Introduction
This Guide contains information pertaining to the MO HealthNet Division (MHD) Fee-For-Service (FFS) Non-Emergency Medical Transportation (NEMT) Program. The purpose of the NEMT Program is to assure transportation for MO HealthNet participants who do not have access to free appropriate transportation to and from scheduled MO HealthNet-covered services.
The NEMT Program provides for the arrangement of transportation and ancillary services by a statewide transportation broker. The NEMT Program is structured to utilize and build on the existing transportation network in the state. The transportation broker may provide NEMT services through direct service and/or subcontracts between the broker and subcontractor(s). The federally approved method to structure the NEMT Program allows the state to have one (1) statewide transportation broker to coordinate the transportation providers. The broker determines which transportation provider will be assigned to provide each transport.
Transportation providers are individuals, including volunteer drivers or entities who, through arrangement or subcontract with the transportation broker, provide NEMT services. Transportation providers are not enrolled as MO HealthNet providers.
- Section 1: Participant Eligibility
1.1 Covered Participants
Individuals must be eligible for MO HealthNet coverage to receive Non-Emergency Medical Transportation (NEMT) services.
The transportation broker shall verify whether the individual seeking NEMT services is eligible for NEMT services on the date of transport by verifying the participant’s MO HealthNet eligibility. Refer to the General Sections Manual for information regarding participant eligibility.
The services to a MO HealthNet-qualified, enrolled medical service provider must be located within the travel standards, based on the participant’s county of residence, willing to accept the participant. Refer to Section 5 in this manual for information on travel standards.
1.2 Non-Covered Participants
Participants with the following Medicaid Eligibility (ME) codes are not eligible for NEMT services provided by the transportation broker.
ME Code
Description
ME Code
Description
02
Blind Pension 80
Women’s Health Services- Uninsured Post-Partum Women 08
Child Welfare Services-Foster Care 82
Missouri Rx (Medicare Part D wrap-around benefits) 52
Division of Youth Services (DYS)-General Revenue 75
Children ages 0-18; family income 225+ to 300% (with premium) 55
Qualified Medicare Beneficiary (QMB) 89
Uninsured Women’s Health Services 57
Child Welfare Services-Foster Care-Adoption Subsidy 91
Gateway to Better Health Tier ½ joint coverage 59
Presumptive Eligibility (Non-Subsidized) 92
Gateway to Better Health Tier 2 Coverage 64
Group Home-Health Initiative Fund (State Placement) 97
Babies born to a mother who is receiving ME 95 (SMHB-Over Income) 65
Group Home-Health Initiative Fund (Parent/Guardian Placement) 9S
SMHB Newborn with Income >= 196%FPL 73
Children ages 1-18; family income 150+ to 185% (with premium) 0F
Child Welfare Services- Foster Care IV-E (state only) 74
Children ages 0-18; family income 185+ to 225% (with premium) 5A
Child Welfare Services- Adoption/ Guardianship IV-E (state only) Refer to the General Sections Manual for information regarding ME codes.
In addition to the above ME codes, the following participants are not eligible for NEMT services provided by the transportation broker:
- Participants who have access to transportation at no cost to the participant. However, such participants may be eligible for ancillary services. Refer to Section 3.2 in this manual for information on ancillary services.
- Participants who have access to transportation through a public entity. However, such participants may be eligible for ancillary services. Refer to Section 6.4 in this manual for more information on public entities.
- Participants who have access to NEMT through the Medicare Program.
- Participants enrolled in hospice. However, the broker shall arrange NEMT services for such participants accessing MO HealthNet-covered services unrelated to the participant's terminal illness.
- Participants in a MO HealthNet Managed Care health plan. NEMT services for participants enrolled in Managed Care health plans are arranged by the health plan for services included in the benefit package. The Fee-For-Service (FFS) transportation broker shall not be responsible for arranging NEMT services for the health plans.
- Section 2: Covered Services
The transportation broker shall ensure the provision of Non-Emergency Medical Transportation (NEMT) services for eligible participants to MO HealthNet-covered services for the Department of Social Services (DSS), MO HealthNet Division (MHD). The transportation broker must ensure that NEMT services are available 24 hours per day, seven (7) days per week, when medically necessary.
The broker shall provide NEMT services to eligible participants to MO HealthNet-covered services that do not include transportation. The broker shall direct or transfer participants with emergent requests to 911 or an appropriate emergency (ambulance) service. Refer to the General Sections Manual for more information on emergency services.
