Noble County Department of Job and Family Services

Noble County Department of Job and Family Services

Non-Emergent Transportation Program

Effective 01/2013

Administration

The NET program will be administered by the Social Services Department in accordance with Ohio Administrative Code Chapter 5101:3-24. The program is intended to assist qualified Noble County residents by providing transportation services to and from scheduled Medicaid reimbursable appointments. Consumers can access the program by contacting the NET coordinator, Diane Dudley.

Documentation

Only individuals with an open/pass eligibility span in a qualifying Medicaid assistance group for the month transportation is requested who are also a resident of Noble County will be eligible for NET services. The qualifying Medicaid assistance group consists of any category of Medicaid, except MAUS, MA Lor MA G. If the consumer has a spenddown, that consumer will be ineligible for services until the spenddown has been met. Pregnant women will be referred for Pregnancy Related Services (PRS) and will not be referred for NET services. Transportation services must be made to a Medicaid reimbursable service within the community unless that service is not available in the community. NCDJFS will allow transportation to providers outside of the local community due to the lack of available providers. NCDJFS withholds the right to amend this policy if additional providers become available within the community.

Requests for transportation services should be made ten (10) business days prior to the scheduled appointment. Exceptions may be made if the Medicaid provider schedules a medically necessary follow-up appointment sooner than the 10 days or if the recipient is ill or injured and requires the Medicaid reimbursable services before the 10 business days. Under NO circumstances will emergency transportation be provided by NCDJFS. Individuals requiring emergency transportation will be advised on how to access such by NCDJFS staff, if needed. Emergency Room visits are not eligible for reimbursement through Net.

Individuals may request NET services verbally, by face to face or phone contacts with a NCDJFS worker, or via written communication. If problems arise with the method of requests, the individual may be requested to submit all NET requests in written form. A notice of approval or denial will be sent regarding each request. (OAC 5101:3-24-0)

Coordination

Medicaid recipients who qualify for transportation services through other Medicaid programs, other than NET, must be referred to that Medicaid program to request transportation. The following programs provide transportation services:

1.  Hospice services

2.  Pregnancy Related Services

3.  Ambulette, ground ambulance and air ambulance

Other transportation services that may be accessed:

1.  Federally qualified health centers (FQHC)

2.  Managed care plans (MCP's)

3.  Home and community based services (HCBS) waiver programs

4.  Healthchek services

5.  Other community services such as :

A.  GMN Tri-County Community Action Corporation, Inc. through the Senior

Center for those ages 60 and over;

B. The Noble County Board of MRDD;

C. The Veterans Association

If the recipient is working with one of the above identified agencies and transportation may be available through that agency, the recipient will coordinate with them to arrange transport through that agency. Whenever possible, NET will be the resource of last resort when no other community resource is available.

Eligibility and Application

Qualified Assistance Groups (AG's) will be required to provide the name and last four digits of the social security number and/or case number of the Medicaid recipient that is attending the medical appointment, the provider name, provider address and provider phone number, along with the date, time and purpose of the medical appointment. In addition, the individual will be required to submit a “Provider Verification Form” after the appointment, as proof that they attended the appointment. A household shall be ineligible for NET services if an AG fails to submit the provider verifications from a previous NET approved trip, the household has an overpayment from the NET program and are in default of the repayment agreement, the household has provided NCDJFS with fraudulent information and or provider verifications, or the household has received a NET suspension.

Method of Transport

There are two methods of transportation assistance available through the NCDJFS. One method of providing service is in the form of reimbursement of gasoline expenses. If the eligible individual does not have access to a vehicle, has access only to an unreliable vehicle or does not have a valid driver’s license or automobile insurance, or the individual is instructed not to drive after the Medicaid eligible service, and transportation cannot be provided by a friend or family member, the NCDJFS provides transportation through a contract provider for the eligible individual to and from their Medicaid reimbursable medical appointment.

