States are required under federal regulations (42 C.F.R. §431.53) to assure necessary transportation to Medicaid beneficiaries to and from medical services.
When travelling to medical appointments, a Medicaid beneficiary is expected to use the same mode of transportation as the beneficiary would use to carry out the activities of daily life. Generally, this mode is public transit or a personal vehicle. However, for some Medicaid beneficiaries, their medical condition necessitates another form of transportation, such as an ambulette. Medicaid will pay for the most medically appropriate and cost-effective level of transportation to and from services covered by the Medicaid Program. All non-emergency transportation must be authorized prior to payment and only emergency ambulance transportation can be reimbursed without a prior authorization.
See IMPORTANT WEBSITES and WHERE TO COMPLAIN HERE.
Enrollees in MLTC plans, Medicaid Advantage Plus plans along with mainstream Medicaid managed care plans do not access transportation services through their plans, but directly through private contractors - Medical Answering Services, LLC, See this article on the NYS Dept. of Health website.
Non-emergency transportation was carved out of the Medicaid managed care benefit package as part of the 2011 Medicaid Redesign Team's Transportation Reform Initiative. The carve-out took place in 2012 and 2013. Medical Answering Services, LLC, gradually became the statewide contractor.
Through February 2024, transportation remained a plan benefit for Managed Long Term Care (MLTC) and Medicaid Advantage Plus (MAP) , requiring MLTC and MAP enrollees to arrange for non-emergency transportation through their plans. HOWEVER, as of March 1, 2024 this service is "carved out" and handled by a State contractor centrally. The carve out was postponed since Oct. 2021, but is now happening effective March 1, 2024.
Temporary Exemption for MLTC Members who use Transportation to get to Social Adult Day Care
MLTC members who use non-emergency transportation to get to Social Adult Day Care should still arrange this transportation through their plan for the time being, after March 1, 2024.. This benefit will be transitioned at a later date that has not yet been announced.
These two websites have information on how to schedule transportation, where to file complaints, where to download manuals and see updates:
NYS DOH Medicaid Transportation Webpage
https://www.health.ny.gov/health_care/medicaid/members/medtrans_overview.htm
Medical Answering Services, LLC - https://www.medanswering.com/ --
You can schedule transportation by phone or by creating an online account. Here are the contact numbers to request transportation (from the websites above)_
Upstate: 866-932-7740 - all other counties
You can also schedule transportation by creating an online account on the MAS website: https://www.medanswering.com.
Medical Providers can file online requests - using an online version of Form 2015 or fax a completed Form 2015 to: (315)299-2786. Providers hotline 1(866) 371-3881
If trip is outside the "Common Medical Marketing Area" - see here for extra form required.
When to request: The MAS website says you should request transportation for routine appointments at least 72 hours in advance, but can request urgent care on the same day.
Medical providers or enrollees should be prepared with the following information when requesting transportation:
NYS DOH Travel Reimbursement & Long-Distance Travel Policy Manual (eff Jan. 1, 2021)
18 NYCRR §505.10 is the regulation governing transportation for medical care and services. “Generally, payment will be made only upon prior authorization for transportation services provided to an eligible medical assistance recipient. Prior authorization will be granted by the prior authorization official only when payment for transportation expenses is essential in order for an eligible MA recipient to obtain necessary medical care and services which may be paid for under the medical assistance program.” 18 NYCRR §505.10(a).
Prior authorization generally must be obtained by the medical assistance recipient, his representative, or an ordering practitioner before the transportation expenses are incurred, but such authorization is not required for emergency ambulance transportation or Medicare approved transportation by an ambulance service under certain circumstances. 18 NYCRR §505.10(d)(1); 18 NYCRR §505.10(d)(2).
The request must be made in the manner required by the prior authorization official. 18 NYCRR §505.10(d)(3). A request for prior authorization for nonemergency ambulance transportation must be supported by the order of an ordering practitioner who is the medical assistance recipient’s attending physician, physician’s assistant, or nurse practitioner. 18 NYCRR §505.10(d)(4). The prior authorization official may approve or deny the request, or require additional information before doing so. 18 NYCRR §505.10(d)(6).
Prior authorization official is defined as the department, a social services district, or their designated agents. 18 NYCRR §505.10(b)(18).
The prior authorization official must use the following criteria to determine whether to authorize the payment of transportation expenses. 18 NYCRR §505.10(d)(7).
Prior authorization may be denied when the recipient can be transported to necessary medical care or services by use of a private vehicle or mass transportation which are used by the recipient for the usual activities of daily living. 18 NYCRR §505.10(d)(7)(i).