Medically necessary refers to service(s) furnished or proposed to be furnished that is (are) reasonable and medically necessary for the prevention, diagnosis, or treatment of a physical or mental illness or injury; to achieve age-appropriate growth and development; to minimize the progression of a disability; or to attain, maintain or regain functional capacity; in accordance with accepted standards of practice in the medical community of the area in which the physical or mental health services are rendered; and service(s) could not have been omitted without adversely affecting the participant’s condition or the quality of medical care rendered, and service(s) is (are) furnished in the most appropriate setting. Services must be sufficient in amount, duration, and scope to reasonably achieve their purpose, and they may only be limited by medical necessity.
Refer to the General Sections Manual for more information on medical necessity.
2.1 Accompaniment Requirements for Children
Under Age 21
The transportation broker must arrange NEMT services for one (1) parent/guardian to accompany children under the age of 21, if requested. The broker must also arrange NEMT services for an attendant, if appropriate, to accompany children under the age of 21.
An attendant is an individual who accompanies a participant under the age of 21 to the MO HealthNet-covered service to assist the participant because the participant cannot travel alone or cannot travel a long distance without assistance. An attendant is an employee of, or hired by, the broker or an NEMT transportation provider.
Under Age 17
If the participant is under the age of 17, unless the participant is an unaccompanied youth as defined in RSMo 431.056, the participant must be accompanied by a parent/guardian. The parent or guardian may designate another adult (i.e., family member or friend) to accompany a child under the age of 17.
2.2 Ancillary Services
The transportation broker shall authorize and arrange the least expensive and most appropriate ancillary services, such as meals and lodging, when a participant must travel to another city, county, or state for medical care and the distance and travel time warrant an overnight stay. NEMT services are tied to MO HealthNet-covered medical services for a MO HealthNet participant. Lodging is provided only when the participant is staying in the room. Meals are available for the participant and one (1) parent or guardian when traveling with a child to a medical appointment that requires an overnight stay.
Ancillary services shall only be authorized if the following criteria are met:
- The medical appointment requires an overnight stay
- Volunteer, community, or other ancillary services are not available at no charge to the participant.
If the participant meets the criteria specified above, the broker shall also authorize and arrange ancillary services for eligible participants who have access to transportation at no charge to the participant or receive transportation from a public entity, and such ancillary services were not included as part of the transportation service. Refer to Section 6.4 in this manual for information on public entities.
Anicillary Services for the Accompaniment of Children
The broker shall also authorize and arrange ancillary services for one (1) parent/guardian when a MO HealthNet eligible child is inpatient in a hospital setting and meets one (1) of the following criteria:
- The hospital does not provide ancillary services without cost to the participant’s parent/guardian, and the hospital is more than 120 miles from the participant’s residence
- Hospitalization is related to a MO HealthNet-covered transplant service
Provider Requested Ancillary Services
A medical provider may request ancillary services (meals and lodging) for adults and children and one (1) parent/guardian, if necessary, to accompany the child if the medical appointment requires an overnight stay and volunteer, community, or other ancillary services are not at no charge to the participant. Medical provider’s may refer to the transportation broker’s Ancillary Services Form to complete this request.
The following is the process by which ancillary services are coordinated:
- The Ancillary Services Form is submitted to the transportation broker by the medical provider authorizing services
- A transportation broker facility representative contacts a non-profit housing facility (e.g., Ronald McDonald House) prior to contacting hotels, as this is the least expensive accommodation option if available within the hospital's geographic area.
- If a room is unavailable at a non-profit housing facility, the broker will arrange the least expensive, most appropriate hotel accommodation. The broker will pay the hotel directly.
- The job number or confirmation number, along with the hotel name and address, will be provided to the participant by the transportation broker.The Ancillary Services Form will then be faxed back to the requesting medical provider.
- If a hospital is unable to provide meal tickets/vouchers, the parent/guardian will need to submit the original receipts for reimbursement to the broker. The participant must reference the job number and date of service on the receipt for reimbursement. The job number or confirmation number can be found on the authorization form faxed to the requesting facility by the transportation broker. The broker provides meal reimbursement at a flat rate of $25.00 per day, provided the participant is not receiving meal tickets/vouchers from the treating facility.
