Balance billing is prohibited. If reimbursement is made, providers must accept this payment as payment in full see Program Rule 8. The provider may only bill the member for services not covered by Health First Colorado. The member, or member’s representative, is responsible for obtaining prior authorization and should be requested as soon as possible. Transportation provided without authorization from the SDE or provider, or their designee, will not be reimbursed or paid.

While not requiring prior authorization, mileage or bus pass reimbursement may be denied if the member does not provide proper documentation to the State Designated Entity within timely filing requirements, or sooner if required by the State Designated Entity’s policies.

Train, air, and out-of-state travel must be prior authorized by the Department. NEMT can only be used to access approved medical services. The SDE will request the required documentation and submit to the Department for review and decision. The decision will be communicated to the SDE.

Appendix F is available under the Appendices drop-down section on the Billing Manuals web page. Transportation for Health First Colorado members to and from a medical provider is a benefit when the medical service provided is a benefit of the Health First Colorado and the provider is enrolled with Health First Colorado to deliver the service. There is no limit to the number of daily trips a client can receive from one or multiple providers, but those trips must meet all NEMT regulatory and policy requirements.

Billing multiple trips for one member in one day with different rendering providers may require the use of a modifier see Procedure Coding , below. Transit passes may be issued when the cumulative cost of bus trips exceeds the cost of a pass.

Personal Vehicle Mileage Reimbursement A private vehicle may be provided by a volunteer, individual or organization, with no member vested interest or a vehicle provided by an individual, family member, self, neighbor , with a member vested interest.

Mileage reimbursement for a personal vehicle is reimbursed per vehicle, without regard to the number of members or escorts in the vehicle and is only reimbursed using the most direct route to and from the appointment. Exceptions can be made by the SDE if the shortest distance is impassable due to severe weather, road closure, or other unforeseen circumstances outside of the member’s control that severely limit using the shortest route. If an exception is made, the SDE must document the reason and can pay mileage for the actual route traveled.

A mobility vehicle may submit claims using wheelchair van procedure codes only when the member is a wheelchair user and the vehicle has been modified with appropriate wheelchair equipment. See Wheelchair Van. The SDE is responsible for ensuring documentation from the member’s medical professional indicates, in writing, the member is unable to use less costly modes of NEMT services e.

Mileage shall be paid for the shortest trip length in miles as determined by an internet-based map, trip planner, or other Global Positioning System GPS. Wheelchair Van A wheelchair van is a vehicle for hire that has been specifically designed, constructed, modified, or equipped to accommodate the needs of wheelchair users.

Wheelchair van services are a Health First Colorado benefit only when the member’s medical professional indicates, in writing, the member is wheelchair-confined and unable to use less costly modes of NEMT services e.

Wheelchair van providers must have, and maintain one of the following PUC licenses, or be determined exempt by PUC statutes:. Taxicab A taxicab service means passenger transportation by a common carrier on a call-and-demand basis in a taxicab, with the first passenger therein having exclusive use of the taxicab unless such passenger agrees to multiple loading. Taxicab providers must have and maintain a common carrier certificate with authority to provide taxicab service. Providers must provide services in compliance with PUC licensure and state and federal laws.

Taxicab services are a Health First Colorado benefit when the member’s medical or physical condition precludes the use of member-purchased public or private transportation, or other less costly modes of Health First Colorado transportation. Stretcher Van Stretcher van is a vehicle that can legally transport a client in a prone or supine position when the client does not require medical attention en route.

This may be by stretcher, board, gurney, or other appropriate device. Medical or safety requirements must be the basis for transporting a client in the prone or supine position. Stretcher van service is a Health First Colorado benefit when the member’s medical professional indicates, in writing, the member must be transported in a prone or supine position and they are unable to use less costly modes of NEMT services e.

Ground Ambulance Ambulance means any publicly or privately-owned vehicle that is specially designed, constructed, modified or equipped to be used, maintained and operated on streets or highways to transport clients to a hospital or other treatment facility in cases of accident, trauma or severe illness.

