Conn. Agencies Regs. § 17-134d-33
These regulations set forth the requirements for payment of Medical Transportation Services rendered to persons determined eligible for such services under provisions of Connecticut's Medical Assistance Program in accordance with Section 17-134d of the General Statutes of Connecticut.
For purposes of Section 17-134d-33, the following definitions apply:
An additional recipient is an eligible Medicaid recipient beyond the first recipient transported by a Medicaid transportation provider during the same trip.
All trips have one pickup point and one drop-off point. An additional stop is a pickup point or drop-off point other than the initial pickup and final drop-off points. Additional stops occur when multiple recipients are transported during a single trip.
Air transportation is transportation provided by a commercial airline.
If the most appropriate type of transportation for a recipient is not available, a different type of transportation may be utilized. This would be an alternative method of transportation.
An ambulance is a vehicle for transporting the sick and injured which is equipped and staffed to provide medical care during transit, and which is operating as an ambulance under the authority and in compliance with promulgated regulations of the Department of Health Services, Office of Emergency Medical Services, and registered as such by the Department of Motor Vehicles.
An ambulance night call charge is an additional fee that may be paid when an ambulance service is dispatched between the hours of 7:00 P.M. and 7:00 A.M. inclusive.
An appropriate method of transportation is the least expensive type of transportation which best meets the physical and medical circumstances of a recipient requiring transportation to a medical service.
Assistance is when a recipient must be physically helped from within or into a building and/or from within or into the medical provider's site. Without such assistance it would be unsafe or impossible for the recipient to reach the livery vehicle or the medical provider's site.
This assistance is provided by an employee of the livery provider, the driver or a person in addition to the driver. This service is beyond a door-to-door service.
An attendant is an employee of an invalid coach or wheelchair accessible livery provider, and is a person in the vehicle in addition to the driver, who provides assistance in the transportation of passengers.
Attendant services are when an attendant must physically assist a recipient from within or into a building and from within or into the medical provider's site. Without such assistance it would be unsafe or impossible for the recipient to reach the invalid coach or wheelchair accessible livery vehicle or the medical provider's site. This service is beyond a door-to-door service.
Available transportation means that a public transportation system, an enrolled Medicaid provider, organization, agency, or individual offers appropriate transportation services to a recipient who requires transportation.
A border provider is a provider located in a state bordering Connecticut, in an area that allows it to generally serve Connecticut residents, and who is enrolled as and treated as a Connecticut Medicaid provider. Such providers are certified and/or licensed by the applicable agency in their state.
A cancelled call is notification to the transportation provider not to provide services to a recipient, prior to the time the vehicle is enroute to the pickup point.
A critical care helicopter is an aircraft which is operating as a critical care helicopter and in compliance with promulgated regulations under the authority of the Department of Health Services, Office of Emergency Medical Services. A critical care helicopter has mobile intensive care capabilities and is called to the scenes of severe accidents or illness.
The Department means the Department of Income Maintenance.
An emergency is defined as a medical condition (including labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
An emergency ambulance trip is an ambulance trip made in accordance with the Department's definition of emergency and has as its destination:
A helicopter assist is medical care provided at the scene to a recipient when such recipient is ultimately transported by a critical care helicopter.
An invalid coach is a vehicle used exclusively for the transportation of non-ambulatory patients and is operating as an invalid coach under the authority and in compliance with promulgated regulations of the Department of Health Services, Office of Emergency Medical Services, and registered as such by the Department of Motor Vehicles, or is a wheelchair accessible livery vehicle.
A livery vehicle is a sedan or van type vehicle capable of carrying up to ten passengers used for the transportation of ambulatory patients, who may require assistance, and which is operated by a livery carrier under the authority and in compliance with the statutes and regulations of the Department of Transportation and/or a transit district and registered as a livery vehicle by the Department of Motor Vehicles. Livery service is a door-to-door service.
A livery vehicle does not include a vehicle registered as a service bus vehicle with the following exception. If the Commissioner determines, in his/her sole discretion, that for access or other reasons use of service bus vehicles is appropriate, equitable and in the best interests of the state, he/she may authorize use of service bus registered vehicles and may impose any additional insurance or other requirements or limitations which he/she deems appropriate. Said authorization must be in writing.
Loaded mileage is the distance traveled by a motor vehicle while carrying passengers from a pickup point to a drop-off point. Mileage between Connecticut towns is determined in accordance with the Public Utility Control Docket Document (PUCA) #6770-A.