2.3 Out-of-State Transportation Requests
The broker shall obtain prior authorization from MO HealthNet for out-of-state transportation to non-bordering states.
13 CSR 70-3.120(3) defines out-of-state as not within the physical boundaries of the state of Missouri or within the boundaries of any state that physically borders on the Missouri boundaries.
Border-state providers of services (those providers located in Arkansas, Illinois, Iowa, Kansas, Kentucky, Nebraska, Oklahoma, and Tennessee) are considered as being on the same MO HealthNet participantion basis as providers of services located within Missouri.
Transportation to out-of-state providers can be approved if an eligible participant has an appointment with a MO HealthNet-enrolled provider, providing a MO HealthNet-covered service. For more information on how providers obtain prior authorization for out-of-state non-emergency services refer to the General Sections Manual.
- Section 3: Non-Covered Services
3.1 Services Ineligible for Non-Emergency Medical Transportation
Transportation to the following services are not eligible for Non-Emergency Medical Transportation (NEMT):
- Pharmacy, except when a participant has an appointment to receive a vaccination
- Services included in the Intellectually Disabled/Developmentally Disabled (ID/DD) Waiver Programs and Department of Health and Senior Services (DHSS) Waiver Programs. NEMT services are arranged by those programs. The transportation broker shall not be responsible for arranging NEMT services for these programs or services. However, the broker shall arrange NEMT services for the participants to other qualified, enrolled medical service providers such as physicians, outpatient hospitals, labs, etc.
- Services included in the Comprehensive Substance Treatment Abuse and Rehabilitation (CSTAR) Program, excluding the intake assessment, assessment update, and to receive medication services. NEMT services are arranged by the program. The transportation broker shall not be responsible for arranging NEMT services for eligible CSTAR services. However, the broker shall arrange NEMT services for the participants to other qualified, enrolled medical service providers such as physicians, outpatient hospitals, labs, etc.
- Services included in the Community Psychiatric Rehabilitation (CPR) Program, excluding medication services. NEMT services are arranged by the program. The transportation broker shall not be responsible for arranging NEMT services for CPR Program medication services. However, the broker shall arrange NEMT services for the participants to other qualified, enrolled medical service providers such as physicians, outpatient hospitals, labs, etc.
- Services covered in a child’s Individual Education Plan (IEP); school districts must supply this service
- Services to a Durable Medical Equipment (DME) provider that provides free delivery or mail order services. The broker shall not provide delivery of DME products in lieu of transporting the participant. Refer to the DME Provider Manual for more information.
- Services for MO HealthNet-covered services provided in the home, such as personal care, home health, etc.
- Services for discharge from a nursing home; refer to the Nursing Home Provider Manual for more information
- Hospital-to-hospital transportation; MO HealthNet covers transfers from one (1) hospital to another when the transfer criteria are met. Refer to the Ambulance Provider Manual for more information.
- Case management services except for participants in a category of assistance for pregnant women
- Services not covered by MO HealthNet
- Services from out-of-state (non-bordering) medical providers without prior authorization from MO HealthNet; refer to Section 3.3 in this manual for more information
3.2 Exception Requests for Non-Covered Services
Under certain conditions of medical need, the MO HealthNet Division (MHD) may authorize payment for a MO HealthNet eligible participant to receive an essential medical service or item of equipment that otherwise exceeds the benefits and limitations of any one (1) of the various medical service programs administer by MHD. Under specific criteria, on a case-by-case basis, an administrative exception may be made.
For consideration of coverage for non-covered services for adults (i.e., physical therapy), providers may submit an Exception Request for review. When an Exception Request is approved, transportation may be approved for those services. Reference the Exceptions Provider Manual for more information related to the exceptions process.
- Section 4: Travel Standards
The participant must request Non-Emergency Medical Transportation (NEMT) services to a MO HealthNet-qualified, enrolled medical service provider located within the travel standards, willing to accept the participant. The travel standards are based on the participant’s county of residence.
Counties are classified as urban, basic, and rural. The counties are categorized as follows:
Travel Standard Counties
Urban
Clay, Greene, Jackson, Jefferson, St. Charles, St. Louis, and St. Louis City Basic
Boone, Buchanan, Cape Girardeau, Cass, Christian, Cole, Franklin, Jasper, Johnson, Lincoln, Newton, Platte, Pulaski, St. Francois, and Taney Rural
All other counties 4.1 Maximum Mileage
The mileage a participant can travel is based on the county classification and the type of provider being seen. The following tables contain the mileage allowed under the travel standards.