Administration of intravenous IV medication en route shall not include self-administered IV medications. Non-emergent ground ambulance service is a Health First Colorado service when the member’s medical professional indicates that the member requires an ambulance in order to be transported safely and they are unable to use less costly modes of NEMT services e.

All out-of-state ground ambulance trips must be prior approved by the Department See Prior Authorization. Air Ambulance Air ambulance means a fixed wing or rotor wing aircraft that is equipped to provide air transportation and is specifically designed to accommodate the medical needs of individuals who are ill, injured, or otherwise mentally or physically incapacitated and who require in-flight medical supervision.

Non-emergent air ambulance service is a Health First Colorado service when the member’s medical professional indicates, in writing, that the member requires air ambulance in order to be transported safely and they are unable to use less costly modes of NEMT services.

Commercial Air Commercial air means travel via an airline which provides scheduled air transportation for passengers. Commercial air transport is a Health First Colorado service when the member’s medical professional indicates that the member requires commercial air in order to be transported safely and they are unable to use less costly modes of NEMT services.

Train transport is a Health First Colorado service when the member’s medical professional indicates that the member requires train transportation in order to be transported safely and they are unable to use less costly modes of NEMT services. NEMT may cover the cost of transporting a second escort with written certification for medical necessity from the member’s medical provider, if:. Minors who are at least thirteen 13 years old, but younger than eighteen 18 years old, may travel alone with a written release from their parent or guardian, as long as an adult is present to receive the minor at the destination and at the return location.

Minors under thirteen 13 years old shall not travel without an escort. Children in a day treatment program may travel without an escort, as long as there is a written release from their parent or guardian, stating that an adult will be present to receive the minor at the destination and return location. Children are not eligible for NEMT travel to and from school-funded day treatment programs.

Meals and lodging may be covered for the escort when a member is a child or an at-risk adult who requires the escort’s continued stay. Reimbursement will only be made for meals and lodging that members and escorts are actually charged for, up to the daily per diem rate established by the Department.

If a member is not normally billed for meals and lodging will not be reimbursed. This is a change to current processes where facilities and transportation vendors work with the State Designated Entity.

Urgent NEMT is transportation needed to receive necessary medical services when a member is unable to provide advanced notice. This includes:. Please visit the Electronic Code of Federal Regulations website for more information. Attachment 3. Colorado’s Medicaid State Plan website.

The Colorado Code of Regulations are the state’s rules governing programs and services. To find the current version of 10 CCR 8. NEMT must be used to access the closest qualified provider of that service. There is an online tool to find the closest provider, accessible on the Department’s website by clicking Find Doctors. The codes are used for submitting claims for services provided to Health First Colorado members and represent services that may be provided by enrolled, certified Health First Colorado providers.

The series of local procedure codes used to bill for mobility van services XX are no longer available. Use the appropriate number of units to identify the actual number of riders. When billing for one member taking multiple trips in the same day with the same rendering provider, modifier 76 must be used.

When billing for one member taking multiple trips in the same day with different rendering providers, modifier 77 must be used. A diagnosis is required on all claims. Enter code R Do not fill unused spaces with zeroes. The diagnosis must be referenced to each detail line by placing a “1” in the diagnosis indicator field.

Both dates must be completed on the electronic record. Enter N or leave blank to indicate the service was non-emergency medical transportation. NEMT claims which require manual pricing must include an attachment that supports the claim. The following paper form reference table shows required, optional, and conditional fields and detailed field completion instructions for the EPSDT claim form.

For more information on timely filing policy, including the resubmission rules for denied claims, please see the General Provider Information manual. Skip to main content. NEMT providers help with administration in the remaining 55 counties. It presents a standardized approach to providing information and reducing ambiguities and difficulties that might arise from unwritten or inconsistent policies or lack of proper communication.

The Non-Emergency Medical Transportation Employee Handbook incorporates all applicable federal employment laws and built-in state employment resources to help you customize the handbook. In a few easy steps, you can print and distribute the handbook or save it as a PDF, which can be distributed via email or posted on the web for your employees to access.

This book is available in paperback format and e-book instant download format. This manual is available in e-book instant download format and Flash Drive for easy editing.

