What plans must do for transportation
DHCS sets the rules in All Plan Letter 22-008. Among them:
- Use a DHCS-approved PCS form, keep a copy on file for every NEMT member, and never change the mode the treating provider prescribed.
- Keep a direct line to the plan’s transportation liaison for providers and members to request rides and get status updates.
- Arrange urgent NEMT if the scheduled provider is late or doesn’t arrive, so the member doesn’t miss the appointment.
- Provide NEMT from an acute care hospital to a skilled nursing or psychiatric facility within 3 hours of the request.
- Keep the review of PCS forms in-house: it can’t be handed to a broker.
What it means for the provider
Plans decide who can drive their members. A provider may join a plan’s network for up to 120 days while its Medi-Cal enrollment is pending, and the plan must end the contract if DHCS denies the enrollment. Each plan, or its broker, also sets the pickup window, the paperwork and the billing route. DHCS names Kaiser Permanente, Anthem Blue Cross and CenCal Health as examples of plans; see California NEMT by plan for what we have checked about each.
Going deeper: Starting an NEMT business in California: licences, insurance and getting on Medi-Cal plans
Related terms
- Transportation brokerA transportation broker is a company that arranges NEMT and NMT rides on behalf of a health plan or state: it runs the call center, schedules the rides and hands them to transportation providers in its network.
- Payer (funding source)The payer, also called the funding source, is whoever pays for a trip leg: a broker, a health plan directly, Medi-Cal fee-for-service, a facility, a workers’ compensation administrator or the rider.
- Physician Certification Statement (PCS form)A Physician Certification Statement (PCS) is the form a member’s provider signs to prescribe NEMT.
- Prior authorizationPrior authorization is the payer’s approval of a ride before it happens.
- NEMT (non-emergency medical transportation)Non-emergency medical transportation (NEMT) is a ride to covered medical care for someone whose condition rules out ordinary public or private transport.
Sources
Checked on . Rules change: check the current version with the payer before you bill.