NEW YORK STATE MEDICAID PROGRAM

TRANSPORTATION MANUAL POLICY GUIDELINES

Transportation Manual Policy Guidelines

Version 2016-2 April 1, 2016 Page 1 of 65

Table of Contents

SECTION I REQUIREMENTS FOR PARTICIPATION .......................................................................... 4

QUALIFICATIONS OF AMBULANCE PROVIDERS CATEGORY OF SERVICE 0601 ............................................. 4 QUALIFICATIONS OF AMBULETTE PROVIDERS CATEGORY OF SERVICE 0602 .............................................. 5 QUALIFICATIONS OF TAXI (CATEGORY OF SERVICE 0603) AND NYC LIVERY (CATEGORY OF SERVICE

0605) PROVIDERS .................................................................................................................................................... 5

SECTION II TRANSPORTATION SERVICES ........................................................................................ 6

RECORD KEEPING REQUIREMENTS................................................................................................................... 6 Loss of Records Due to Unforeseen Incident ......................................................................................... 7

SERVICE COMPLAINTS ....................................................................................................................................... 8 REIMBURSEMENT FEES ..................................................................................................................................... 9 MEDICAID ENROLLMENT DOES NOT SUPPLANT LOCAL REGULATIONS ........................................................... 9 MEDICAID MANAGED CARE INVOLVEMENT........................................................................................................ 9 MANAGED LONG TERM CARE INVOLVEMENT .................................................................................................. 10 PREPAID MENTAL HEALTH PLAN INVOLVEMENT ............................................................................................. 10 AMBULANCE SERVICES .................................................................................................................................... 10

Advanced Life Support Assist/Paramedic ALS Intercept/Fly-Car Service ........................................ 10 Advanced Life Support First Response Services ................................................................................. 11 Advanced Life Support vs. Basic Life Support Services ..................................................................... 14 Territory ...................................................................................................................................................... 14 Ambulance Transportation of Neonatal Infants to Regional Perinatal Centers ............................... 14 Air Ambulance Guidelines and Reimbursement ................................................................................... 15 Abuse of Emergency Medical Services ................................................................................................. 17 Transportation of a Hospital Inpatient .................................................................................................... 17 Transport from an Emergency Room to a Psychiatric Center ............................................................ 17 Transport from an Emergency Room to a Trauma/Cardiac Care/Burn Center ............................... 18 Transportation from an Emergency Room to an Emergency Room ................................................. 18 Transportation from an Emergency Room to Another Facility ........................................................... 18 Ambulance Transportation by Volunteer Ambulance Services .......................................................... 18 Rules for Requesting Non-emergency Ambulance Transportation ................................................... 18 Medicare Involvement .............................................................................................................................. 19 Medicare Denied Excess Mileage........................................................................................................ 20 Subrogation Notice ................................................................................................................................... 21 National Provider Identifier ...................................................................................................................... 21

AMBULETTE SERVICES .................................................................................................................................... 21 Ambulette Enrollment Changes .............................................................................................................. 22 New York City Taxi & Limousine Licensure Requirement for Ambulette Companies Having

Contract Carrier Permits Issued by the New York State Department of Transportation ....................... 22 Subcontracting Transports ....................................................................................................................... 23 Stretcher Ambulette .................................................................................................................................. 23 Ambulettes and Oxygen ........................................................................................................................... 32 Ambulettes and Star of Life Logo ......................................................................................................... 33 Policy Regarding Vehicle Ownership or Leasing and Insurance ....................................................... 33 Ambulette as Taxi/Livery .......................................................................................................................... 33 Personal Assistance, Escorts and Carry-Downs .................................................................................. 33 Card Swipe Program ................................................................................................................................ 34 Surety Bond Requirement ....................................................................................................................... 35 Rules for Requesting Ambulette Transportation .................................................................................. 36

Transportation Manual Policy Guidelines

Version 2016-2 April 1, 2016 Page 2 of 65

TAXI AND LIVERY SERVICES ............................................................................................................................ 37 Rules for Requesting New York City Livery Transportation ............................................................... 37

SECTION III BASIS OF PAYMENT FOR SERVICES PROVIDED ..................................................... 38

PRIOR AUTHORIZATION.................................................................................................................................... 39 DOH-Contracted Prior Authorization Official ......................................................................................... 40 Inappropriate Prior Authorization Practices........................................................................................... 42 Requests for Prior Authorization Submitted After the Trip .................................................................. 42

RIDES GROUPED BY THE TRANSPORTATION PROVIDER ................................................................................. 43 Group Rides Developed by the Medicaid Program.............................................................................. 44 Multiple Riders from the Same Location ................................................................................................ 45

NON-EMERGENCY TRANSPORTATION OF RESTRICTED ENROLLEES ............................................................. 45 TOLL REIMBURSEMENT .................................................................................................................................... 46 SITUATIONS WHERE MEDICAID WILL NOT PROVIDE REIMBURSEMENT AND/OR MAY SEEK POST-PAYMENT

RECOUPMENT ......................................................................................................................................................... 47 REPORTING OF VEHICLE AND DRIVER LICENSE NUMBERS ............................................................................ 47 TRANSPORTATION UNDER THE FAMILY PLANNING BENEFIT PROGRAM ......................................................... 48 PROGRAMS AND FACILITIES CERTIFIED BY THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES

(OPWDD) ............................................................................................................................................................... 48 ADULT DAY HEALTH CARE (ADHC) TRANSPORTATION ................................................................................. 48 AMBULETTE FEE CHANGES IMPLEMENTED BY THE MEDICAID REDESIGN TEAM ........................................ 49

New York City Fee Change Effective March 15, 2014 ........................................................................ 50 AMBULANCE SERVICES - USE OF CLAIM MODIFIER ........................................................................................ 51

Acceptable Claim Modifiers ..................................................................................................................... 52 AIR AMBULANCE FEE SCHEDULE .................................................................................................................... 53 AMBULANCE PR