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Specialized Transportation Guide

Posted
Updated
ByStephanie Kovatich

There are 3 types of specialized transportation service that can be utilized by participants.  It is important to understand and discuss with the participant which one is appropriate for their individual situation.  Specialized transportation can be utilized for both medical and non-medical transportation.

Stretcher transport

  1. The participant requires hands on help to get out of their home
    1. Ie. The participant has paralysis with no stair glide/lift/ramp outside of the home or the participant is in a wheelchair, but has no way to get down the front steps.

Paralift

  1. The participant can get out of their home, but they require a ramp/lift to get into a vehicle.
    1. ie. The participant is in a wheelchair and needs a vehicle with a lift/ramp to transport them, but they live on the first floor and are able to leave their house independently.
    2. In the southeast SEPTA CCT does this, so link the participant with CCT rather than putting this service in the PCSP

Ambulance

  1. The participant must require some type of medical treatment while in route
    1. ie. The participant needs to be on oxygen 24/7 and is waiting on a portable oxygen tank to be delivered.

Process:

  1. If a participant requests specialized transportation services for Medical or Non-medical appointments and is NOT in the area that CCT services, then you will need to find out if they have a Medicare Advantage plan.
    1. If the participant does have Medicare Advantage, then the SC should assist them with using their Medicare Advantage covered transportation benefit.
    2. If the participant does NOT have Medicare Advantage, then the SC can add the request for specialized transportation service to the PCSP.
  2. If the participant would benefit from another service that would alleviate the need for specialized transportation, this should be discussed with the participant.  These services may improve the quality of life for the participant in a more significant way than just adding specialized transportation.
    1. If the participant is unable to leave their home at all, due to being in a wheelchair and having stairs that they would need to use to get outside, they may benefit from a different service.
      1. Home modification (for ramp, lift outside of the home, or stair glide) would allow ptp to utilize other forms of transportation, but also may allow the participant to go to visit family and friends, more easily attend medical appointments, attend ADC, or have access to more of their home or their community.
  3. Once the need for specialized transportation is determined, the PCSP must be updated and an SRT submitted for the request.

PCSP documentation:

