeating Mode of Transportation Being Requested Special Accommodations (e.g. oxygen tank, no multi-loading) Companion or Attendant Information Special Requirements Forms Depending on your personal situation, different forms may need to be completed before booking transportation with Veyo. Below are the most common examples: Medically Appropriate Mode Form. If you are unable to travel by public transportation, this form must be completed by your healthcare provider indicating the most medically appropriate mode(s) of transportation for you. Closest Provider Certification. This form must be completed by your healthcare provider to verify that, for medical reasons, you need to travel to an appointment over 20 miles from your house. Minor Consent to Travel Form. This authorization form must be completed by a parent or legal guardian before a child veyo.com 8

between the ages of 12-15 can travel without an adult escort or aide. Companion Request Form. This form must be completed when you have a medical need to have someone travel with you to your medical appointment. Mileage Reimbursement Driver Registration Form. Have your friend or family member register as your driver if they intend to use their own vehicle to bring you to and from your appointments and need to be reimbursed for the trip. Mileage Reimbursement Form. Have your friend or family member complete this form if they have registered as your driver and driven you to an appointment that they would like to request reimbursement for the trip. Each form can be downloaded at ct.ridewithveyo.com/forms or requested over the phone by calling the Veyo Call Center at 855-478- 7350. You can find out your form(s) approval status by calling 855-478- 7350. All forms must be signed by a licensed treatment professional (example: MD, LCSW, LMFT, APRN, RN). Signatures from Certified Nursing Assistants, Patient Techs, Receptionists, Medical Assistants, etc. are not acceptable. Please make sure you call the Veyo Call Center if any information (such as your address, phone number, etc.) changes. veyo.com 9

Children Under 16 Years Old A parent, legal guardian, or caregiver is required to travel with any child under 16 years of age. Parents must fill out, sign, and return the Minor Consent to Travel Form to Veyo before any child between 12-15 years old will be able to ride alone. Any child who behaves inappropriately while riding alone will need to be accompanied by an adult for all future rides. Medically Required Attendants or Escorts A medically required attendant, escort, aide, assistant, or companion may ride with you if you need help. Your healthcare provider will need to fill out and submit the Companion Request Form before your trip. Once your healthcare provider has verified that the person (for example: your sibling or your parent for family counseling) is needed at your appointment, the person may ride with you. Your newborn or nursing infant (up to 6 months old) may ride with you, as long as you provide an appropriate car seat for the child. If a person does not meet the criteria above, they will not be able to ride with you to or from your appointment. veyo.com 10

Approvals and Denials of Transportation Requests Approvals You will know you have been approved for NEMT when you call the Veyo Call Center at 855-478-7350 to ask about your status or a Veyo Call Center agents calls you to confirm your appointment. Denials You will know you have been denied for services when you call the Veyo Call Center to ask about your status or you receive a Notice of Action (NOA) letter in the mail informing you that you were denied. With the NOA letter, you will receive instructions on how to appeal the denial by submitting a request for an Administrative Hearing to question the decision. This process is called Requesting a Hearing. If you do not submit the request for an Administrative Hearing paperwork within 60 days from the receipt of the NOA letter, you will lose your right to appeal the denial. During Your Ride We want Veyo to be enjoyable and safe for everyone. These ground rules are designed to ensure that riders and drivers have the best experience possible. veyo.com 11

Your Responsibilities: Be ready 15 minutes before your scheduled pick up time Wait in a safe area where you can see when the driver arrives Enter the vehicle immediately upon its arrival If needed, bring your own special equipment such as a car seat, wheelchair, oxygen, or a walker Be thoughtful and respectful to the driver and any additional passengers Do not bring alcohol, drugs, or weapons in the vehicle Do not smoke, eat, or drink in the vehicle Always wear your seatbelt while traveling in the vehicle Sign the driver s log after you are driven to your drop off location. You should only sign for the trip you just received. If you have a return trip, you will sign for that trip after it is completed. This is used to document that the trip was provided to you. Shared Rides You may be sharing a ride with another member who is traveling to and from the same area as you. Shared rides with other Medicaid members are allowed. If there are special health circumstances which prevent you from sharing a ride with other individuals, please tell Veyo when you call to schedule your ride. Your healthcare provider will need to note this on the Medically Appropriate Mode Form to communicate to Veyo that you should not be scheduled for a shared ride. veyo.com 12

Finding Your Ride If the ride is late, you can call Veyo at 855-478-7350 prompt #4 to ask for an update on your ride. Updating Your Reservation If you are not able to make your appointment and need to cancel or reschedule your ride, please call the Veyo Call Center at 855-478-7350 as soon as you become aware that you no longer need a ride. Please cancel your ride even if it is a bus ride or a mileage reimbursement trip. If your appointment date or time has changed, please remember to call and update the Veyo Call Center at 855-478- 7350 of the change so we can adjust your transportation reservation. Snowstorm or Bad Weather Event If there is a snowstorm or bad weather, check with your healthcare provider to make sure their office is open. If you do not feel it is safe to travel, call Veyo s Call Center 855-478-7350 as soon as possible to cancel your ride. If your town cancels school for the day or has early dismissal due to weather, children will not be transported to after-school treatment programs if the schools in the town they live in are closed or the schools in the town the program is located in are closed. veyo.com 13

Every effort is made to continue to operate transportation services during bad weather, however, delays and cancellations may occur due to unsafe travel conditions. Because safety is Veyo s top priority, we ask members and drivers to reschedule trips if they do not feel it is safe to be on the road. Driver Responsibilities All drivers and cars must be properly licensed and insured Drivers must follow all the normal rules of the road including not using a cell phone without a hands-free device unless the vehicle is parked No smoking while a member is in the vehicle Reduce volume on the radio, per member request Maintain air conditioning or heat at a reasonable temperature Secure passengers who are in a wheelchair as appropriate for safe travel Store any unoccupied wheelchairs or other medical equipment safely Pick members up between 15 minutes before and 15 minutes after the scheduled pick up time Wait up to 15 minutes after the scheduled pick up time for the member to enter the vehicle Drivers are required to help members get from the outside door of their pick-up location into the vehicle, and from the vehicle to the outside door of their drop-off location, if you ask for their veyo.com 14

help. The amount of assistance you receive will depend on the type and level of service you request. How to File a Complaint You, your healthcare provider, or caregiver can make a complaint through Veyo s website at ct.ridewithveyo.com/contact by phone at 877-558-2437. A complaint can be about many different things like an extremely late pick up, the condition of the vehicle you rode in, the behavior of another passenger, or courtesy of Veyo s Call Center agents. Please include the following information in your complaint to help the Veyo compliance team with their investigation: Your first name Your last name Your Medicaid ID # The date of your trip A description of the problem Any additional information that can help us investigate the issue After submitting a compliant, you will receive a call or written response within one to three business days depending on the type of complaint. You must also ask for a call back if you would like to receive one. veyo.com 15