Nonemergency Medical Transportation Overview April 2007

1. NONEMERGENCY MEDICAL TRANSPORTATION – STATE MEDI-CAL PROGRAM Nonemergency Medical Transportation Overview April 2007 California Department of Health Services

2. OVERVIEW • Description • Eligibility Criteria • Available Services

3. NONEMERGENCY MEDICAL TRANSPORTATION Nonemergency medical transportation is defined as: • transportation by ambulance, litter van and wheelchair van of the sick, injured, invalid, convalescent, infirm or otherwise incapacitated persons whose medical conditions require medical transportation services but do not require emergency services or equipment during transport.

4. WHO MAY RECEIVENONEMERGENCY MEDICAL TRANSPORTATION? Nonemergency medical transportation is available to all Medi-Cal beneficiaries: • when the beneficiary's medical and physical condition is such that transport by ordinary means of public or private conveyance is medically contraindicated, and transportation is required for the purpose of obtaining needed medical care.

5. SUMMARY OF CORE SERVICES • Medical transportation (both emergency and nonemergency) may be authorized only when the beneficiary’s medical condition precludes transport by ordinary means of public or private conveyance, such as a bus or passenger car (i.e., non-medical transportation).

6. SUMMARY OF CORE SERVICES • Under the Medi-Cal Administrative Activities Program, allowable activities include arranging and providing nonemergency non-medical transportation of Medi-Cal eligibles to Medi-Cal covered services provided by an enrolled Medi-Cal provider. When medically necessary, this activity may include the cost of accompanying Medi-Cal eligibles to Medi-Cal services.

7. SUMMARY OF CORE SERVICES Covered medical transportation services rendered in connection with the Local Educational Agency Medi-Cal Billing Option Program include: • Medical transportation (trip) • Mileage (must be in conjunction with trip)

8. REGULATORY REQUIREMENTS All nonemergency medical transportation, necessary to obtain program covered services, requires a physician's, dentist's or podiatrist's prescription and prior authorization except:  • when provided to a patient being transferred from an acute care hospital immediately following a stay as an inpatient at the acute level of care to a skilled nursing facility or an intermediate care facility licensed pursuant to Section 1250 of the Health and Safety Code.

9. REGULATORY REQUIREMENTS • When the service needed is of such an urgent nature that written authorization could not have reasonably been submitted beforehand, the medical transportation provider may request prior authorization by telephone. Such telephone authorization shall be valid only if [subsequently] confirmed by a written request for authorization. • Transportation shall be authorized only to the nearest facility capable of meeting the patient's medical needs.

10. ADDITIONAL INFORMATION For further information, please refer to: • Title 22, California Code of Regulations, Division 3, Health Care Services • Medi-Cal Provider Manual at: www.medical-cal.ca.gov • Welfare and Institutions Code, Sections 14124.5, 14132, & 14136.6

11. ADDITIONAL INFORMATION For further information, please refer to: • Medi-Cal Administrative Activities Program and Local Governmental Agency Provider Manual http://www.dhs.ca.gov/maa/webpages-section-units/ACOU.htm

12. Thank You