HOW TO ACCESS:
Medical transportation is accessed through the beneficiary’s health plan or the FFS transportation broker.
Medicaid beneficiaries eligible for NEMT services through a health plan should contact the call centers to schedule transportation services using the following phone numbers. A request for transportation services should be made to the call center at least 48 hours prior to the date the transportation services are needed.
Medicaid beneficiaries NOT eligible for NEMT services through a health plan should contact Verida, the Fee-For-Service (FFS) transportation broker. Beneficiaries should contact Verida’s call center at (855) 325-7626 to schedule transportation services. A request for transportation services should be made to the call center at least 48 hours prior to the date the transportation services are needed.
Aetna Better Health of Louisiana uses the broker, MediTrans, contact them at 1(877) 917-4150 or TTY 1(866) 288-3133.
AmeriHealth Caritas Louisiana uses the broker, Verida, contact them at 1(888) 913-0364 or TTY 1(866)428-7588.
Healthy Blue uses the broker, MediTrans, contact them at 1(866) 430-1101 or TTY 1(800) 846-5277.
Humana Healthy Horizons uses the broker, MediTrans, contact them at 1 (844) 613-1638 or TTY 1(800) 618-4781.
Louisiana Healthcare Connections uses the broker, MTM, contact them at 1(855) 369-3723 or TTY 711.
United Healthcare Community Plan uses the broker, ModivCare, contact them at 1(866) 726-1472 or TTY 1(844) 488-9724.
ELIGIBILITY:
Medicaid covered transportation is available to Medicaid beneficiaries when:
- The beneficiary is enrolled in a Medicaid benefit program that explicitly includes transportation services; and
- The beneficiary or their representative has stated that they have no other means of transportation.
COVERED SERVICES:
NEMT services include transportation services provided by the Local Transit Authority (local buses) or by NEMT providers contracted with the health plan’s transportation broker.
NEMT provides an eligible beneficiary transportation to and/or from medical services covered by Medicaid when no other means of transportation is available.
Transportation to additional services may be approved depending on the beneficiary’s health plan.
Beneficiaries eligible for physical health services through Legacy Medicaid, both children and adults, are enrolled in a health plan for Medicaid transportation services.
Attendants
An attendant shall be required when the beneficiary is under the age of 17.
The attendant must:
- Be a parent, legal guardian, or responsible person designated by the parent/legal guardian; and
- Be able to authorize medical treatment and care for the beneficiary.
Attendants may not:
- Be under the age of 17; or
- Be a Medicaid provider or employee of a Medicaid provider that is providing services to the beneficiary being transported, except for employees of a mental health facility in the event an beneficiary has been identified as being a danger to themselves or others or at risk for elopement.
- Be a transportation provider or an employee of a transportation provider.
If a child is to be transported, either as the beneficiary or an additional passenger, the parent or guardian of the child is responsible for providing an appropriate child passenger restraint system as required in all cars and detailed in La. R.S. 32:295.
Exception:
- All females, regardless of their age, seeking prenatal and/or postpartum care shall not be required to have an attendant.
Meals and Lodging
Eligible expenses include the following when necessary to ensure the delivery of medically necessary services:
- Transportation for the beneficiary and one attendant; and
- Meals, lodging, and other related travel expenses for the beneficiary and one attendant when long distance travel is required. Long distance is defined as when the total travel time, including the duration of the appointment plus the travel to and from the appointment, exceeds 12 hours
Medicaid covers meals and lodging for trips that are not otherwise covered in the inpatient per diem, primary insurance, or other payer source.
COMMENTS:
Healthcare facilities or beneficiaries should contact the MCO/transportation broker if the scheduled transportation does not show up or cancels the scheduled transport. This will allow the MCO/transportation broker the ability to reassign the transport to an available NEMT provider.
Prior approval is not required for NEMT services which accommodate the beneficiaries using either an ambulatory or a wheelchair level of service, unless the transportation request includes an out-of-state destination.
With the exception of urgent transportation requests and discharges from inpatient facilities, arrangements for NEMT services should be made at least 48 hours in advance. The 48-hour minimum does not include non-business days.
The MCO may approve transportation to out-of-state medical care only if the beneficiary has been granted approval to receive medical treatment out of state when it is the nearest option available. Coordination of approvals may take longer than 48 hours.
Source: https://ldh.la.gov/