  1. A new visit is NOT needed to add just specialized transportation (if there are no visits currently due).
  2. Specialized transportation must be requested in the PCSP on a monthly basis.
    1. If the participant knows all of the information for appointments that are in different months at the time of their request, you can add them all to the PCSP/SRT at the same time.
      1. If you are adding trips for different months, then you must list each month separately in the PCSP and the SRT.
      2. During your call to schedule any visit, ask the participant to have information about any upcoming appointments ready for the day of the visit, if they are going to be requesting specialized transportation.
  3. Goal
    1. There must be a goal that directly ties to the transportation need
      1. Medical Transportation example:
        1. Betty is diagnosed with paraplegia and diabetes.  Betty will attend appointments with her Endocrinologist, once per month for the next year, utilizing stretcher transport, in order to decrease hospitalizations.
      2. Non-Medical Transportation example:
        1. Betty is diagnosed with paraplegia and depression.  Betty will go to her local Senior Center, at least once per week, until CCT keycard is received, utilizing paralift transportation, in order to increase her socialization to help decrease depression symptoms.
  4. Service Plan
    1. Service Type
      1. Non-Medical transportation
        1. Listed for both medical and non-medical specialized transportation requests.
    2. Start date
      1. The date of the first trip for that month
    3. End date
      1. The date of the last trip for that month
    4. Service Details
      1. The type of specialized transportation being requested
        1. ie. ambulance, paralift, or stretcher.
      2. The reason “why” the specific specialized transportation is needed must be listed.
        1. Ie. diagnosis related to the specialized transportation need and/or reason the participant can not use other forms of transportation
      3. Whether the request is “recurring” or “one-time”
        1. Recurring
          1. Same location for drop off and pick up
          2. Consistent schedule each month for transport
          3. Example
            1. The participant goes to the same Senior Center every Monday and Wednesday from 9a-11a each time.
        2. One time
          1. A trip that is only taking place one time OR trips to the same location, but without a consistent schedule
          2. Examples
            1. The participant need to go to view a new apartment they may move to and is only requesting the trip one time
            2. The participant is going to the same Senior Center each time, but goes random days each month.
      4. Total number of “trips” being requested
        1. A trip is ONE way
      5. Where the participant is going for the trip
        1. Addresses to location where the participant needs to go
      6. Total miles
        1. Add together the miles for the trips there and back, if it is two trips to and from one location
      7. If requesting Ambulance transport
        1. The special needs that cause this type of transport to be needed
          1. Examples
            1. 24/7 Oxygen
            2. Trach/vent usage
      8. If the participant uses a wheelchair
        1. Is it manual or electric
      9. Who is going
        1. State if the participant is going alone OR
        2. State if the participant has someone going with them 
      10. Does the SC agree with the specialized transportation need
      11. Why did Medicare not cover the transport
        1. The participant may not have Medicare
        2. Medicare may have denied
          1. Reason for denial must be specified
      12. Examples:
        1. Medical transportation examples:
          1. MTM as provider
            1. Betty is diagnosed with paralysis and her landlord will not agree to home modifications.  Transportation via stretcher to attend medical appointments, once per month, recurring, 2 trips per month.   Betty is going to her Endocrinologist at 123 First Street, Phila, PA 19101 and returning to her home at 456 South Street, Phila, PA, 19105.  Total of 11 miles each appointment day.  Betty uses a manual wheelchair and will be going to the appointment by herself.  SC agrees that stretcher transportation is needed and Betty does not currently have Medicare.
          2. MATP as provider
            1. Betty is diagnosed with paralysis and uses an electric wheelchair and will be going to the appointment by herself.   Betty is requesting Paralift transportation and does not live in an area where CCT is an option.  Betty is going to her Endocrinologist at 123 First Street, Pittsburgh, PA 1205 and returning to her home at 456 South Street, Pittsburgh, PA, 15206.  Total of 11 miles for 2 trips, one to go to the appointment and one to  return home on 8/17/23.   SC agrees that Paralift transportation is needed and Betty does not currently have a Medicare Advantage plan.
        2. Non-Medical Transportation example:  MTM for all Non-
          1. Betty is diagnosed with paralysis and uses an electric wheelchair.  Betty can exit her home independently, but needs a lift to use transportation.  Transportation via paralift to Senior Center, at least once per week, one time for 9/6, 9/14, 9/20, and 9/25, until CCT keycard is received.  Total of 8 trips.  Betty will be going alone and uses an electric wheelchair.  Senior Center is at 789 W Front Street, Phila, PA, 19150 and Betty’s address is 1011 Roosevelt Blvd, Phila, PA 19154.  Total miles: 21 each day.  SC agrees that paralift is needed, until the keycard is received.  Betty does not currently have Medicare.
    5. Frequency and amount of visits
      1. The frequency is “Monthly”
      2. The amount is based on “trips”
        1. If Betty needs to go to one appointment and then back home, 2 trips would be listed in the PCSP and SRT for that one appointment
    6. Provider
      1. MATP- for medical transport
        1. For specialized Paralift transportation only
      2. MTM- for non-medical transportation
        1. For all non-medical transportation
      3. MTM- for medical transportation
        1. For specialized Ambulance or Stretcher Transportation only

SRT documentation:

  1. Medical specialized transportation
    1. If the transportation request is for Medical Transportation and goes through MATP, then an SRT is NOT needed.
  2. Non- Medical specialized transportation
    1. Benefit requested
      1. Other (non covered benefit)
    2. Request type
      1. New
    3. Unit of measure
      1. Trips
    4. Frequency
      1. Monthly
    5. Start date
      1. Date of the first requested trip
    6. Current authorized amount
      1. 0
    7. CC findings
      1. All of the above information from the Service Details MUST be included
      2. Examples
        1. Medical Transportation
          1. NO SRT is needed if MATP is being used
          2. SRT is needed if Paralift is being used for Specialized transportation
            1. Betty is diagnosed with paralysis and uses an electric wheelchair and will be going to the appointment by herself.   Betty is requesting Paralift transportation and does not live in an area where CCT is an option.  Betty is going to her Endocrinologist at 123 First Street, Pittsburgh, PA 1205 and returning to her home at 456 South Street, Pittsburgh, PA, 15206.  Total of 11 miles for 2 trips, one to go to the appointment and one to  return home on 8/17/23.   SC agrees that Paralift transportation is needed and Betty does not currently have a Medicare Advantage plan.
        2. Non-medical Transportation
          1. Betty is diagnosed with paralysis and uses an electric wheelchair.  Betty can exit her home independently, but needs a lift to use transportation.  Transportation via paralift to Senior Center, at least once per week, one time for 9/6, 9/14, 9/20, and 9/25, until CCT keycard is received is being requested by Betty.  Total of 8 trips.  Betty will be going alone and uses an electric wheelchair.  Senior Center is at 789 W Front Street, Phila, PA, 19150 and Betty’s address is 1011 Roosevelt Blvd, Phila, PA 19154.  Total miles: 21 each day.  SC agrees that paralift is needed, until the keycard is received.  Betty is not eligible for Medicare.