Authorization to Release Protected Health Information 2. Background Check Release Form 3. Client Invoice Form 4. Client Satisfaction Survey Form 5. Client Service Plan Agreement Form 6. Client Service Schedule 7. Daily Trip Log Form 8. Daily Vehicle Status Log 9. Driver Job Description Drug Testing Consent Form Employee Counseling Form Employee Satisfaction Survey Form Employee Statement of Confidentiality Employee Time Sheet Employment Application Form Employment Termination Contract Hepatitis B Immunization Consent Incident Report Form Independent Contractor Agreement Form Job Offer Letter License Verification Form Notice to Employee of Suspension Without Pay

 
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This book was created to help you navigate the details of opening and growing a NEMT. A step-by-step guide simplifies the process of meeting county, state, and federal requirements for operating your business. Need all the sample policies and procedures to create your NEMT manual? Some states also require the submission of written NEMT policies and procedures as part of the licensing process.

This manual has all the sample policies that are easy to understand and can be customized to meet the unique needs of your operations. Plan for a smooth operation of your non-emergency medical transportation business with our customized policies and procedures manual. Policies and procedures are an essential component of a NEMT business.

It’s a necessary roadmap for the day-to-day operation of your business. Compiled by experts with over 18 years of experience, the Customized Non-Emergency Medical Transportation Policies and Procedures Manual will address all applicable state regulations, broker requirements, federal and state labor laws.

Included in this manual are forms and templates for the daily operations of the NEMT business. Our 5-step quality process assures the content of the policy manual accurately reflect the regulations and standards. The manual is available in e-book format and hardcopy. It provides a thorough and consistent way to communicate your policies and set expectations with your employees. The handbook addresses specific polices that your drivers and crewmembers need to know to comply with regulations and standards.

It presents a standardized approach to providing information and reducing ambiguities and difficulties that might arise from unwritten or inconsistent policies or lack of proper communication.

The Non-Emergency Medical Transportation Employee Handbook incorporates all applicable federal employment laws and built-in state employment resources to help you customize the handbook. In a few easy steps, you can print and distribute the handbook or save it as a PDF, which can be distributed via email or posted on the web for your employees to access.

This book is available in paperback format and e-book instant download format. This manual is available in e-book instant download format and Flash Drive for easy editing. Authorization to Release Protected Health Information 2. Background Check Release Form 3. Client Invoice Form 4. Client Satisfaction Survey Form 5. Client Service Plan Agreement Form 6. Client Service Schedule 7. Daily Trip Log Form 8. Daily Vehicle Status Log 9. Driver Job Description Drug Testing Consent Form Employee Counseling Form Employee Satisfaction Survey Form Employee Statement of Confidentiality Employee Time Sheet Employment Application Form Employment Termination Contract Hepatitis B Immunization Consent Incident Report Form Independent Contractor Agreement Form Job Offer Letter License Verification Form Notice to Employee of Suspension Without Pay Patient Care Report Form Patient Complaint Form Payroll Deduction Authorization Form Pre-Trip Daily Inspection Report Pre-employment Checklist Reference Release Form Sample Brochure Termination of Contract Form Trip Confirmation Sheet Trip Documentation Sheet Trip Request Form Vehicle Aide Job Description Vehicle Inspection and Maintenance Form.

Request a Quote.

 
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Non emergency medical transportation policies and procedures manual

The prohibition of referrals and conflicts of interest were later described in the implementing regulations 42 CFR Section These regulations apply to those states that choose to file a Section a Non-Emergency Medical Transportation for Medicaid 27 state plan amendment to obtain authority to provide NEMT as a medical service through a broker A key provision of the regulation is the prohibition against self-referral.

This means that the broker cannot assign a trip where the broker has some organizational, financial, or personal relationship with the provider. The basis to include this provision was a matter of law but implemented by discretion of the Secretary of DHHS by regulation. The law directed the Secretary of DHHS to apply the conflict of interest rules issued for physicians to prevent doctors from making referrals to other health care providers where the physician has some type of ownership interest Section of the Social Security Act Under 42 CFR Section Exceptions for Non-governmental Brokers The regulation provides exceptions to the provisions for self-referral.

