Health Net is responsible for NMT to Medi-Cal services, including services that are carved-out, including but not limited to dental services, specialty mental health services and pharmacy services. Members are instructed to contact the Medi-Cal Member Services Department , Community Health Plan of Imperial Valley Member Services Department or CalViva Health Medi-Cal Member Services Department (for Fresno, Kings and Madera counties) to request NMT services.

PPGs or hospitals that have risk for NEMT in the Division of Financial Responsibility (DOFR) must authorize and coordinate with their transportation provider for medically necessary services in a timely manner. Failure to do so will result in the plan approving and arranging the transportation and processing a capitation payment deduction. A Physician Certification Statement (PCS) form is required for all NEMT services. A PCS process must be followed to collect the PCS form and arrange NEMT services.

Participating physician groups and hospitals that have risk for NEMT in the Division of Financial Responsibility (DOFR) must authorize and coordinate with their transportation provider to ensure Medi-Cal members have 24-hour access to NEMT to a pharmacy or urgent care facility that is open 24 hours a day.

Health Net provides NMT through Modivcare for medically necessary covered services and all Medi-Cal covered services.

NEMT services are covered when the member's condition is such that ordinary means of transportation are medically inadvisable. Such transportation is covered only for the purpose of obtaining needed Health Net-covered service. Coverage is limited to the least costly medical transportation available to adequately meet the member's medical needs. Modivcare will send a physician certification (PCS) form to physicians to indicate approval for level of service. A PCS form is required before NEMT can be provided, therefore, it is very important for ordering providers to return the completed and signed form.

NMT services are covered for members to obtain medically necessary Medi-Cal services, including carve out services, including but not limited to, specialty mental health, substance use disorder, pharmacy, dental, and any other benefits covered by FFS Medi-Cal.

NEMT and NMT services include transportation for the member and one attendant, such as a parent, guardian or spouse, and must be requested at the time of the initial transportation arrangement.

With written consent of a parent or guardian, NEMT and NMT may be arranged for a minor under age 18 who is unaccompanied by a parent or guardian. Health Net provides transportation services for unaccompanied minors under age 18 when state or federal law does not require parental consent for the minor's services. All necessary written consent forms, such as Consent for Minors to Travel without an Escort Form (PDF), must be received prior to arranging transportation for an unaccompanied minor and must be provided to Health Net.

Non-emergency medical transportation (NEMT) includes ambulances, wheelchair vans and gurney vans and is provided when medically necessary and the patient is not ambulatory.

NEMT is a covered Medi-Cal benefit when the member needs to obtain medically necessary covered services and when prescribed in writing via the PCS form signed by a physician, physician assistant (PA), nurse practitioner (NP), certified nurse midwife (CNM), dentist, podiatrist, or mental health or substance use disorder provider. NEMT under Medi-Cal is covered only when the patient's medical and physical condition is such that transport by ordinary means of public or private conveyance is medically contraindicated. Additionally, NEMT is covered for patients who cannot ambulate or are unable to stand or walk without assistance, including those using a walker or crutches. This includes door-to-door assistance for all members receiving NEMT services.

The physician is required to document the member's limitations and provide specific physical and medical limitations that preclude the member's ability to reasonably ambulate without assistance or to be transported by public or private vehicles. NEMT may be authorized for visits up to 12 months in advance. A new PCS form is required every 12 months if NEMT is continued to be utilized.

NEMT necessary to obtain medical services is covered subject to the written authorization of a licensed practitioner consistent with their scope of practice. Additionally, if the non-physician medical practitioner is under the supervision of a physician, then the ability to authorize NEMT also must have been delegated by the supervising physician through a standard written agreement.

PAs, NPs and CNMs may sign authorization forms required by the department for covered benefits and services that are consistent with applicable state and federal law and are subject to the supervising physician and PA/NP/CNM being enrolled as Medi-Cal providers pursuant to Article 1.3 (commencing with Section 14043) of Chapter 7 Part 3 of Division 9 of the Welfare and Institutions Code (W I Code).

The NEMT modalities, in accordance with the Medi-Cal Provider Manual, are:

Use the Physician Certification Statement Form – Request for Transportation – Health Net (PDF), Physician Certification Statement Form – Request for Transportation – CalViva Health (PDF) or Physician Certification Statement Form – Request for Transportation – Community Health Plan of Imperial Valley (PDF) to document the specific transportation restrictions of a member due to a medical condition, and request non-emergency medical transportation (NEMT) for Medi-Cal members. A physician certification statement (PCS) form is not required for non-medical transportation (NMT).Providers who may complete and sign the PCS form include:

• Physician
• Dentist
• Podiatrist
• Physician assistants (PAs)
• Nurse practitioners (NPs)
• Certified nurse midwives (CNMs)
• Mental health or substance use disorder providers

Modivcare can also arrange non-medical transportation (NMT), including rideshare, passenger car, taxi or other forms of public/private conveyances for certain ambulatory members needing transportation assistance when services are covered or for any Medi-Cal covered service, as follows:

NMT includes transportation for medically necessary appointments or for any Medi-Cal covered service, and may be provided by rideshare, passenger car/sedan, taxicab, paratransit, such as Access, or fixed route transportation, such as a bus, and mileage reimbursement.

NMT services include: round-trip transportation for a member by rideshare, passenger car, taxicab, or any other form of public or private conveyance (private vehicle), as well as mileage reimbursement (at the time transportation is arranged), bus passes, taxi vouchers, or train tickets for medical purposes.

Round-trip NMT is available for the following:

Participating physician groups (PPGs) and hospitals must submit a list of their contracted ground emergency medical transportation (GEMT) providers annually. This applies to Medi-Cal providers contracted under a global and dual risk arrangement. The list is due annually no later than March 31.The list will help identify non-contracted GEMT providers for automated payments that meet the requirements under the Department of Health Care Services’ Public Provider Ground Emergency Medical Transport (PP-GEMT) and GEMT quality assurance fee (QAF) programs. At a minimum, include the following information on the list:

• Provider name.
• Provider type (PPG or Hospital).
• Risk type (Dual or Global).
• GEMT provider name.
• GEMT National Provider Identifier (NPI) number.

PPGs and hospitals can send their list to their assigned Provider Relations & Contracting Specialist (PRCS).