Noncontiguous town is a town which does not border the town in which a provider's headquarters is housed. Noncontiguous towns are towns which do not border each other.
Non-emergency ambulance trip is a pre-arranged ambulance trip that is not responding to an emergency injury or illness. However, ambulance services are needed because a recipient may require medical care during transit, which an ambulance is equipped and staffed to provide.
No-show is when a recipient fails to utilize a transportation service approved in writing by the Department, and which is not cancelled.
An individual who is not ambulatory is unable to walk despite the possible use of assistive devices (e.g., cane, crutch, walker) and/or the assistance of an attendant.
A nursing home is an intermediate care or skilled nursing facility (ICF, SNF, or ICF/MR) or Chronic Disease Hospital.
Other commercial carriers are those regulated carriers other than taxi, livery, wheelchair accessible livery, ambulance, invalid coach, and air transportation that transport the public for a fee and which meet all applicable state and federal permit and licensure requirements to operate as such.
An out-of-state trip is a trip originating or ending outside Connecticut that is to transport a patient to or from a medical provider that is not located in Connecticut and is not a border provider.
Prior authorization means approval for a service from the Department or the Department's agent before the provider actually provides the service. In order to receive reimbursement from the Department a provider must comply with all prior authorization requirements. The Department in its sole discretion determines what information is necessary in order to approve a prior authorization request.
Private transportation is transportation by a vehicle owned by a recipient or by a friend, relative, acquaintance or other individual, provided the vehicle is not licensed for commercial carriage. Individual does not mean communities, companies, corporations, societies or associations.
The provider agreement is the signed written contractual agreement between the Department and the provider of services or goods.
Provider headquarters is the provider's base of operations closest to the pickup point. A provider may have more than one (1) headquarters.
PUCA Document is the Department of Public Utility Control Docket Document #6770-A and all its supplements which specify the mileage between Connecticut towns.
Recipient means a person eligible for services under the Department's Medical Assistance Program.
A round trip is the dispatching of a vehicle to the recipient(s) pickup point, transporting the recipient(s) to a medical provider and transporting the recipient(s) back to the pick-up point.
A shared ride is when more than one recipient occupies a vehicle during the same trip.
A special attendant is a second attendant who is an employee of the ambulance provider, and who is in the vehicle in addition to the driver and one attendant. This attendant is needed due to the recipient's medical condition.
A taxi is a vehicle operating as a taxi under the authority and in compliance with promulgated regulations of the Department of Transportation and/or a transit district and registered as such by the Department of Motor Vehicles.
A trip is the dispatching of an empty vehicle to the recipient pickup point and transporting the recipient to a medical provider, or from a medical provider to the drop-off point.
A livery trip is the dispatching of an empty livery vehicle to the recipient(s) pickup point and transporting the recipient(s) to a medical provider or from a medical provider to the drop-off point. A trip for livery services begins when an empty vehicle picks up a recipient(s) and ends when the last recipient is dropped off and the vehicle is empty.
Unloaded mileage is the distance traveled by the motor vehicle carrying no passengers, enroute to the point of pickup or, enroute from the point of drop-off.
Unpaid health care is a service(s) provided to a recipient which is voluntary in nature, and usually provided by a family member, neighbor, friend or other person(s) within the individual's support system.
Waiting time is the time that a vehicle is waiting at a medical provider's facility, to which the transportation provider transported the recipient, in order to transport the recipient to another destination, during the same trip.
A wheelchair accessible livery vehicle is a vehicle specifically designed for the transportation of wheelchair mobile patients, and which is operating as a wheelchair accessible livery, under the authority and in compliance with promulgated regulations of the Department of Transportation and/or a transit district and registered as such by the Department of Motor Vehicles. Wheelchair accessible livery vehicles are treated the same as invalid coach vehicles.
In order to participate in the Medicaid program and receive payment directly from the Department, all commercial transportation providers must:
Payment for medical transportation services is available for all Medicaid eligible recipients subject to the conditions and limitations which apply to these services.
Payment may be made for transporting a patient by airplane provided:
Payment may be made for critical care helicopter service if the utilization of this helicopter is justified rather than ground ambulance service. The factors that will be considered in determining if the use of a critical care helicopter was appropriate are those criteria published by the Department of Health Services, Office of Emergency Medical Services as Minimum Quality Standards for critical care helicopter responses, (Section 6.2), as they may be amended from time to time.