An exception to the self-referral prohibition may apply for transportation pro- vided in a rural area when there are no other available Medicaid providers determined to be qualified except the non-governmental e.

The definitions of rural and urban areas are consistent with other Medicaid regulation 42 CFR Section A rural area is defined as any area outside an urban area, and an urban area is defined as a metropolitan statistical area or New England county metropolitan area. An exception to the self-referral prohibition may apply for transportation so specialized that there is no other available Medicaid-participating trans- portation provider determined to be qualified except the non-governmental broker.

An exception to the self-referral prohibition may apply if the state Medicaid agency determines that the availability of other qualified Medicaid-participating transportation providers is insufficient to meet the need for transportation.

Exception for Governmental Brokers Another exception to the self-referral and conflict of interest provisions applies if the broker is a governmental entity. The contract between the state Medicaid agency and the governmental broker provides for payment that does not exceed the actual costs calculated as though the broker were a distinct unit, and excludes from these payments any personnel or other costs shared with or allocated from parent or related entities.

Medicaid will not pay costs that are shared with or allocated from other governmental entities The governmental unit that acts as a broker maintains an accounting system such that all funds allocated to the Medicaid brokerage program and all costs charged to the brokerage program will be completely separate from any other program.

States continue to have the flexibility to provide NEMT as an optional medical service expense or as an administrative expense. States that wish to establish an NEMT brokerage without being required to comply with general Medicaid requirements such as freedom of choice, comparability, and statewideness may continue to do so through the Section b waiver process every two years.

The Section b waiver does not prohibit the broker from self-referral, nor does it require that the broker be selected through competitive bidding. Providing NEMT as an administrative expense maximum 50 percent federal match provides a state with the greatest flexibility in designing the NEMT program. Medicaid funds may only be used for Medicaid-approved services provided to eligible Medicaid beneficiaries. DRA included provisions that are intended to protect the integrity of the Medicaid program and prevent fraud and abuse.

Federal regulations require each state Medicaid agency to establish an integrity program that includes methods for identifying and investigating suspected fraud and abuse cases, including NEMT. Examples of NEMT provider abuse are billing Medicaid for services when taking a beneficiary to pick up groceries or run other errands or billing for a trip when the beneficiary did not show up for the service.

For initiatives such as coordination of human services transportation and public transportation, coordination is appropriate as long as it does not conflict with the policies and rules of the Medicaid program. The guidance was in the form of a letter to state Medicaid directors for states that claimed NEMT as an administrative expense not as a medical service expense State Medicaid agencies must select the broker through competitive bidding.

Incentive Brokerages established under Section a 70 may be claimed by the state as an optional medical service at the FMAP rate 50 percent to An NEMT broker must have oversight procedures to monitor beneficiary access and complaints, to ensure that transportation is timely, and to confirm that transportation providers are licensed, qualified, competent, and courteous. Medicaid funding limited to Medicaid- approved services NEMT is for eligible Medicaid beneficiaries who need to get to authorized medical services and have no other means of transportation.

Medicaid funds may only be used for Medicaid services provided to eligible Medicaid beneficiaries. Using Medicaid funds for any NEMT service that is not for an eligible Medicaid beneficiary to an authorized medical service could be identified as fraud or abuse of the Medicaid program.

Medicaid is the payer of last resort By law, the Medicaid program is the payer of last resort. If another insurer or program has the responsibility to pay for medical costs incurred by a Medicaid-eligible individual, that entity is generally required to pay the cost of the claim prior to Medicaid making any payment.

Transportation coordination For initiatives such as coordination of human services transportation and public transportation, coordination is appropriate as long as it does not conflict with the policies and rules of the Medicaid program.

Table 1. According to the guidance, a state can claim federal matching payments for transit passes as an administrative expense if the state can show the pass is cost effective compared to other modes of transportation. The cost of a monthly pass should not exceed the cost of the individu- ally approved NEMT trips in the month.

