This chapter contains our plan policies related to medically necessary transportation services for Medicaid members to and from health care appointments (including Child/Teen Health Program [C/THP] appointments for all children under age 21), whether services are covered by EmblemHealth or by Medicaid fee-for-service (FFS). It also includes plan policies related to medically necessary transportation services for members enrolled in our Medicaid Advantage and Managed Long Term Care (MLTC) benefit plans. In counties where transportation services are covered by Medicaid FFS, information on how to access services through the local department of social services or other Medicaid FFS transportation vendor is provided.
Transportation in the event of a medical emergency does not require a prior approval for any of our members, including ASO and Commercial/CHPlus, as well as members in Medicare plans which are not otherwise covered in this chapter. All members are instructed to dial 911 to obtain immediate assistance.
Dual Eligible HMO SNP
These members, while "dual eligible" may only have very limited Medicaid coverage, e.g., Medicaid only covers payment of members' Medicare Part B, and may therefore not have transportation coverage through Medicaid FFS. Where members have both Medicare and Medicaid coverage for the same transportation service, the Medicare coverage is primary and considered part of their benefits through our plan.
Distance Travel Standards
Members are expected to select primary care physicians (PCPs) whose offices are within a reasonable proximity to their residence. Members are not entitled to transportation for distances less than 10 blocks unless there are special circumstances such as a physical disability.
In New York City, members must use public transportation unless a specific medical condition contraindicates such use.
General Reimbursement When the Plan Covers Transportation
- Health care providers (e.g., PCPs, OB/GYNs, physician group practices and dentists) are to reimburse members for round-trip public transportation to medical appointments and to appointments to which they refer members, including specialist appointments.
- EmblemHealth, or the applicable Managing Entity financially responsible for transportation services, will:
- Reimburse health care providers who dispense car fare to members upon submission of a properly completed Public Mass Transportation Reimbursement Ledger. Separate ledgers must be used to record transportation disbursements to members for whom a Managing Entity is financially responsible, and ledgers must be submitted to the Managing Entity.
- Reimburse health care providers who submit FFS claims when they include the transportation expense on the claims for the visit using CPT codes (Livery/Taxi A0100, Ambulette A0130 and Ambulance A0425 Mileage, A0426 ALS Non ER, A0427 ALS ER, A0428 BLS Non ER and A0429 BLS ER).
- Reimburse transportation costs for escorts of children and escorts for members of any age when medically necessary.
- Reimburse contracted taxi, ambulette and ambulance providers directly.
Exception: The Plan does not reimburse members for use of private vehicles.
EmblemHealth Contact Information When Transportation Is Covered by the Plan
- Members with HIP or HealthCare Partners (HCP) as their assigned Managing Entity: Call EmblemHealth Customer Service at 1-800-447-8255 to request transportation or fax the Medical Necessity Taxi Transportation Request Form to 1-631-719-0911.
- If the Managing Entity is Montefiore (CMO): Call 1-877-447-6668 to request taxi transport, or fax request to 1-914-377-4798. Please note: This does not apply to Medicaid members because we do not cover non-emergency transportation in CMO's service area of New York City and Westchester.
LDSS' Vendor Contact Information When Transportation Is Covered by Medicaid FFS
- Nassau County: EmblemHealth does not cover non-emergency rides for Medicaid members. Members should call Logisticare Solutions at 1-877-813-5602 to request transportation. Providers and members call1-516-227-8070 for reimbursement.
- New York City: EmblemHealth does not cover non-emergency rides for Medicaid members. Members and providers should call Logisticare of New York City at 1-877-564-5922 to request transportation. For Dual Eligible (PPO) SNP, call Human Resources Administration (HRA) at 1-212-630-1810.
- Suffolk County: EmblemHealth does not cover non-emergency rides for Medicaid members. Members should call Servisair at 1-866-952-1564 to register and request transportation. Providers call 1-866-952-1564 for reimbursement.
- Westchester County: EmblemHealth does not cover non-emergency rides for Medicaid members. These members or their providers should call Medical Answering Services at 1-866-883-7865 to request transportation services.