State of Wisconsin Non Emergency Medical Transportation ...

logisticare.com

State of Wisconsin

Non – Emergency Medical

Transportation Services (NEMT)

Webinar for Healthcare Providers

All Providers

2011 LogistiCare Solutions, LLC – Confidential & Proprietary 2

Today’s Agenda

Introduce LogistiCare

Transportation Management Model

Program Overview

Overview of Contracting Process

Questions


Over 20 years experience in transportation management including over 12 years of experience as a transportation manager of NEMT

Successfully operate in more diverse environments than any other transportation manager.

More experience than any other organization in the country with successfully managing capitated NEMT projects, both large and small

Contract retention rate – over 95% over the past 15 years

Met all start-up dates, met or exceeded all contract obligations, and established positive partnerships and long lasting working relationships

Consistently work to improve quality and access

LogistiCare Experience


Total Covered Lives:

over 6.9 million

Total Vehicles:

over 13,000

Completed Annual Trips:

over 24 million

Contracted Transportation

Providers: over 2,400

Public Transit Trips

Annually: over 7 million

Gross Trip Reservations

Annually: over 29 million

LogistiCare by the Numbers


Local Office

LogistiCare Solutions

2335 City View Drive

Suite 200

Madison, WI 53718


Contact Numbers

Health Care Providers:

(866) 907-1497

Members:

Reservation (866) 907-1493 English, Spanish, Hmong

Reservation (866) 288-3133 TTY Line/hearing impaired

Ride Assist (866) 907-1494 English, Spanish, Hmong

Administration:

Phone (866) 907-5194

Fax (866) 907-5195


What are the changes?

As of September 1, 2012:

• DHS has contracted with LogistiCare to manage NEMT services

for members in Milwaukee, Waukesha, Washington, Ozaukee,

Racine and Kenosha Counties that are enrolled in HMOs that

require transportation to medical appointments.

LogistiCare has been managing NEMT services for members not

enrolled in HMOs in these counties since July 2011,as well as

serving members statewide.

Beginning August 17, 2012:

• Members and healthcare facilities will contact LogistiCare to

request NEMT services for SEWI HMO members for services

needed September 1st and forward.


LogistiCare Responsibilities

Operate a Call Center and take trip requests from Medicaid clients, their families and/or their healthcare providers or those supporting clients.

Assess their need for transportation

Authorize/prior authorize transportation to a Medicaid-covered service

Determine the level of service based on the client’s health care needs

Schedule and assign trips to transportation provider

Contract with a network of transportation providers and monitor their compliance with driver, vehicle & insurance requirements

Pay providers & monitor their performance quality

Coordinate and communicate with DHS & other agencies


Members Served by LogistiCare

• Wisconsin Medicaid- ex: EBD 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-for-service basis

As of September 1, 2012 LogistiCare will also serve:

BC+ and SSI Managed Care Members in Milwaukee, Waukesha, Washington, Ozaukee, Racine and Kenosha Counties that are enrolled in HMOs.

Please note: Members enrolled in Family Care, Pace Partnership or Nursing

Home will not have their NEMT managed by LogistiCare.


What are the “criteria” for NEMT?

1. The member is eligible for NEMT services

2. The member has a financial hardship

3. The “type” of transportation required is covered

4. The service the member is going to is a Medicaid

covered service


What “types” of NEMT are covered?

1. Bus/Mass Transit

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

The member understands common signs and directions

Bus passes can be obtained by calling LogistiCare

2. Ambulatory:

The member can walk unassisted

3. Wheelchair can transfer

Member can transfer from the wheelchair to the seat of an ambulatory vehicle

The member’s wheelchair folds and can be placed in the rear of the vehicle


What “types” of NEMT are covered?

4. Wheelchair

The member is permanently confined to wheelchair

The member cannot transfer from the wheelchair to the seat of an ambulatory vehicle

The member requires a lift-equipped wheelchair van

No Medical Necessity Form is required

5. Stretcher The member is confined to bed

The member cannot sit up or sit in a wheelchair

The member does not require medical monitoring during transport

No Medical Necessity Form is required

6. Mileage, meals and lodging are also covered and can be obtained by calling LogistiCare

7. Non-Emergency Ambulance transportation is covered if the member requires advanced life support or basic life support services.


Examples of covered NEMT Transports

1. A discharge from the hospital

2. Transport to a Medicaid enrolled physician to receive a

medically covered service

3. Transport for a medical treatment like dialysis

4. Mental Health Programs

5. Physical Therapy

6. Pharmacy, associated with a scheduled transport


Examples of non-covered NEMT

1. Transport to a non-covered service (e.g., AA meetings, medically unsupervised weight reduction)

2. Transport for a nursing home resident

3. Transport of additional riders that are not a medically required attendant or a parent/caregiver of a young child

4. Transport of a member in “spend down”or “deductible” status


When do you contact LogistiCare?

1. Routine Trips:

• Reservations for future appointments should be made by calling (866) 907-1493

• Must be reserved a minimum of two business days prior to travel

• Staffed with English, Spanish and Hmong speaking representatives and availability of a language line.

• 866-288-3133 is the reservation number for the deaf/hearing impaired.

2. Standing Orders – Routine Services

• A routine Standing Order is an episodic trip to a Medicaid covered service. For example, Dialysis or Physical Therapy

• Schedule routine trips five business days in advance

3. Urgent Services

• Contact LogistiCare for Same day, Urgent or Discharges

• Reservations services are available 24 hours by 7 days


What is Urgent Care?

1. It’s an unscheduled episodic situation in which there is

no immediate threat to life or limb, but the member

must be seen on the day of the request and treatment

cannot be delayed until the next day.

2. LogistiCare will verify with the medical provider that

medical service is of an urgent nature

3. Valid requests for urgent care transport shall be

honored within three (3) hours of the time the request is

made.


What are LogistiCare Service Hours?

1. Routine Reservations:

• Monday to Friday from 7:00 a.m. until 6:00 p.m.

2. Standing Order Reservations:

• Monday to Friday from 7:00 a.m. until 6:00 p.m.

3. “Urgent” and Hospital Discharges Reservations:

• 24 Hours per Day and 7 days a week

4. Ride Assist/Where’s My Ride?:

• 24 Hours per Day and 7 days a week


Key Reminders • Members can request a ride only if they have no other way to get a ride.

• Members can request a ride only for a Medicaid covered service

• Members must call to schedule a ride at least 2 business days in advance, unless a situation meetings the urgent trip standards.

• When a reservation is placed the caller must have the member’s ForwardHealth ID number, and the name, address and phone number of the medical provider ready.

• Members must be ready to board the vehicle at the scheduled time.

• Members are responsible for any medical equipment, like a car seat for a child or a wheelchair.

• Only members receiving treatment, parents accompanying a young child, or a medically required assistant are permitted to ride in the vehicle.

• Urgent rides will be verified with the providers

• Members must contact LogistiCare to coordinate a stop at a lab or pharmacy on the way home from an appointment and have that part of the trip authorized.


Where is my Ride Line

“Where’s My Ride?” telephone number:

866-907-1494

A member, family member, social worker,

case manager or other medical provider can

call concerning a service issue. For example,

if transportation is late dropping off or picking

up the member.


Questions?

State of Wisconsin Non Emergency Medical Transportation ...

Documents

Transcript of State of Wisconsin Non Emergency Medical Transportation ...