For informational purposes, as of the date of the adoption of this regulation, the factors are:
Payment may be made for transportation by means of other commercial carriers provided no other alternative less expensive means of transportation is available as determined by the Department.
Payment may be made for the transporting of a patient by private transportation when no alternative less expensive transportation is available as determined by the Department.
Providers who have contracts with organizations to provide transportation services shall not be paid higher rates for services than what the Department would pay another available provider for these same services. The Department is not bound to use the services of a provider because this provider has an exclusive contract with an organization.
The Department may pay for transportation services which are required in order for a recipient to receive necessary medical care which is covered under the Medicaid Program.
All transportation services require written prior authorization, except emergency ambulance, non-emergency ambulance with designated medical conditions, in-state invalid coach and wheelchair accessible livery services with designated diagnoses, bus, train, and private transportation within the same town.
Prior authorization for transportation services is required as listed below. Prior authorization, when required, may be given for single or multiple trips, depending on the circumstances. Multiple trips, where medical need has been shown, can be authorized for periods up to a maximum of three months at a time. An example would be a recipient receiving dialysis services.
Consideration will be given to after-the-fact authorization requests received after fifteen (15) working days, if the failure to submit an authorization was for a recipient who had a pending application with the Department, or had other third party coverage. A written authorization request for the above situations must be received within ninety (90) working days of the date the transportation services were provided. Verification of other third party payment or denial must be attached to the request.
Consideration will be given to after-the-fact authorization requests received after fifteen (15) working days, if the failure to submit an authorization was for a recipient who had a pending application with the Department. A written authorization request for the above situations must be received within ninety (90) working days of the date the transportation services were provided.
Consideration will be given to after-the-fact authorization requests received after fifteen (15) working days, if the failure to submit an authorization was for a recipient who had a pending application with the Department. A written authorization request for the above situations must be received within ninety (90) working days of the date the transportation services were provided.
All non-emergency commercial carrier transportation except bus and train transportation within the same town require prior authorization.
However reimbursement will be made only if the recipient documents a visit to a medical provider for a needed service. Requests for reimbursement must be made within thirty (30) days of the date of the transportation.
Prior authorization is required for trips between towns and out-of-state private transportation. No prior authorization is required for private transportation for trips within a town. Reimbursement for all private transportation will be made only if the recipient documents a visit to a medical provider for a needed service. Requests for private transportation reimbursement must be made within thirty (30) days of the date of the transportation need.
Prior authorization for ambulance, invalid coach and wheelchair accessible livery trips is obtained from the Department's Central Office. The authorization request must be made by the transportation provider. Verbal authorization may be obtained during Departmental business hours from the Central Office.
To obtain authorization the following information is required:
All out-of-state trips require prior authorization from the Department's Central Office, however, arrangements are made through the Department's District Office, as follows:
All livery, taxi trips from nursing homes require prior authorization from the Department's Central Office. The authorization request must be made by the transportation provider. Verbal authorization may be obtained during Departmental business hours from the Central Office.
To obtain authorization the following information is required:
Trips by livery and taxi other than those listed in (i) and (ii) above are arranged and authorized by the District Office, as follows:
No prior authorization is required for trips within the same town, however, reimbursement will be made to the Medicaid recipient, only if the Department receives documentation of a visit to a medical provider. Documentation consists of a signed statement by the medical provider or his authorized representative, or a completed Departmental W-610 Form. Requests for transportation reimbursement must be made within thirty (30) days of the date of the transportation need.
Trips between towns require prior authorization. These trips are approved and arranged by the District Office, as follows:
When non-emergency transportation involves other commercial carriers, prior authorization must be obtained from the District Office. The District Office will either arrange the transportation through a travel agent or the provider of service.
Air transportation requires prior authorization from the Department's Central Office to be obtained as follows:
The provider submits the bill for service on the HCFA 1500, "Health Insurance Claim Form," to the Department's fiscal agent.
The provider of service submits the bill on the Departmental livery claim form to the Department's fiscal agent.
The provider of service submits the bill on the Departmental taxi claim form to the Department's fiscal agent.
Ambulance providers may be paid for a trip, I.V. level life support services, advanced life support services, waiting time, loaded mileage, additional recipient transported, a night call charge, special attendant, paramedic intercept, helicopter assist, out-of-state tolls and for services provided to a recipient who is not subsequently transported by the ambulance provider in accordance with this regulation.
