State of Wisconsin Non Emergency Medical Transportation Services (NEMT) Webinar for Healthcare Providers All Providers. logisticare.

Transcription

1 State of Wisconsin Non Emergency Medical Transportation Services (NEMT) Webinar for Healthcare Providers All Providers logisticare.com

2 Today s Agenda Introduce LogistiCare Transportation Management Model Program Overview Overview of Contracting Process Questions 2011 LogistiCare Solutions, LLC Confidential & Proprietary 2

3 LogistiCare Experience Over 20 years experience in transportation management including over 12 years of experience as a transportation manager of NEMT Successfully operate in more diverse environments than any other transportation manager. More experience than any other organization in the country with successfully managing capitated NEMT projects, both large and small Contract retention rate over 95% over the past 15 years Met all start-up dates, met or exceeded all contract obligations, and established positive partnerships and long lasting working relationships Consistently work to improve quality and access 2011 LogistiCare Solutions, LLC Confidential & Proprietary 3

4 LogistiCare by the Numbers Gross Trip Reservations Annually: over 29 million Total Covered Lives: over 6.9 million Completed Annual Trips: over 24 million Public Transit Trips Annually: over 7 million Contracted Transportation Providers: over 2,400 Total Vehicles: over 13, LogistiCare Solutions, LLC Confidential & Proprietary 4

5 Local Office LogistiCare Solutions 2335 City View Drive Suite 200 Madison, WI LogistiCare Solutions, LLC Confidential & Proprietary 5

6 Contact Numbers Health Care Providers: (866) Members: Reservation (866) English, Spanish, Hmong Reservation (866) TTY Line/hearing impaired Ride Assist (866) English, Spanish, Hmong Administration: Phone (866) Fax (866) LogistiCare Solutions, LLC Confidential & Proprietary 6

7 What are the changes? As of September 1, 2012: DHS has contracted with LogistiCare to manage NEMT services for members in Milwaukee, Waukesha, Washington, Ozaukee, Racine and Kenosha Counties that are enrolled in HMOs that require transportation to medical appointments. LogistiCare has been managing NEMT services for members not enrolled in HMOs in these counties since July 2011,as well as serving members statewide. Beginning August 17, 2012: Members and healthcare facilities will contact LogistiCare to request NEMT services for SEWI HMO members for services needed September 1 st and forward LogistiCare Solutions, LLC Confidential & Proprietary 7

8 LogistiCare Responsibilities Operate a Call Center and take trip requests from Medicaid clients, their families and/or their healthcare providers or those supporting clients. Assess their need for transportation Authorize/prior authorize transportation to a Medicaid-covered service Determine the level of service based on the client s health care needs Schedule and assign trips to transportation provider Contract with a network of transportation providers and monitor their compliance with driver, vehicle & insurance requirements Pay providers & monitor their performance quality Coordinate and communicate with DHS & other agencies 2011 LogistiCare Solutions, LLC Confidential & Proprietary 8

9 Members Served by LogistiCare Wisconsin Medicaid- ex: EBD Medicaid Family-Planning Only Services. BadgerCare Plus Standard Plan BadgerCare Plus Benchmark Plan. Tuberculosis-Only Services. Express Enrollment for Pregnant Woman. Members enrolled in state-contracted managed care organizations (MCOs) who receive NEMT services on a fee-forservice basis As of September 1, 2012 LogistiCare will also serve: BC+ and SSI Managed Care Members in Milwaukee, Waukesha, Washington, Ozaukee, Racine and Kenosha Counties that are enrolled in HMOs. Please note: Members enrolled in Family Care, Pace Partnership or Nursing Home will not have their NEMT managed by LogistiCare LogistiCare Solutions, LLC Confidential & Proprietary 9

10 What are the criteria for NEMT? 1. The member is eligible for NEMT services 2. The member has a financial hardship 3. The type of transportation required is covered 4. The service the member is going to is a Medicaid covered service 2011 LogistiCare Solutions, LLC Confidential & Proprietary 10

11 What types of NEMT are covered? 1. Bus/Mass Transit The member lives within ¼ mile of a bus stop The medical facility is within ¼ mile of a bus stop The member can walk ¼ mile The member understands common signs and directions Bus passes can be obtained by calling LogistiCare 2. Ambulatory: The member can walk unassisted 3. Wheelchair can transfer Member can transfer from the wheelchair to the seat of an ambulatory vehicle The member s wheelchair folds and can be placed in the rear of the vehicle 2011 LogistiCare Solutions, LLC Confidential & Proprietary 11