Physicians
The maximum mileage a participant can travel based on the physician being seen and the county classification are below.
Provider/Service Type
Urban
Basic
Rural
Allergy 25
50
100
Cardiology 25
50
100
Chiropractor 15
30
60
Dermatology 25
50
100
Endocrinology 25
50
100
Gastroenterology 25
50
100
General surgery 15
30
60
Hematology/Oncology 25
50
100
Infectious Disease 25
50
100
Nephrology 25
50
100
Neurology 25
50
100
Obstetrics/Gynecology 15
30
60
Ophthalmology 25
50
100
Orthopedics 25
50
100
Otolaryngology 25
50
100
Pediatric 25
50
100
Physical Medicine/Rehabilitation 25
50
100
Podiatry 25
50
100
Primary Care Physician (PCP) 10
20
30
Psychiatrist-Adult/General 15
40
80
Psychiatrist-Child/Adolescent 22
45
90
Psychologists/Other Therapists 10
20
40
Pulmonary Disease 25
50
100
Rheumatology 25
50
100
Urology 25
50
100
Vision Care/Primary Eye Care 15
30
60
Hospitals
The maximum mileage a participant can travel based on the type of hospital and the county classification are below.
Provider/Service Type
Urban
Basic
Rural
Basic Hospital 30
30
30
Secondary Hospital 50
50
50
Tertiary Services
The maximum mileage a participant can travel based on the tertiary service and the county classification are below.
Provider/Service Type
Urban
Basic
Rural
Level I or Level II trauma unit 100
100
100
Neonatal Intensive Care Unit (NICU) 100
100
100
Perinatology services 100
100
100
Comprehensive cancer services 100
100
100
Comprehensive cardiac services 100
100
100
Pediatric subspecialty care 100
100
100
Mental Health Facilities
The maximum mileage a participant can travel based on the type of mental health facility and the county classification are below.
Provider/Service Type
Urban
Basic
Rural
Inpatient mental health treatment facility 25
40
75
Ambulatory mental health treatment providers 15
25
45
Residential mental health treatment providers 20
30
50
Therapy Services
The maximum mileage a participant can travel based on the therapy service and the county classification are below.
Provider/Service Type
Urban
Basic
Rural
Audiology 50
50
50
Occupational Therapy 30
30
30
Physical Therapy 30
30
30
Speech Language Therapy 50
50
50
4.2 Exceptions to Travel Standard Limitations
The transportation broker must transport the participant when the participant has chosen a qualified, enrolled medical service provider who is not within the travel standards if the participant is eligible for one (1) of the exceptions listed below and can provide proof of the exception:
- The participant has a previous history of other than routine medical care with the qualified, enrolled medical service provider for a special condition or illness
- The participant has been referred by a PCP to a qualified, enrolled medical service provider for a special condition or illness
- No routine or specialty care appointment is available within 30 calendar days to a qualified, enrolled medical service provider within the travel standards
The broker shall transport the participant to the following MO HealthNet-covered services without regard to the travel standards:
- The participant is scheduled for an appointment arranged by the Family Support Division (FSD) for a Medical Review Determination (MRD) to determine continued MO HealthNet eligibility
- The state agency has locked the participant into a MO HealthNet medical service provider. The broker shall receive prior authorization from MO HealthNet for lock-in trips exceeding travel standards.
- The participant has chosen to receive MO HealthNet-covered services free of charge from the Veterans Administration or Shriners Hospitals. Transportation to these facilities must be to the closest, most appropriate Veterans Administration or Shriners Hospital. The broker must document and maintain verification of service for each transport provided to free care. The broker must verify that each request for such transport meets all NEMT criteria, including but not limited to participant eligibility and MO HealthNet-covered services.
- Section 5: Modes of Transportation
The transportation broker must arrange the least expensive and most appropriate mode of transportation based on the participant’sphysical, mental, or medical condition. The broker shall ensure that the transportation provided to the participant is comparable to the transportation resources available to the public (e.g., buses, taxis).