Specialized Transportation FAQ’s

  1. I just recently completed a PCSP/SRT, I selected “no” to specialized transportation and it forced me to complete the sections on specialized transportation when The PTP did not request. What do you do then?

This has been fixed in FP

  1. What if they forget about an appointment and call when they’ve remembered? Will everything need to be updated again for that one appointment? Would it be expedited?

Yes, you would need to update the PCSP and even if you expedited it may not be enough time to give the 3 days notice to the transportation provider, so make sure you are asking the ptp before the visit date to gather all information on appointments (especially the specialized transportation ones.

  1. What if this is an MCO transfer or previous nursing facility PTP should a change event be completed? for example last PCSP is NF PCSP in portal.

Yes, NF PCSP’s would never have HCBS services on them, so a visit would be needed.  Visit in this situation would also be due, because the ptp has gone from NF to HCBS and if HCBS services are not already in place at the time of referral, then they would need to be discussed.

  1. MATP will still be “Other” on the PCSP correct?

Correct, only if the ptp does is not requesting specialized transportation.  If the ptp needs paralift and does not have Medicare Advantage plan coverage, then “non-medical transportation” for MATP would be used for specialized transportation requests.

  1. Do we need to update PCSP for PTP that’s already getting these services?

You would update the PCSP any time the participant is asking for a new trip.  Specialized transportation is requested Monthly and based on specifics about the trip.  

  1. If a ptp has a medical appointment like 2 months later, can we update the pcsp and srt now or do we wait until 3 days before the medical appointment?

Yes, update the PCSP as soon as you know the information for the specialized transportation request.  We need to make sure that we are submitting requests from participants right away! Three days prior to the appointment will likely result in the ptp not getting the transportation they need, because the transportation providers need a minimum of 3 days notice for appointments and PHW would not have enough time to review or build an authorization.

  1. Is this for dialysis ptps or regular apts?

Specialized transportation can be used for medical appointments, only if the participant needs ambulance, stretcher, or paralift transport and it is not going to be covered by a Medicare Advantage Plan.  If a ptp meets that criteria, then the type of appointment requested does not matter.

  1. So if it’s a medical appointment the provider is MATP but it’s listed as NMT in PCSP?

If it is a specialized transportation request, for paralift, to a medical appointment and the ptp does not have Medicare Advantage plan coverage, then yes, MATP would be on the PCSP and “non medical transportation” would be selected. For Ambulance and stretcher, you would select MTM and “non medical transportation”.

  1. So we are updating the pcsp and srt each time for a medical appointment every month if it’s not the same medical appointment?

You will be reminding the ptp prior to any visits to have all of the information for any trips that will require a specialized transportation request. You can submit up to a year of specialized transportation, it is just requested by month.  So if there are 3 months of trips being requested during the next year, then you will add all 3 months worth of trip information to the PCSP/SRT, but you must have all of the required information about the trips.  If these are new appointments the ptp is scheduling after you did your regular visit and the ptp gives you the information for the trips separately, then yes, you would update the PCSP/SRT each time.  Talk with your participants about this prior to the first time they request specialized transportation, so they know to give you any requests that they can at the same time.  When you are updating the PCSP with the ptp, ask them for any future visits they have as well, to help decrease the amount of updates needed.

  1. How are we figuring out the miles?

You would look at both addresses the ptp provided you with and use whatever app or site you use for directions.  And add together the mileage for the trips for that day.

  1. Is Mtm for specialized transportation? PHW is saying for medical appointments for specialized transportation to use MTM

Yes, MTM should be used for specialized transportation for ambulance and stretcher transport to medical appointments.  You would still specify what type of appointment it is.  For Paralift, MATP, is the provider for specialized transportation.  Please make sure you check if they have a Medicare Advantage plan and if it would be covered through that first though.  

  1. Do these updates require visits monthly

You are not doing a visit for specialized transportation requests, unless a visit is already due for the participant.  If no Annual, Change event, or Quarterly is due, then you would just update the PCSP/SRT to include the information on Ambulance, Stretcher, or Paralift transport.

  1. Can you provide the examples you mentioned in PCSP format for specialized and normal transportation for reference?

Yes, as soon as Function Portal is updated with all the questions, then examples from FP will be in Knowledge Base, which you can access at any time.  In KB, search for “transportation” and all related documents will show up.

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