If the transit pass is used by the Medicaid beneficiary for other trip purposes, the state Medicaid agency should determine whether there are other funding sources to allocate a portion of the cost of the pass and prepare a cost allocation plan. If the only or primary need of the Medicaid beneficiary is to obtain transportation to Medicaid- approved medical service providers, and there are no other, or minimal, uses of the pass, no cost allocation is necessary The Medicaid agency responsibilities include operating the call center for Medicaid beneficiaries to request transportation, reviewing and providing transportation authorizations, and assigning trips to qualified private or public transportation providers.

States using the in-house management NEMT model operate on a fee-for- service basis. Transportation providers submit reimbursement requests for services rendered. States that operate using only an in-house management model not a mix of models usually claim federal financial participation as an administrative expense at the 50 percent matching rate unless they have requested waivers or have amended the state Medicaid plan for approval to use the higher FMAP rate for medical services.

Brokers execute contracts with private, human services transportation or public transportation providers to make authorized trips for eligible Medicaid beneficiaries under the supervision of the broker. Brokers pay transportation providers for the authorized trips by eligible Medicaid beneficiaries. The transportation providers are required to document the authorized Medicaid passenger trips delivered for the broker.

According to the requirements of the state Medicaid agency, NEMT brokers may operate statewide or within a region, and they may be full-risk brokers or a shared-risk brokers. Non-Emergency Medical Transportation for Medicaid 31 Statewide Broker Under a statewide broker NEMT model, the broker manages service statewide, centralizing call centers, eligibility determination, and trip authorization.

Statewide brokers are typically for-profit, national brokers. Regional Broker Though it operates much like a statewide broker NEMT model, the regional broker NEMT model uses multiple call centers in a state, each responsible for eligibility determination and trip authorization at a regional level. A broker may operate in one region or several regions, as the state Medicaid agency may specify. States use a variety of means to determine regional bound- aries, including metropolitan statistical area boundaries, health care service areas, public transit service areas, regional planning areas, and county boundaries.

Regional brokers may be for-profit, not-for-profit, or human services program brokers. Not-for-profit brokers may be human services agencies, public transit agencies, or other nonprofit organizations serving as a regional broker. Full-Risk Broker A full-risk broker accepts the financial risk for performing all broker responsibilities under the contract with the state Medicaid agency under a capitation payment plan.

As previously discussed, capitation is a flat periodic payment per Medicaid enrollee member to the broker; it is the sole reimbursement for providing NEMT services to a defined population. Table 2 is an example of capitation payment for a broker. The total capitated pay includes , members who are both children and adults in rural and urban areas.

The capitated rate PMPM is different by age category and if the member is in a rural or urban area. Many statewide and regional brokers are full-risk brokers, compensated on a capitated, per-Medicaid-beneficiary basis where the number of people eligible for service, not the amount of service received, determines the payment rate.

A full-risk broker takes the risk that the contractual rate agreement will cover all costs, and is responsible for reporting beneficiary and trip data. A full-risk broker contract may have an escalation clause tied to some measures of inflation, but otherwise costs increase only with the number of Medicaid beneficiaries.

From the perspective of the state Medicaid agency, full-risk brokers limit state Medicaid agency financial liability and administrative costs. Full-risk brokers provide the advantage of consistent and predictable costs to the state Medicaid agency from year to year.

Calculation of capitation payment. Shared risk is less predictable and may lead to unanticipated, increased costs to the state Medicaid agency; however, the transportation provider has an opportunity to document and request a payment adjustment based on actual cost. Managed Care Organizations Managed care is an organized health care delivery system designed to manage health care cost, use, and quality.

Through contracted arrangements with state Medicaid agencies, MCOs seek to improve health care for a population of Medicaid beneficiaries, often with chronic and complex conditions, while also managing the cost of that care. This means the MCO receives a lump sum payment per month based on the number of beneficiaries, and all health costs must be covered by that payment. Capitated payment encourages cost control. State Medicaid agencies that use broker and MCO models typically use a capitated payment system.

The trend to use statewide or regional NEMT brokers also reflects a trend that separates NEMT from locally or regionally coordinated transportation systems. As part of the research for this handbook, the research team conducted a survey of state Medicaid agencies about NEMT in Table 3 summarizes the models used by the 50 states and the District of Columbia, and Figure 8 provides a map illustrating the state NEMT models.