The modes of transportation that the broker may utilize include, but are not limited to:
- Ambulance (for non-emergent transportation only)
- Gas reimbursement
- Multi-passenger van
- Para-lift van
- Public transit (i.e., bus tokens, bus pass)
- Rideshare services (i.e., Uber, Lyft)
- Stretcher van
- Taxi
- Volunteer driver program, if approved by the state agency
5.1 Level of Service
The type of vehicle assigned by the transportation broker is determined by the Level of Service (LOS) required for the participant. The transportation broker may arrange shared rides, so participants should anticipate traveling with other participants (excluding specialized transport that requires stretcher services).
The following is considered when determining the LOS:
- Ambulatory: Includes individuals using a manual wheelchair who can stand or pivot independently. This may include the use of public transportation and/or taxis.
- Wheelchair: For participants who use an electric wheelchair or a manual wheelchair and are unable to transfer.
- Stretcher service: For participants confined to a bed, contact the broker to obtain the Stretcher Assessment Form.
- Non-emergency ambulance: For participants requiring equipment only available on an ambulance (e.g., non-portable oxygen) or when travel by other means could be detrimental to the participant's health (e.g., a body cast).
The authorized clinicians (i.e., Facility Support Worker (FSW), Case Manager (CM), or Registered Nurse (RN)) at a treatment facility may assist the broker by providing the necessary information to determine the LOS and by keeping this information updated on the Standing Orders (SOs). Refer to the Section 7.2 in this manual for more information on SOs.
5.2 Gas Reimbursement
If the participant drives themselves, or a family or friend transports the participant, they may qualify to be reimbursed for mileage. To qualify for mileage reimbursement, the ride must meet the following criteria:
- The participant must be eligible for Non-Emergency Medical Transportation (NEMT) services
- The trip is to a MO HealthNet covered service
- The trip distance is appropriate based on travel standards; refer to Section 5 in this manual for more information
Participants have two (2) ways to submit a request for mileage reimbursement. Requests must be submitted within 60 days of the actual trip. Refer to NEMT Mileage Reimbursement for submission information. For reimbursement due to dialysis, refer to Section 7.2 in this manual for information.
Prior to reimbursing a participant for gas, the broker shall verify that the participant saw a MO HealthNet medical service provider on the date of the request for gas reimbursement and verify the mileage from the participant’s trip origin street address to the trip destination street address. The broker shall use zip codes to verify mileage if the street address is unavailable. Gas reimbursement shall be made at no less than the Internal Revenue Service (IRS) medical mileage rate in effect on the date of service.
5.3 Public Entity Agreements
MHD has existing interagency agreements with public entities to provide access (subject to availability) to transportation services for a specific group(s) of participants. The transportation broker shall refer participants to public entities when the participant qualifies for transportation services under such agreements.
The following are the public entities and the specific individuals for which transportation is covered.
Children’s Division
The Department of Social Services (DSS) Children’s Division (CD) provides reimbursement for transportation services to MO HealthNet-covered services for some children who are determined eligible by CD. Participants and their families should contact their CD caseworker for additional information.
Columbia Public Paratransit
Columbia Paratransit transports individuals with disabilities within the Columbia city limits. This service provides buses during peak hours, including para-transit curb-to-curb services.
Jefferson City Transit Division
The Jefferson City Transit Division (JEFFTRAN) is a curb-to-curb, origin-to-destination transportation service with wheelchair and lift equipped buses. Jefftran is provided to all eligible individuals with disability without priority given for trip purposes. Jefftran is intended to be used by individuals who, because of disability, cannot travel to or from a regular fixed route bus stop or cannot get on, ride, or get off a regular fixed route bus that is not wheelchair lift equipped. This service operates to and from any location within Jefferson City.
Kansas City Area Transportation Authority
Kansas City Area Transportation Authority (KCATA), also referred to as RideKC, provides door-to-door accessible transportation to persons with disabilities and the elderly. Services are available to residents of Kansas City. Individuals must complete an application and be approved to participate in the program.
Nevada City Hospital
Nevada City Hospital transports individuals who live within a 20-mile radius of Nevada City.
School-Based Non-Emergency Medical Transportation Services
Some school districts provide transportation for children to obtain medically necessary services provided as a result of a child’s Individual Education Plan (IEP). The school district identifies eligible children.
Springfield City Utilities Transit Center
The City Utilities Transit Center in Springfield operates a para-transit service to serve disabled participants who are unable to ride a fixed route bus. This service, referred to as The Bus, is operated on a demand-responsive curb-to-curb basis. A one (1)-day notice is required for reservations.