12 What types of NEMT are covered? 4. Wheelchair The member is permanently confined to wheelchair The member cannot transfer from the wheelchair to the seat of an ambulatory vehicle The member requires a lift-equipped wheelchair van No Medical Necessity Form is required 5. Stretcher The member is confined to bed The member cannot sit up or sit in a wheelchair The member does not require medical monitoring during transport No Medical Necessity Form is required 6. Mileage, meals and lodging are also covered and can be obtained by calling LogistiCare 7. Non-Emergency Ambulance transportation is covered if the member requires advanced life support or basic life support services LogistiCare Solutions, LLC Confidential & Proprietary 12

13 Examples of covered NEMT Transports 1. A discharge from the hospital 2. Transport to a Medicaid enrolled physician to receive a medically covered service 3. Transport for a medical treatment like dialysis 4. Mental Health Programs 5. Physical Therapy 6. Pharmacy, associated with a scheduled transport 2011 LogistiCare Solutions, LLC Confidential & Proprietary 13

14 Examples of non-covered NEMT 1. Transport to a non-covered service (e.g., AA meetings, medically unsupervised weight reduction) 2. Transport for a nursing home resident 3. Transport of additional riders that are not a medically required attendant or a parent/caregiver of a young child 4. Transport of a member in spend down or deductible status 2011 LogistiCare Solutions, LLC Confidential & Proprietary 14

15 When do you contact LogistiCare? 1. Routine Trips: Reservations for future appointments should be made by calling (866) Must be reserved a minimum of two business days prior to travel Staffed with English, Spanish and Hmong speaking representatives and availability of a language line is the reservation number for the deaf/hearing impaired. 2. Standing Orders Routine Services A routine Standing Order is an episodic trip to a Medicaid covered service. For example, Dialysis or Physical Therapy Schedule routine trips five business days in advance 3. Urgent Services Contact LogistiCare for Same day, Urgent or Discharges Reservations services are available 24 hours by 7 days 2011 LogistiCare Solutions, LLC Confidential & Proprietary 15

16 What is Urgent Care? 1. It s an unscheduled episodic situation in which there is no immediate threat to life or limb, but the member must be seen on the day of the request and treatment cannot be delayed until the next day. 2. LogistiCare will verify with the medical provider that medical service is of an urgent nature 3. Valid requests for urgent care transport shall be honored within three (3) hours of the time the request is made LogistiCare Solutions, LLC Confidential & Proprietary 16

17 What are LogistiCare Service Hours? 1. Routine Reservations: Monday to Friday from 7:00 a.m. until 6:00 p.m. 2. Standing Order Reservations: Monday to Friday from 7:00 a.m. until 6:00 p.m. 3. Urgent and Hospital Discharges Reservations: 24 Hours per Day and 7 days a week 4. Ride Assist/Where s My Ride?: 24 Hours per Day and 7 days a week 2011 LogistiCare Solutions, LLC Confidential & Proprietary 17

18 Key Reminders Members can request a ride only if they have no other way to get a ride. Members can request a ride only for a Medicaid covered service Members must call to schedule a ride at least 2 business days in advance, unless a situation meetings the urgent trip standards. When a reservation is placed the caller must have the member s ForwardHealth ID number, and the name, address and phone number of the medical provider ready. Members must be ready to board the vehicle at the scheduled time. Members are responsible for any medical equipment, like a car seat for a child or a wheelchair. Only members receiving treatment, parents accompanying a young child, or a medically required assistant are permitted to ride in the vehicle. Urgent rides will be verified with the providers Members must contact LogistiCare to coordinate a stop at a lab or pharmacy on the way home from an appointment and have that part of the trip authorized LogistiCare Solutions, LLC Confidential & Proprietary 18

19 Where is my Ride Line Where s My Ride? telephone number: A member, family member, social worker, case manager or other medical provider can call concerning a service issue. For example, if transportation is late dropping off or picking up the member LogistiCare Solutions, LLC Confidential & Proprietary 19

20 Questions? 2011 LogistiCare Solutions, LLC Confidential & Proprietary 20