Summary of NEMT models by state. The manual is available in e-book format and hardcopy. It provides a thorough and consistent way to communicate your policies and set expectations with your employees. The handbook addresses specific polices that your drivers and crewmembers need to know to comply with regulations and standards.

It presents a standardized approach to providing information and reducing ambiguities and difficulties that might arise from unwritten or inconsistent policies or lack of proper communication. The Non-Emergency Medical Transportation Employee Handbook incorporates all applicable federal employment laws and built-in state employment resources to help you customize the handbook. In a few easy steps, you can print and distribute the handbook or save it as a PDF, which can be distributed via email or posted on the web for your employees to access.

This book is available in paperback format and e-book instant download format. This manual is available in e-book instant download format and Flash Drive for easy editing. Authorization to Release Protected Health Information 2. Background Check Release Form 3. Client Invoice Form 4. Client Satisfaction Survey Form 5. Client Service Plan Agreement Form 6. Client Service Schedule 7. Daily Trip Log Form 8.

Daily Vehicle Status Log 9. Driver Job Description Drug Testing Consent Form Employee Counseling Form Employee Satisfaction Survey Form Employee Statement of Confidentiality Employee Time Sheet Employment Application Form Employment Termination Contract Hepatitis B Immunization Consent Incident Report Form Independent Contractor Agreement Form

 
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Incident Report Form Independent Contractor Agreement Form Job Offer Letter License Verification Form Notice to Employee of Suspension Without Pay Patient Care Report Form Patient Complaint Form Payroll Deduction Authorization Form Pre-Trip Daily Inspection Report Pre-employment Checklist Reference Release Form Sample Brochure Termination of Contract Form Trip Confirmation Sheet Trip Documentation Sheet Trip Request Form Vehicle Aide Job Description Vehicle Inspection and Maintenance Form.

Our resources for providers explain important guidelines such as the difference between emergency and non-emergency medical transportation, accepted types of transportation, the types of transportation service delivery systems, and driver and vehicle acceptance criteria. We also discuss common fraud schemes and provide fraud and abuse prevention tips.

The fact sheet for beneficiaries gives an overview of the NEMT benefit. The broker pays enrolled providers directly for NEMT services. Services provided in the broker service area are only reimbursable by the State Contracted Broker and cannot be submitted directly to the Department. Reimbursement for services provided outside the state-contracted broker service area should be submitted directly to the Department. Regardless of whether Health First Colorado has actually reimbursed the provider, billing members for covered services is strictly prohibited.

Balance billing is prohibited. If reimbursement is made, providers must accept this payment as payment in full see Program Rule 8.

The provider may only bill the member for services not covered by Health First Colorado. The member, or member’s representative, is responsible for obtaining prior authorization and should be requested as soon as possible. Transportation provided without authorization from the SDE or provider, or their designee, will not be reimbursed or paid.

While not requiring prior authorization, mileage or bus pass reimbursement may be denied if the member does not provide proper documentation to the State Designated Entity within timely filing requirements, or sooner if required by the State Designated Entity’s policies.

Train, air, and out-of-state travel must be prior authorized by the Department. NEMT can only be used to access approved medical services.

The SDE will request the required documentation and submit to the Department for review and decision. The decision will be communicated to the SDE. Appendix F is available under the Appendices drop-down section on the Billing Manuals web page. Transportation for Health First Colorado members to and from a medical provider is a benefit when the medical service provided is a benefit of the Health First Colorado and the provider is enrolled with Health First Colorado to deliver the service.

There is no limit to the number of daily trips a client can receive from one or multiple providers, but those trips must meet all NEMT regulatory and policy requirements. Billing multiple trips for one member in one day with different rendering providers may require the use of a modifier see Procedure Coding , below.

Transit passes may be issued when the cumulative cost of bus trips exceeds the cost of a pass. Personal Vehicle Mileage Reimbursement A private vehicle may be provided by a volunteer, individual or organization, with no member vested interest or a vehicle provided by an individual, family member, self, neighbor , with a member vested interest. Mileage reimbursement for a personal vehicle is reimbursed per vehicle, without regard to the number of members or escorts in the vehicle and is only reimbursed using the most direct route to and from the appointment.

