23-1261 Transportation Benefit for Members in Long-Term Care
Date: 10/31/23
Get members to appointments and stay engaged with their primary care providers
As of January 2023, most non-dual and dual long-term care (LTC) members residing in skilled nursing facilities (SNFs) are required to enroll in a managed care plan. Based on All Plan Letter (APL) 23-0041 (PDF), the Department of Health Care Services (DHCS) clarifies the SNF LTC benefit, including transportation services.
Transportation
Health Net provides non-emergency medical transportation (NEMT) and non-medical transportation (NMT) to members, including members who reside in a SNF. This includes providing NEMT services if the member is being transferred from an emergency room or acute care hospital to a SNF without prior authorization. For covered services requiring recurring appointments, Health Net provides authorization for NEMT for the duration of the recurring appointments, not to exceed 12 months. The member must have an approved Physician Certification Statement (PCS) form authorizing NEMT by the provider.
Complete PCS form to request NEMT for members
DHCS requires that a physician or other provider must complete a PCS form authorizing NEMT for the member. The member’s physician or other provider must submit the PCS form to Health Net’s transportation vendor (Modivcare) or to Health Net’s delegated entity for the provision of NEMT services. If a PCS form is not received, members will not receive the necessary transportation.
Download the PCS form (PDF).
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center at 800-675-6110.
1https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2023/APL23-004.pdf.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.