Ambulatory, NMT and NEMT
In Medi-Cal, members who can ride in an ordinary car and just need a way to get there use NMT: a sedan, a taxi, rideshare or mileage reimbursement. But walking is not the whole test. DHCS tells plans to provide NEMT for members who cannot reasonably walk, or stand or walk without help, “including those using a walker or crutches,” and forbids plans and brokers from downgrading a member from NEMT to NMT, “including ambulatory door-to-door services.”
What it means for the provider
An ambulatory rider might be on a broker’s NMT file one day and an NEMT authorization the next, with different rates and different paperwork. The trip should carry the space type and the service level the payer authorized, not the one the van happens to have free.
Ambulatory riders are also the easiest to share a ride, which is why many providers run sedans or keep seats in their wheelchair vans for them.
Going deeper: Wheelchair, ambulatory and stretcher trips: space types and what each needs from dispatch and billing
Related terms
- Space type (level of service)Space type, also called level of service, says how a rider travels and so what room they take in a vehicle: ambulatory (a seat), wheelchair, stretcher or bariatric.
- NMT (non-medical transportation)Non-medical transportation (NMT) is a Medi-Cal ride by private or public vehicle for a member who has no other way to get to a covered appointment.
- Curb-to-curb, door-to-door and door-through-doorCurb-to-curb, door-to-door, door-through-door and hand-to-hand are service levels: they say how far the driver goes with the rider, from the vehicle only to handing them to a named person inside.
- Wheelchair vanA wheelchair van is a vehicle with a lift or ramp and securements that carries a rider seated in their wheelchair.
Sources
Checked on . Rules change: check the current version with the payer before you bill.