St. Louis City and County Metro Transit
The Bi-State Development Agency, Metro Transit, provides curb-to-curb accessible transportation to persons with disabilities and the elderly who reside in St. Louis City and County.
- Section 6: Arranging Transportation
Participants may schedule Non-Emergency Medical Transportation (NEMT) by calling the transportation broker or by downloading the broker’s mobile app. Refer to MTM Health Missouri Participants for information on the mobile app.
The number for scheduling NEMT is (866) 269-5927. Non-urgent trips may be scheduled Monday through Friday, 8:00 am - 6:00 pm. Representatives are available 24 hours a day, seven (7) days a week for urgent trips and to provide assistance. The transportation broker shall arrange NEMT services within 24 hours of receiving the request.
Participants should follow the below guidelines when arranging NEMT:
- Living in urban county: Call at least two (2) business days before their scheduled appointment for a MO HealthNet covered service
- Living in a rural or basic county: Call at least three (3) business days before their scheduled appointment for a MO HealthNet covered service
- If being discharged from the hospital or for an urgent medical need, rides may be scheduled the same day; refer to Section 7.1 in this manual for more information
- Have trip information ready and available
Refer to Section 5 in this manual for information on county classifications
A one (1)-way trip is from the participant’s home to the appointment. A round trip is from the participant’s home to the appointment and then back home. The broker shall limit the participant to no more than three (3) transportation legs (2 stops) per day unless the broker receives prior authorization from the MO HealthNet Division (MHD). For example:
- First leg of the trip – Home to first doctor
- Second leg of the trip – First doctor to second doctor
- Third leg of the trip – Second doctor to home
6.1 Urgent Requests
NEMT services may be scheduled with less than the required notice described above if there is an urgent medical need. Urgent is defined as a serious but not life-threatening illness/injury. Urgent trips may be requested by the participant or the participant’s medical provider.
The participant or provider should call (866) 269-5927, 24 hours a day, seven (7) days a week. They must provide the following information:
- Participant’s name
- Date of birth
- Address
- Phone number
- MO HealthNet ID number
- Medical provider of the scheduled MO HealthNet covered service’s name, address, and phone number
- Date and time of the medical appointment
- Any special transportation needs of the participant (e.g., wheelchair service, stretcher service)
- The type of MO HealthNet-covered service (e.g., physician, dentist, therapy)
- Whether the participant is under 21 years of age and needs someone to accompany the participant to the appointment
- For facilities arranging transportation for dialysis participants, refer to Section 7.2 in this manual.
6.2 Standing Orders
Participants or authorized clinicians (i.e., Facility Support Worker (FSW), Case Manager (CM), or Registered Nurse (RN)) at a treating facility may request the transportation broker facility representative to enter a Standing Order (SO) for ongoing NEMT services for their MO HealthNet participants who are required to attend a covered recurring appointment. For example, the participant attends an appointment every Monday, or every Monday, Wednesday, and Friday.
To arrange a SO for NEMT, the participant or authorized clinician at the treating facility should contact the broker by phone at (866) 269-5927.
Medical facilities may refer participants to MTM Link to schedule NEMT for SOs.
SOs require recertification by the provider every 90 days with the broker. To recertify, authorized clinicians should contact the broker by phone at (866) 269-5927.
Changes to Standing Orders
Authorized clinicians are required to report any change to the SO (i.e., death, transplant, address, time, level of service, or facility) as soon as they are aware of the change.
Cancellations and changes can be made by the participant through the MTM Link or the authorized clinician may call at (866) 269-5927. For participant hospitalizations, the broker will deactivate SOs upon notification.
When the participant is discharged from the hospital and is ready to resume transportation, a new SO will need to be arranged with the broker.
Standing Orders for Dialysis
SOs for dialysis do not have an expiration date and only require updates when a change or cancellation is needed. Participants who wish to provide their own transportation and receive mileage reimbursement may submit the NEMT Mileage Reimbursement Trip log. Participants should complete the form, obtain a signature from a facility clinician, and send the form to the broker so that it is received within 60 days after the appointment.
6.3 Where’s My Ride?
All facilities are provided with the Where’s My Ride (WMR) contact information which is included in the information packets provided by the transportation broker. The WMR line is (866) 269-5944.