Gas Reimbursements

Gas reimbursements will be issued to qualified recipients who can either drive themselves or have a friend or family member willing to provide transportation. Individuals who are driving must have a valid driver’s license and automobile insurance and current copies of each must be on file with the agency. If agency discovers insurance and/or driver’s licenses on file are expired, agency will request current copies from provider in writing. Failure to provide requested information within 15 days of date of request may result in denial of reimbursement. Gas reimbursements will be issued according to the distance that must be traveled by the qualified recipients. Those traveling to a provider within Noble County will be given a $15.00 gasoline reimbursement; those traveling to one of the surrounding counties (Guernsey, Washington, Morgan, Monroe, Belmont) will be given a $25.00 gas reimbursement and those traveling to a provider beyond the surrounding counties, will be issued a $35.00 gas reimbursement. Only one reimbursement will be issued per household, per day. If there are household members requiring multiple Medicaid reimbursable services on the same date, a gas reimbursement will be issued for the appointment that is the greatest distance away. If there is more than one household member traveling together for a medical appointment, there is only one gas reimbursement issued for the trip. Pharmacy trips, regardless of distance, will be reimbursed at a rate of $5.00. Pharmacy visits that occur on the same date of a medical appointment will be bundled with the travel for reimbursement for that appointment. If a family, household member or individual is caught giving false information in order to receive gas reimbursement they are not eligible for, is caught trying to receive more than one gas reimbursement , or do not follow any of the other rules for this program, they will be ineligible for to participate in the program as follows: 1st occurrence- repayment of the amount of the reimbursement and one month suspension from the program (whichever is longer), 2nd occurrence – repayment of the amount of the reimbursement and three months suspension, (whichever is longer), 3rd and subsequent occurrences – repayment of the amount of the reimbursement and six months suspension from the program (whichever is longer).

Before gas reimbursement is issued, the individual should have approval for the travel to and from the medical appointment from the NET coordinator and must have the medical provider complete the Provider Verification form documenting they have attended the appointment. This verification must be returned to NCDJFS within 30 days of the date of the provided service before the reimbursement can be issued and/or before another reimbursement request can be approved. Any provider verification forms submitted more than 30 days after the provided service will be subject to denial.

Contract Services

The NCDJFS contracts for transportation services to be provided to eligible Medicaid recipients who do not have their own transportation or a friend or family member who can transport them. The current contract providers are:

·  Lena Huffman, 111 Apt. 10, Jefferson Drive, Caldwell, Ohio 43724

Phone: 740-732-1747 Cell: 740-509-2515

Length of contract: 09/11/12 through 09/10/13

·  David Ritterbeck, 17546 Hunkadora Road, Caldwell, Ohio 43724

Phone: 740-732-1012

Length of contract: 12/9/12 through 12/2/13

·  Patty Koval, 48752 Hillcrest Drive, Caldwell, Ohio 43724

Phone: 740-732-2655 Cell: 740-630-7348

Length of contract: 9/28/12 through 9/27/13

·  Joyce Schott, 44390 Arnold Road, Caldwell, OH 43724

Cell: 740-509-0186

Length of contract: 4/10/12 through 4/9/13

Contract identifies that provider will receive mileage reimbursement at the rate established by the IRS at the time service is provided. Reimbursement will be provided from the provider’s home and return (i.e., from the Provider’s home to the home of the Medicaid Consumer, to the medical appointment, back to the home of the Medicaid consumer, and return to the Provider’s home.) Mileage reimbursement rate is $.565 per mile, to be increased and/or decreased at the time the IRS establishes a new rate.

The individual requests transportation services through NCDJFS and upon the eligibility determination, is approved or denied for services. If the individual is eligible, transportation arrangements will be confirmed by the contracted driver and the individual. An approval notice is provided to the applicant and to the provider.

Contract providers will not provide transportation to an emergency service. If the customer is in need of ambulance services, NCDJFS can make a referral to appropriate providers.

When it is determined by the Noble County DJFS to be medically necessary, an attendant’s salary/stipend may be paid at the current federal minimum wage for up to eight (8) hours per day. Relatives of the consumer will not be eligible to receive an attendant’s salary/stipend.

(a)  “Relative” is defined as spouse, child, grandchild, parents, grandparents, siblings, step-child, step-parents, step-siblings, mother-in-law, father-in-law, son-in-law, daughter-in-law, or legal guardian or other person who stands in the place of a parent.

(b) “Attendant” is a person who accompanies the consumer who is unable

to travel independently during a Medicaid covered service.

When it is determined by the Noble County DJFS to be medically necessary, lodging and/or travel related expenses such as parking may be paid for the consumer and an attendant, if applicable; at the same rate the agency pays expenses for agency employees.

A parent or legal guardian may also accompany the consumer when the consumer is twenty (20) years of age or younger.

The Noble County Department of Job and Family Services agrees to follow the procedures outlined in this plan when implementing the Non-Emergency Transportation (NET) Program.

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Kelli Clark, Supervisor Mindy Harding, Director