Medicaid Transportation in NYS

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. (https://www.medanswering.com/page.taf?ID=10)

Carve Out / Transportation Contractors

Non-emergency transportation was carved out of the Medicaid managed care benefit package as part of the Medicaid Redesign Team's Transportation Reform Initiative. The carve-out took place in 2012 and 2013. Enrollees in mainstream Medicaid managed care plans do not access transportation services through their plans, but directly through private contractors. Medical Answering Services, LLC, which until recently managed transportation in all counties statewide except Nassau, Suffolk, and New York City, was recently awarded the contract for New York City transportation. 

Medical Answering Services, LLC is handling New York City transportation as of April 23, 2017. LogistiCare continues to be the contractor for Nassau and Suffolk Counties. 

The complete list of contact phone numbers for the transportation vendors in each county is available here: https://www.emedny.org/providermanuals/transportation/pdfs/transportation_pa_guidelines_contact_list.pdf

PLEASE NOTE: Transportation remains a plan benefit for Managed Long Term Care (MLTC). MLTC enrollees must arrange for non-emergency transportation through their plans.

Prior Authorization for Non-Emergency Transportation 

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).

Coverage of Public Transportation in New York City: Public Transportation Automated Reimbursement System (PTAR) 

Medical Answering Services Procedures (all of NYS except Nassau and Suffolk Counties)

Who cannot get a ride through Medical Answering Services?

Medical Answering Services Contact Information

Medical Answering Services, LLC 

PO Box 12000 

Syracuse, NY 13218 

LogistiCare Procedures (Nassau and Suffolk Counties)

Fair Hearing Advice:

DOH Contact Information

To complain about transportation issues, contact the Department of Health at medtrans@health.ny.gov or (518) 473-2160.

Links



Article ID: 143
Last updated: 06 Jul, 2017
Revision: 10
Medicaid -> Other Services -> Medicaid Transportation in NYS
http://www.wnylc.com/health/entry/143/