Exceptions can be made by the SDE if the shortest distance is impassable due to severe weather, road closure, or other unforeseen circumstances outside of the member’s control that severely limit using the shortest route.

If an exception is made, the SDE must document the reason and can pay mileage for the actual route traveled. A mobility vehicle may submit claims using wheelchair van procedure codes only when the member is a wheelchair user and the vehicle has been modified with appropriate wheelchair equipment.

See Wheelchair Van. The SDE is responsible for ensuring documentation from the member’s medical professional indicates, in writing, the member is unable to use less costly modes of NEMT services e. Mileage shall be paid for the shortest trip length in miles as determined by an internet-based map, trip planner, or other Global Positioning System GPS.

Wheelchair Van A wheelchair van is a vehicle for hire that has been specifically designed, constructed, modified, or equipped to accommodate the needs of wheelchair users. Wheelchair van services are a Health First Colorado benefit only when the member’s medical professional indicates, in writing, the member is wheelchair-confined and unable to use less costly modes of NEMT services e.

Wheelchair van providers must have, and maintain one of the following PUC licenses, or be determined exempt by PUC statutes:. Taxicab A taxicab service means passenger transportation by a common carrier on a call-and-demand basis in a taxicab, with the first passenger therein having exclusive use of the taxicab unless such passenger agrees to multiple loading.

Taxicab providers must have and maintain a common carrier certificate with authority to provide taxicab service. Providers must provide services in compliance with PUC licensure and state and federal laws. Taxicab services are a Health First Colorado benefit when the member’s medical or physical condition precludes the use of member-purchased public or private transportation, or other less costly modes of Health First Colorado transportation.

Stretcher Van Stretcher van is a vehicle that can legally transport a client in a prone or supine position when the client does not require medical attention en route. This may be by stretcher, board, gurney, or other appropriate device. Medical or safety requirements must be the basis for transporting a client in the prone or supine position. Stretcher van service is a Health First Colorado benefit when the member’s medical professional indicates, in writing, the member must be transported in a prone or supine position and they are unable to use less costly modes of NEMT services e.

Ground Ambulance Ambulance means any publicly or privately-owned vehicle that is specially designed, constructed, modified or equipped to be used, maintained and operated on streets or highways to transport clients to a hospital or other treatment facility in cases of accident, trauma or severe illness.

Administration of intravenous IV medication en route shall not include self-administered IV medications. Non-emergent ground ambulance service is a Health First Colorado service when the member’s medical professional indicates that the member requires an ambulance in order to be transported safely and they are unable to use less costly modes of NEMT services e.

All out-of-state ground ambulance trips must be prior approved by the Department See Prior Authorization. Air Ambulance Air ambulance means a fixed wing or rotor wing aircraft that is equipped to provide air transportation and is specifically designed to accommodate the medical needs of individuals who are ill, injured, or otherwise mentally or physically incapacitated and who require in-flight medical supervision.

Non-emergent air ambulance service is a Health First Colorado service when the member’s medical professional indicates, in writing, that the member requires air ambulance in order to be transported safely and they are unable to use less costly modes of NEMT services. Commercial Air Commercial air means travel via an airline which provides scheduled air transportation for passengers.

Commercial air transport is a Health First Colorado service when the member’s medical professional indicates that the member requires commercial air in order to be transported safely and they are unable to use less costly modes of NEMT services. Train transport is a Health First Colorado service when the member’s medical professional indicates that the member requires train transportation in order to be transported safely and they are unable to use less costly modes of NEMT services.

NEMT may cover the cost of transporting a second escort with written certification for medical necessity from the member’s medical provider, if:. Minors who are at least thirteen 13 years old, but younger than eighteen 18 years old, may travel alone with a written release from their parent or guardian, as long as an adult is present to receive the minor at the destination and at the return location.

Minors under thirteen 13 years old shall not travel without an escort. Children in a day treatment program may travel without an escort, as long as there is a written release from their parent or guardian, stating that an adult will be present to receive the minor at the destination and return location.