Covered and Noncovered Services : Covered Services and Requirements

Advanced Life Support and Basic Life Support Procedure Codes Covered by ForwardHealth and Not Reimbursed by the NEMT Manager

Providers should submit claims with the following BLS and ALS procedure codes to ForwardHealth, not to the NEMT manager contracted with the Wisconsin DHS.

Appealing a Denied Transportation Service

Members have the right to appeal a transportation service that was denied by the NEMT manager contracted with the Wisconsin DHS. Denials may include a denied ride or denied payment for meals or overnight stays.

For more information about fair hearings, members may refer to their ForwardHealth Enrollment and Benefits Handbook or call 800-362-3002.

Drop-Off Details and Requirements

For return rides from covered appointments, providers or members can call the NEMT manager contracted with the Wisconsin DHS at 866-907-1493 (711 TTY) if the provider or member:

• Scheduled a return ride in advance and the vehicle has not arrived within 15 minutes after the scheduled pick-up time.
• Has not scheduled a return ride in advance and thus needs to schedule a ride after the appointment. If, after calling, the return ride has not arrived within one hour, providers and members should call 866-907-1493 (711 TTY) again to inquire about the ride.

Members can also access MTM's mobile-friendly portal and mobile app for managing and scheduling rides. The portal and app also allow members to request pickup for their ride home after an appointment, to view the real-time location of their ride, and, if available, to view driver photos and vehicle information.

Members will be asked by the driver to sign a driver log for the ride home after their appointment.

General Non-Emergency Medical Transportation Information

Members are eligible for NEMT if they have no other way to receive a ride to a covered appointment. If members are financially able to drive themselves to the covered appointment or if neighbors, friends, relatives, or voluntary organizations are able to provide transportation at no cost, the member is not eligible for transportation through the NEMT manager contracted with the Wisconsin DHS. Providers should note that a "ride" can also mean public transportation.

For members eligible to receive a ride through the NEMT manager to their covered appointments, the NEMT manager is required to schedule the least costly type of ride that meets the member's medical and transportation needs per 42 C.F.R. § 447.200. The NEMT manager will require members to ride a bus to their covered appointment when appropriate. The NEMT manager may be able to offer mileage reimbursement to members who have a car and are able to drive themselves to their covered appointment but are unable to pay for gas.

For members unable to ride a bus and unable to use their own car, the NEMT manager will coordinate a ride with the most appropriate type of vehicle based on the member's medical and transportation needs. Rides may include an SMV or other type of vehicle. Members may be required to share a ride with another rider during their trip to their covered appointment.

Three modes of NEMT are covered for members who do not have any other means of transportation going to and from services that are covered by the program in which they are enrolled. Modes of NEMT include:

• Common carrier transportation
• SMV transportation
• Non-emergency ambulance transportation

Common Carrier Transportation

Common carrier transportation is transportation by any mode other than ambulance or SMV. Common carrier vehicles or providers are not required to be enrolled in Wisconsin Medicaid but must be under contract with the NEMT manager. These vehicles are not required to have permanently installed ramps or lifts and are not enrolled for cot or stretcher transportation. This may include vehicles such as public transportation, volunteer vehicles, and HSVs. HSVs must maintain a current State Patrol HSV inspection.

Specialized Medical Vehicle Transportation

SMVs are vehicles that are equipped with permanently installed ramps or lifts and are required to be enrolled in Wisconsin Medicaid. SMVs that are also used for cot or stretcher transportation must meet the additional requirements of Wis. Admin. Code § DHS 107.23(3)(b).

To be eligible for SMV transportation, a member must have a documented physical or mental disability that prevents them from traveling safely in a common carrier or private motor vehicle to a covered service. To be eligible for transport on a cot or stretcher, a member must require transport in a supine position.

The NEMT manager provides coordination and reimbursement for Medicaid-enrolled SMV providers for NEMT. SMV providers must be contracted with the NEMT manager and submit claims directly to the NEMT manager in order to receive reimbursement. The referring hospital, clinic, or other originating facility coordinates the transportation through the NEMT manager.

Certification of Need

Members receiving NEMT through the NEMT manager are not required to have a Certification of Need for Specialized Medical Vehicle Transportation form signed by a physician, nurse practitioner, or physician assistant on file prior to receiving SMV services. However, the NEMT manager may verify in other ways whether or not an SMV is the appropriate mode of travel for a member.

