Frequently Asked Questions: Non-emergent Medical Transportation
See DMAP's Medical Transportation rules for more about covered transportation services. The OHP Client Handbook also provides information about transportation services.
Q. What is a transportation brokerage?
A. The brokerage contracts with the Division of Medical Assistance Programs (DMAP) to provide non-emergent transportation services to OHP Plus (BMM, BMH, BMD) clients. Transportation providers are contracted through the brokerage. The brokerage has professional call takers trained specifically to perform the duties of the call center, including verifying eligibility, appointment eligibility, reviewing the client’s ride resources and authorizing appropriate transportation services.
The costs of the rides are reconciled through the brokerage service and billing is monitored. The brokerage produces monthly reports of the number of rides, costs, unduplicated clients, "no-shows" and complaints.
Q. Can you arrange transportation outside the brokerage (i.e., directly with a preferred transportation provider)?
A. All medical ride requests must go through the brokerage. The brokerage contract specifically requires the rides to be authorized and assigned to contracted providers that meet the client needs most appropriately and are the lowest cost. If a facility or branch arranges transportation without the broker's authorization, the transportation provider will not be paid through Medicaid. The provider could try to recover payment from the branch or facility that contacted them.
Q. Does the call center offer any choices?
A. The brokerage or call center staff have to meet two main criteria:
Find the most appropriate ride for the client based on actual need, not want, and
Find the ride that is the lowest cost. A client's freedom of choice is not allowed by federal waiver and current federal law.
Q. What questions do brokerages ask when clients call for a ride?
A. The call takers will check the eligibility of the person and if the ride is a Medicaid-covered service. These questions are contract requirements that meet Medicaid standards:
Where do you want to go?
Do you have any other means of transportation?
Do you have any special needs?
Q. Clients at residential facilities expect to be helped (from their room, into the van, into the doctor’s office, etc.). Can we expect this level of service in the brokerage environment?
A. The drivers are there to drive. If a client needs a care attendant, it is the facility's or the client's responsibility to provide one. The brokerage contract will not allow drivers to enter clients' rooms or escort clients to their appointments. Clients will need to be ready at the front door of the pick-up address.
Q. Some clients have limited mobility; will the driver assist them with getting onto the van?
A. Yes, client ride requests should identify their special needs, so the drivers will know to provide assistance boarding and de-boarding the vehicle.
Q. Will the brokerages transport children under twelve years unescorted? In addition, is this negotiable?
A. No, the brokerage will not transport children under twelve years unescorted. This is non-negotiable, primarily due to protocols established by the DHS Child Welfare program and to liability issues.
Q. What would happen if the hospital needs to discharge a patient at 9:30 p.m.?
A. Brokerages have their own processes and protocols for after-hours transportation that allow for the transport to take place with authorization to follow. Hospitals should follow the after hours procedure for the brokerage and contact the appropriate after hours providers. Sometimes, hospitals will call an ambulance provider for a discharge because it is easy. However, ambulance providers should not be used unless that is the appropriate mode for the client.
Q. Can non-OHP clients ride along free for appointments at the same destination?
A. The answer is "yes" or "no" depending on whether the transportation provider agrees to allow it at no additional cost. In addition, this must be negotiated with the call center.
Q.Does the brokerage have a time limit on how long a client must wait if they are in a grouped ride?
A. Wait times on shared rides are reviewed individually. Client needs are always factored in.
Q. What would happen if all of the transportation providers refused to give a client a ride due to scheduling conflicts?
A. Could this appointment be re-scheduled or delayed without doing harm to the client? If not, a provider from a different service level could be secured to provide the ride or a provider from outside the region could be secured. The client will be given options.
Q. If a client calls a provider directly for a ride, will the provider get paid for the ride?
A. No, all Medicaid rides require authorization. All medical ride requests must go through the brokerage.
Q. What is a client "no-show"?
A. If a client has a scheduled ride and they are not at the pick-up location as arranged, the driver will report a "no-show" to the brokerage. Clients cannot be billed, and the brokerage cannot pay providers for rides provided without a client on board. If a client needs to cancel their ride, they should call the brokerage. Repeated no-shows may result in requirements that the client phone in to confirm rides before pick up, schedule no more than one ride at a time, travel with a specific provider, or travel with an escort. The no-show policy holds clients accountable for using their ride privileges appropriately.
Q. Do the brokerages fulfill same-day ride requests?
A. The broker will try to arrange for same-day rides; however, it will depend on whether there is a provider available. They may already be booked with other people's appointments.
Q. What if clients have complaints about a certain driver or transportation service?
A. All concerns and complaints need to be turned into the brokerage. That is the process that will make the corrections. After the complaint is researched, a provider may be sanctioned or possibly terminated of the contract if they are unable to provide on-time, safe services.
Q. If a provider gets a call after hours directly from a client asking for a ride, how does the provider know they'll get paid if they provide the ride?
A. Providers take a risk when they accept this type of ride. They can ask to see the client’s medical card or call the toll-free number for AVR to see if the person is eligible for services.