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Tioga County Medicaid Transportation Information - MEDICAL

By Gloria Hamilton,2014-08-29 00:02
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Tioga County Medicaid Transportation Information - MEDICAL

    TIOGA COUNTY DEPARTMENT OF SOCIAL SERVICES

    P.O. Box 240, 1062 STATE ROUTE 38

    OWEGO, NY 13827

    (607) 687-8300

    NON-EMERGENCY MEDICAL TRANSPORTATION POLICY

    Medicaid recipients are encouraged to conduct responsible planning for their transportation activities through:

    ; Maximizing their own transportation resources through coordination of transportation

    activities.

    ; Utilizing available public transportation or other community based transportation resources.

    ; Planning ahead for transportation hardships.

    Tioga County DSS contracts with a single transportation Manager, Tioga Transport, Inc., for the provision of all non-emergency transportation needs. This transportation Manager will either deliver or subcontract with other vendors to deliver all necessary non-emergency medical transportation for eligible Tioga County Medicaid recipients.

    Tioga Transport, Inc. is the only Medicaid transportation Manager in Tioga County. Medicaid recipients who receive prior authorization for transportation services must use Tioga Transport for their medical transportation needs. Recipients do not have the “freedom of choice” to choose any

    transportation vendor. It is the transportation Manager’s decision how the recipient is transported to

    necessary care and services. The least expensive mode of transportation, which is suitable to the needs of the Medicaid recipient, will be utilized. This may include, at the transportation Manager’s

    option, reimbursement for private vehicle mileage. Reimbursement is based upon the designated Average Operating Cost as calculated by the American Automobile Association (AAA) and will be adjusted annually when the updated AAA amount is published.

    Prior Authorization Requests

    Must call at least THREE (3) business days (72 hrs.) before the transportation is needed!

     Call (607) 699-RIDE or toll free at 1-800-388-4881

    Fax # is (607) 429-0203

    PLEASE HAVE YOUR MEDICAID NUMBER READY WHEN YOU CALL.

    All requests for non-emergency medical transportation service must be prior authorized by contacting Tioga Transport at the above listed number(s). The recipient, his or

    her representative or ordering practitioner must make request for transportation authorization at least three (3) business days (72 hrs.) prior to the scheduled appointment.

    Requests made less than three (3) business days prior will be screened for urgent care needs only (statement from physician may be required) and if deemed appropriate will be scheduled to assure needed urgent medical care. All requests will be screened in order to ensure that the medical transportation can be provided under the terms specified for Medicaid funded transportation. If approved, the transportation Manager will then coordinate and schedule all necessary transportation.

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    TIOGA COUNTY DEPARTMENT OF SOCIAL SERVICES

    P.O. Box 240, 1062 STATE ROUTE 38

    OWEGO, NY 13827

    (607) 687-8300

    NON-EMERGENCY MEDICAL TRANSPORTATION POLICY

    Prior authorization will be granted only when payment for transportation expenses is essential in order for an eligible Medicaid recipient to obtain necessary medical care and services covered under the Medicaid program.

    The following Medicaid recipients will not be eligible for transportation services under this policy

    unless verification is provided which demonstrates not doing so would create a hardship:

     Recipients with access to a vehicle.

     Recipients who reside and receive medical services within an area served by public

    transportation.

     Recipients with access to transportation for routine activities of daily living (such as

    shopping, recreation, and worship services).

    The following factors will be considered to determine if a hardship exists:

     Medical condition requires an extraordinary mode of transportation as documented by

    recipient’s primary care provider.

     Medical condition requires multiple weekly trips as documented by recipient’s primary care

    provider.

     Destination of medical service exceeds 30 miles round trip via direct route. (Common

    medical marketing area)

     Absence of public transportation service.

Transportation To Medicaid Covered Services Outside Common Medical Marketing Area

     Prior authorization requests for transportation needs outside the recipients common medical marketing area (30 miles one way via direct route from residence) may be approved only if the Medicaid covered service cannot be obtained locally or when there is a need to continue a regimen of medical care and services with a specific medical provider located outside their common medical marketing area. A completed medical necessity form will be required from the treating medical provider before prior authorization will be considered. Other transportation costs (meals, lodging, parking, tolls, etc.) require prior authorization by the transportation Manager.

    Remember: Call at least THREE (3) business days (72 hrs.) before the date

    transportation is needed!

    Requests for Special Mode of Transportation

     Requests for authorization of special vehicles (ambulance, Invalid Coach, stretcher transportation, etc.) will require verification of medical necessity as documented by the recipient’s

    medical care provider. If approved, it is the decision of the transportation Manager how the recipient is transported to necessary care and services. The least expensive mode of transportation that is suitable to needs of the Medicaid recipient will be utilized. The following information will be requested at the time of the request for prior authorization:

     Recipient’s Client Identification Number (CIN), also known as Medicaid number.

     Recipient’s name, residence and telephone number.

     Name, address and phone number of Medical Care Provider.

     Completion of medical necessity form by Medical Care Provider to document need for special

    mode of transportation.

     Information regarding the date and destination of the transport.

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