The Certification of Need for Specialized Medical Vehicle Transportation form is required for SMV services provided to ForwardHealth members not affected by the NEMT management system.

Non-Emergency Ambulance Transportation

To be eligible for non-emergency ambulance transportation, a member must require life support services (either ALS or BLS), require transportation in a supine position, or suffer from an illness or injury that prevents them from traveling safely by any other means.

The NEMT manager provides coordination and reimbursement for Medicaid-enrolled ambulance providers for NEMT. Ambulance providers who provide NEMT to covered members must be contracted with the NEMT manager and must submit claims directly to the NEMT manager in order to receive reimbursement for these transportation services.

The NEMT manager also reimburses claims for limited medical services provided during a non-emergency ambulance trip. Providers should continue to submit claims to ForwardHealth for most medical services provided during a non-emergency ambulance trip. Refer to a complete list of ALS and BLS procedure codes that should be submitted to ForwardHealth in all circumstances (whether transporting under emergency or non-emergency cases).

Interpretive Services

ForwardHealth reimburses interpretive services provided to BadgerCare Plus and Medicaid members who are deaf or hard of hearing or who have LEP. A member with LEP is someone who does not speak English as their primary language and who has a limited ability to read, speak, write, or understand English.

Interpretive services are defined as the provision of spoken or signed language communication by an interpreter to convey a message from the language of the original speaker into the language of the listener in real time (synchronous) with the member present. This task requires the language interpreter to reflect both the tone and the meaning of the message.

Only services provided by interpreters of the spoken word or sign language will be covered with the HCPCS procedure code T1013 (Sign language or oral interpretive services, per 15 minutes). Translation services for written language are not reimbursable with T1013, including services provided by professionals trained to interpret written text.

Covered Interpretive Services

ForwardHealth covers interpretive services for deaf or hard of hearing members or members with LEP when the interpretive service and the medical service are provided to the member on the same DOS and during the same time as the medical service. A Medicaid-enrolled provider must submit for interpretive services on the same claim as the medical service, and the DOS they are provided to the member must match. Interpretive services cannot be billed by HMOs and MCOs. Providers should follow CPT and HCPCS coding guidance to appropriately document and report procedure codes related to interpretive and medical services on the applicable claim form. Time billed for interpretive services should reflect time spent providing interpretation to the member. At least three people must be present for the services to be covered: the provider, the member, and the interpreter.

Interpreters may provide services either in-person or via telehealth. Services provided via telehealth must be functionally equivalent to an in-person visit, meaning that the transmission of information must be of sufficient quality as to be the same level of service as an in-person visit. Transmission of voices, images, data, or video must be clear and understandable. Both the distant and originating sites must have the requisite equipment and staffing necessary to provide the telehealth service.

Billing time for documentation of interpretive services will be considered part of the service performed. BadgerCare Plus and Wisconsin Medicaid have adopted the federal "Documentation Guidelines for Evaluation and Management Services" (CMS 2021 and 2023) in combination with BadgerCare Plus and Medicaid policy for E&M Services.

Most Medicaid-enrolled providers, including border-status or out-of-state providers, are able to submit claims for interpretive services.

Standard ForwardHealth policy applies to the reimbursement for interpretive services for out-of-state providers, including PA requirements.

Interpretive Services Provided Via Telehealth for Out-of-State Providers

ForwardHealth requirements for services provided via telehealth by out-of-state providers are the same as the ForwardHealth policy for services provided in-person by out-of-state providers. Requirements for out-of-state providers for interpretive services are the same whether the service is provided via telehealth or in-person. Out-of-state providers who are not enrolled as either border-status or telehealth-only border-status providers are required to obtain PA before providing services via telehealth to BadgerCare Plus or Medicaid members. The PA would indicate that interpretive services are needed.

Documentation

While not required for submitting a claim for interpretive services, providers must include the following information in the member's file:

• The interpreter's name and/or company
• The date and time of interpretation
• The duration of the interpretive service (time in and time out or total duration)
• The amount submitted by the medical provider for interpretive services reimbursement
• The type of interpretive service provided (foreign language or sign language)
• The type of covered service(s) the provider is billing for

Third-Party Vendors and In-House Interpreters

Providers may be reimbursed for the use of third-party vendors or in-house interpreters supplying interpretive services.