- Facilities should have these numbers available for participants. If a transportation provider is more than 15 minutes late for a Standing Order (SO) appointment or pick-up time, Facility Support Workers (FSWs), participants, or any facility designee should call the WMR line. The broker staff will determine where the driver is and ensure the participant is transported. (NOTE: The transportation provider is allowed a grace period of 15 minutes past the SO appointment and pick-up time.)
- The WMR line should be used when a participant is ready to return home after dialysis or any other medical appointment, when the pick-up time is not scheduled.
- Participants should call the WMR line when they know they are going to be late.
- The WMR line is answered 24 hours a day, seven (7) days a week, and is available for questions or concerns with after-hours appointments.
A pick-up time is the actual time the participant boarded the vehicle for transport. Pick-up time must be documented by the transportation provider for all trips and must be no later than five (5) minutes from the scheduled pick-up time. Trips completed or canceled due to the transportation provider being late must be included in the pick-up time reporting.
- Section 7: Denials
If the transportation broker denies the request for Non-Emergency Medical Transportation (NEMT) services, the broker shall provide the participant with written notification. The notice must indicate that the broker has denied the services, the reasons for the denial, the participant’s right to request a state fair hearing, and how to request a state fair hearing. Refer to Section 8.1 in this manual for more information on state fair hearings. If the broker denies the request for services, the broker shall provide verbal and written notification to the participant.
The reasons a request for NEMT may be denied include, but are not limited to, the following:
- Appointment is for a non-covered service
- Lack of adequate notice to schedule the ride
- Participant is ineligible for NEMT services
- Exceeds travel standards; refer to Section 5 in this manual for more information
- Urgency not verified by medical provider, when applicable; refer to Section 7.1 in this manual for more information on urgent requests
- Participant has Other Coverage
- Trips the broker does not assign to a transportation provider due to the inability or unwillingness of the transportation provider to accommodate the trip
- Access to vehicle
- The appointment is not with the closest MO HealthNet provider available for the service
- Over trip leg limit; refer to Section 7 in this manual for more information
- Participant has access to free transportation
- The provider rendering services to the participant is not enrolled with MO HealthNet
- Incomplete information to schedule the ride
- Refused appropriate mode; refer to Section 6 in this manual for more information
- Participant under 17 without accompaniment; refer to Section 3.1 in this manual for more information
- Participant is outside the service area of the broker
- Section 8: Request a Hearing
The MO HealthNet Division (MHD) shall maintain an independent state fair hearing process as required by federal law and regulation, as amended. The state fair hearing process shall provide participants an opportunity to have a state fair hearing before an impartial hearing officer. The parties to the state fair hearing include the broker, the participant, and their representative or the representative of a deceased participant’s estate.
Participants have 90 days from the date of the written notice of denial to request a state fair hearing. The written notice will include information on how to request a state fair hearing.
- Section 9: Participant Rights and Grievances
9.1 Participant Rights
Participants must be given the rights listed below by the transportation broker:
- General rule: The transportation broker must comply with any applicable federal and state laws that pertain to participant rights and ensure that the broker’s personnel and transportation providers take those rights into account when furnishing services to participants.
- Dignity and privacy: Each participant is guaranteed the right to be treated with respect and with due consideration for their dignity and privacy.
- Copy of transportation records: Each participant is guaranteed the right to request and receive a copy of their transportation records.
- Free exercise of rights: Each participant is free to exercise their rights, and exercising those rights does not adversely affect how the broker and the broker’s transportation providers or the state agency treat the participant.
9.2 Participant Grievance Process
If a participant is not satisfied with the services provided by the Non-Emergency Medical Transportation (NEMT) broker, a grievance may be filed. A grievance is a verbal or written expression of dissatisfaction from the participant about any matter other than an action. Actions include the denial, termination, suspension, or reduction of a NEMT service. For these situations, participant’s should file a state fair hearing request. Refer to Section 8.1 in this manual for more information on state fair hearings.
Possible subjects for grievances include, but are not limited to, the following:
- Quality of care or services received
- Condition of mode of transportation
- Aspects of interpersonal relationships, such as rudeness of a transportation provider or broker’s personnel
- Failure to respect the participant’s rights
The transportation broker must thoroughly investigate each grievance and shall acknowledge receipt of each grievance in writing within 10 business days of receiving the grievance. To file a complaint, the transportation broker can be contacted at (866) 436 0457or by visiting MTM Health.