Transportation

Health Net provides non-emergency medical transportation (NEMT) and non-medical transportation (NMT) to and from medical appointments for medically necessary covered services or any Medi-Cal covered services to all its Medi-Cal members through Health Net's preferred provider Modivcare™ (formerly LogistiCare). Health Net is responsible for NMT to services that are carved-out, including dental 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.

Non-Emergency Medical Transportation

Non-emergency medical transportation (NEMT) includes ambulances, wheelchair vans and gurney vans and is provided when medically necessary and the patient is not ambulatory. The NEMT under Medi-Cal is covered only when the patient's medical and physical condition does not allow them to travel by bus, passenger car, taxi, or another form of public or private conveyance.

NEMT is a covered Medi-Cal benefit when the member needs to obtain medically necessary covered services and when prescribed in writing by a physician, 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.

A Physician Certification Statement (PCS) form is required for NEMT services only. Modivcare will send a PCS form to physicians to indicate approval for level of service which may be authorized for a maximum of 12 months.

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.

The following types of providers are also able to authorize non-emergency medical transportation (NEMT) via a PCS form:

• Physician assistants (PAs)
• Nurse practitioners (NPs)
• Certified nurse midwives (CNMs)
• Physical therapists
• Speech therapists
• Occupational therapists
• Mental health or substance use disorder providers

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).

PAs, NPs or CNMs may not sign authorization forms for the following covered benefits and services due to restrictions in Title 42 of Code of Federal Regulations Section 440.70 for home health services, Section 418.00 for hospice care or any other federal restriction for Medicaid. Restrictions include the following benefits and services:

• For hospice care, a physician's authorization is required for patient certification (at the beginning of the first 90-day period) and recertification (at the beginning of each subsequent period of care) of terminal illness.
• For home health services, a physician's authorization is required for durable medical equipment, medical supplies, enteral nutrition and other medical services provided through home health agencies, such as physical therapy, occupational therapy, speech pathology and audiology services.

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

• NEMT ambulance services which include:
  • Transfers between facilities for members who require continuous intravenous medication, medical monitoring or observation.
  • Transfers: 1) from an acute care facility to another acute care facility, immediately following an inpatient stay at the acute level of care, 2) to a skilled nursing facility or 3) to a licensed intermediate care facility.
• Litter van services, when the member's medical and physical condition does not meet the need for NEMT ambulance services but meets both of the following:
  • The member must be transported in a prone or supine position because the member is incapable of sitting for the period of time needed for transport.
  • Specialized safety equipment is required over and above that which is normally available in passenger cars, taxi cabs or other forms of public conveyance.
• Wheelchair van services, when the member's medical and physical condition does not meet the need for litter van services, but meets any of the following:
  • The member is incapable of sitting in a private vehicle, taxi or other form of public transportation for the period of time needed to transport.
  • The member must be transported in a wheelchair or assisted to and from a residence, vehicle and place of treatment because of a disabling physical or mental limitation.
  • Specialized safety equipment is required over and above that which is normally available in passenger cars, taxi cabs or other forms of public conveyance.
• NEMT by air (requires Health Net authorization and Letter of Agreement) only under the following conditions:
  • Transportation by air is necessary because of the member's medical condition or because practical considerations render ground transportation not feasible.

Non-Medical Transportation

NMT includes transportation for medically necessary appointments or 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.

• Passenger car/sedan, taxi (ambulatory curb-to-curb): Member is ambulatory and can walk to the curb and board and exit the vehicle unassisted but cannot utilize the bus or train (curb-to-curb).
• Rideshare, passenger car/sedan (ambulatory door-to-door): Member is ambulatory and can walk but requires driver assistance from residence to the medical appointment. Member may use:

• Wheelchair, able to transfer from a folding wheelchair without assistance. Note, if assistance is required, choose wheelchair van under NEMT.
• Walker.
• Cane.
• Crutches.
• Paratransit services: Member is ambulatory and can walk to the curb and board and exit the vehicle unassisted but cannot utilize the bus (curb-to-curb).
• Mass transit: Member is ambulatory and is able to use public transportation and may be medically able to walk up to a half mile to a bus stop (curb-to-curb).
• Mileage reimbursement: Member is ambulatory and has access to other means of transportation such as a working vehicle in the home, family member or neighbor. Member may request mileage reimbursement at the time the trip is scheduled (curb-to-curb).

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:

• medically necessary covered services
• members picking up drug prescriptions that cannot be mailed directly to the member
• members picking up medical supplies, prosthetics, orthotics, and other equipment
• dental services
• mental health services
• substance abuse services

Providers must request NEMT services (other than 911) through Modivcare. Health Net only reimburses for transports that are medically necessary and covered by the member's benefit plan.

Modivcare works with providers to determine the level of transportation needed and schedules pick-up and return time, if necessary.