Invalid coach providers may be paid for a trip, waiting time, loaded mileage, additional recipient transported and attendant services in accordance with this regulation.
Livery providers may be paid for a trip, loaded mileage, additional stops, waiting time, assistance, "no shows", and out-of-state tolls in accordance with this regulation.
Taxi providers may be paid for trips by an all inclusive metered rate and out-of-state tolls in accordance with this regulation.
Wheelchair accessible livery providers may be paid for a trip, waiting time, loaded mileage, an additional recipient transported, and out-of-state tolls attendant services in accordance with this regulation.
The Department's fees for wheelchair accessible livery shall be the same as the Department's fees for invalid coach services.
Payment may be made at the per mile fee established by the Department, but only if the total payment exceeds $1.00.
Payment may be made at the lowest charge to the general public for the same service.
Taxi services are paid by the metered rate, regardless of the number of recipients transported.
The Department shall not pay for cancelled calls for any type of transportation.
The Department may pay for a livery service approved in writing by the Department and not cancelled, which a recipient does not utilize, provided the vehicle went to the pickup point. For livery the base rate may be paid for a "no show" for single recipient trips. For multiple recipient trips, a base rate or an additional stop, whichever is appropriate, and mileage if appropriate may be paid for the portion of the trip incurred for the "no show." A "no show" fee will not be paid for nursing home residents.
Waiting time shall only be paid when it is cost effective or the Department has determined it is necessary in order for a recipient to receive a medical service.
One-hour's waiting time may be paid for all or any portion of the first hour. After one hour of actual waiting time, additional waiting time may be paid in fifteen (15) minute increments for all or any portion of the fifteen minutes.
When waiting time is provided as part of a round trip, the Department shall not pay for two base rates and waiting time. One base rate and waiting time may be paid.
No payment shall be made for the first one-half hour of waiting; thereafter waiting time may be paid in fifteen (15) minute increments for all or any portion of the fifteen minutes.
When waiting time is provided as part of a round trip, the Department shall not pay for two base rates and waiting time. One base rate and waiting time may be paid.
No payment shall be made for the first fifteen minutes of waiting; thereafter waiting time will be paid in 15 minute increments for all or any of the fifteen minutes.
When waiting time is provided as part of a round trip, the Department shall not pay for two trips and waiting time. One trip and waiting time may be paid.
Waiting time may be paid in accordance with the tariff established by the Department of Transportation and/or a state approved transit district and is considered part of the metered rate.
The Department may pay for loaded mileage if the vehicle must cross a town line in order to transport a recipient(s) to or from a medical provider. Loaded mileage shall be paid and calculated by the Department in accordance with PUCA Docket #6770-A and all its supplements.
The Department may pay for loaded mileage if the vehicle must cross a town line in order to transport a recipient(s) to or from a medical provider. Loaded mileage shall be paid and calculated by the Department in accordance with PUCA Docket #6670-A and all its supplements.
Mileage may be paid in accordance with the tariff established by the Department of Transportation and/or a state approved transit district and is considered part of the metered rate.
Invalid Coach
Attendant services may be paid when provided by an employee other than the driver.
Livery
Livery assistance services provided by the driver or another employee may be paid for each recipient assisted. Payment may be made for assistance at either or both the pickup point and drop-off point except assistance from or into a nursing home from a livery vehicle will not be covered. Physically helping a recipient only into or out of the livery vehicle is not considered assistance.
All payment rates include all expenses, including tolls and telephone calls.
Payment shall be made based on the mileage from the recipient's home to the medical provider.
Payment is in accordance with the following schedule:
Trip (Base Rate) | Ambulance | Invalid Coach | Wheelchair Livery | Livery | Taxi Metered Rate All inclusive |
X X | X X | X X | X X | ||
Waiting Time | X | X | X | X | |
Loaded Mileage | X | X | X | X | |
Additional Pt. | X | X | X | ||
Additional Stop | X | ||||
Attendant | X | X | |||
Special Attendant | X | ||||
Assistance | X | ||||
Advanced Life | X | ||||
I.V. Level | X | ||||
Paramedic Intercept | X | ||||
No Show | X | ||||
Night Call Charge | X | ||||
Out-of-State Tolls | X | X | X | X | X |
Helicopter Assist | X | ||||
Special Services | X |
Conn. Agencies Regs. § 17-134d-33