When the recipient requires multiple visits or treatments within a short period of time and would suffer undue financial hardship if required to make payment for the transportation to such visits or treatments, prior authorization for transportation expenses may be granted for a means of transportation ordinarily used by the recipient for the usual activities of daily living. 18 NYCRR §505.10(d)(7)(ii).
Prior authorization may be granted when the nature and severity of the recipient’s illness necessitates a mode of transportation other than that ordinarily used by the recipient. 18 NYCRR §505.10(d)(7)(iii).
Prior authorization for another mode of transportation may be granted when the nature and severity of the recipient’s illness necessitates a mode of transportation other than that ordinarily used by the recipient. 18 NYCRR §505.10(d)(7)(iv).
Prior authorization for the recipient’s usual mode of transportation may be granted when the distance to be travelled necessitates a large transportation expense and undue financial hardship to the recipient. 18 NYCRR §505.10(d)(7)(v).
Consumers must receive prior authorization for transportation outside the common medical marketing area (CMMA). Providers should submit Common Medical Marketing Area Form 2020-U to MAS in order to qualify.
Common medical marketing area is the geographic area from which a community customarily receives its medical care and the medical marketing takes place. It is not a geographic boundary but rather depends on the service from county to county and enrollee to enrollee. For instance, in NYC, the CMMA generally spans the five boroughs.
Prior authorization for transportation outside the CMMA will be granted ONLY when one of the following conditions are met:
When the requested medical care/services are not available within consumer's CMMA
When the medical need to continue a specialized regimen of care or service with a specific provider necessitates travel outside the CMMA even though the medical care or service is available within the CMMA
When there are any other circumstances which are unique to the enrollee and the transportation manager and/or the New York State Department determines that travel outside the CMMA is appropriate.
Common Medical Marketing Area 2020 Policy and Procedure and form:
Prior authorization for transportation expenses to medical care and services outside of the recipient’s common medical marketing area may be denied when the needed medical care and services are available within the common medical marketing area of the recipient’s community. 18 NYCRR §505.10(d)(7)(vi). (See Fair Hearing #6629770L below).
However, prior authorization for payment of transportation expenses for medical care and services outside the common medical marketing area may be granted when the need to continue a regimen of medical care or services with a special provider necessitates travel outside of the common medical marketing area, notwithstanding the fact that the medical care or service is available within the common medical marketing area. 18 NYCRR §505.10(d)(7)(vii).
Prior authorization for payment of transportation expenses may be granted when there are any circumstances which are unique to the recipient and which the prior authorization official determines to have an effect on the need for payment of transportation expenses. 18 NYCRR §505.10(d)(7)(viii).
Coverage of Public Transportation in New York City and elsewhere - see this link.
NYS has a Public Transportation Automated Reimbursement System (PTAR) - see PTAR webpage. Medicaid beneficiaries who are able to use mass transit can receive a pre-paid Metro Card for this purpose or from their provider. If they request the transportation from MAS at least 5 days before the appointment, they will receive a pre-paid card in the mail.
Medicaid expects that New York City Medicaid enrollees will use public transit if their appointment is within ten (10) city blocks of a bus or subway stop, so long as their medical condition permits this.
Medicaid enrolled facilities and practitioners may voluntarily participate in a web-based application established by the Department of Health called PTAR.
See this NYS eMedNY PTAR webpage for providers, including a user manual, instructions for providers to enroll, etc. Facilities and practitioners participating in PTAR purchase MetroCards directly from the Metropolitan Transit Authority (MTA) and when a patient enrolled in Medicaid uses public transportation to travel to a medical appointment covered by Medicaid, the participating facility or practitioner will distribute a pre-paid MetroCard to the enrollee. The facility or practitioner is then reimbursed by the State.
SEE eMedny Medicaid Transportation Ordering Guidelines - NYS
Who cannot get a ride through Medical Answering Services?
Enrollees who live within 10 blocks of their medical practitioner and who can walk there.
Enrollees who are able to utilize mass transit and are visiting a medical practitioner who participates in the Public Transit Automated Reimbursement (PTAR) system should not request transportation services from Medical Answering Services.
EMERGENCY needs - call 911 not MAS.
MLTC members who use non-emergency transportation to get to Social Adult Day Care should continue to use that transportation through their MLTC plan.. until further notice.
Provide as much documentation as possible and officially request reimbursement.
Fair Hearing #6629770L
Fair Hearing #6522862M
Fair Hearing #8045907Z
Contractor must inform Medicaid recipients of the need for prior authorization in order for transportation expenses to be paid and of the procedures for obtaining such prior authorization.
Fair Hearing #6532143J:
NYS DOH Travel Reimbursement & Long-Distance Travel Policy Manual (eff Jan. 1, 2021)