Providers are reminded that HIPAA confidentiality requirements apply to interpretive services. When a covered entity or provider utilizes interpretive services that involve PHI, the entity or provider will need to conduct an accurate and thorough assessment of the potential risks and vulnerabilities to PHI confidentiality, integrity, and availability. Each entity or provider must assess what are reasonable and appropriate measures for their situation.

Limitations

There are no limitations for how often members may utilize interpretive services when the interpretive service is tied to another billable medical service for the member for the same DOS.

Claims Submission

To receive reimbursement, providers may bill for interpretive services on one of the following claim forms:

• 1500 Health Insurance Claim Form (for dental, professional, and professional crossover claims)
• Institutional UB-04 (CMS 1450) claim form (for outpatient crossover claims and home health/personal care claims)

Noncovered Services

The following will not be eligible for reimbursement with procedure code T1013:

• Interpretive services provided in conjunction with a noncovered, non-reimbursable, or excluded service
• Interpretive services provided by the member's family member, such as a parent, spouse, sibling, or child
• The interpreter's waiting time and transportation costs, including travel time and mileage reimbursement, for interpreters to get to or from appointments
• The technology and equipment needed to conduct interpretive services
• Interpretive services provided directly by the HMOs and MCOs are not billable to ForwardHealth for reimbursement via procedure code T1013

Cancellations or No Shows

Providers cannot submit a claim for interpretive services if an appointment is cancelled, the member or the interpreter is a no-show (is not present), or the interpreter is unable to perform the interpretation needed to complete the appointment successfully.

Procedure Code and Modifiers

Providers must submit claims for interpretive services and the medical service provided to the member on separate details on the same claim.

Procedure code T1013 is a time-based code, with 15-minute increments. Rounding up to the 15-minute mark is allowable if at least eight minutes of interpretation were provided.

Providers should use the following rounding guidelines for procedure code T1013.

Claims for interpretive services must include HCPCS procedure code T1013 and the appropriate modifier(s):

• U1 (Spoken language)
• U3 (Sign Language)
• GT (Via interactive audio and video telecommunication systems)
• 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system)

Providers should refer to the interactive maximum allowable fee schedules for the reimbursement rate, covered provider types and specialties, modifiers, and the allowable POS codes for procedure code T1013.

*Any telehealth service must be provided using HIPAA-compliant software or delivered via an app or service that includes all the necessary privacy and security safeguards to meet the requirements of HIPAA.

Dental Providers

Dental providers submitting claims for interpretive services are not required to include a modifier with procedure code T1013. Dental providers should retain documentation of the interpretive service in the member's records.

Allowable Places of Service

Claims for interpretive services must include a valid POS code where the interpretive services are being provided.

Federally Qualified Health Centers

Non-tribal FQHCs, also known as CHCs, (POS code 50), will not receive direct reimbursement for interpretive services as these are indirect services assumed to be already included in the FQHC's bundled PPS rate. However, CHCs can still bill the T1013 code as an indirect procedure code when providing interpretive services. This billing process is similar to that of other indirect services provided by non-tribal FQHCs. This will enable DHS to better track how FQHCs provide these services and process any future change in scope adjustment to increase their PPS rate that includes providing interpretive services.

Rural Health Clinics

RHCs (POS code 72) receives direct reimbursement for interpretive services. Procedure code T1013 should be billed when providing interpretive services.

Interpreter Qualifications

The two types of allowable interpreters include:

• Sign language interpreters—Professionals who facilitate the communication between a hearing individual and a person who is deaf or hard of hearing and uses sign language to communicate
• Foreign language interpreters—Professionals who are fluent in both English and another language and listen to a communication in one language and convert it to another language while retaining the same meaning.

Qualifications for Sign Language Interpreters

For Medicaid-enrolled providers to receive reimbursement, sign language interpreters must be licensed in Wisconsin under Wis. Stat. § 440.032 and must follow the specific requirements regarding education, training, and locations where they are able to interpret. The billing provider is responsible for determining the sign language interpreter's licensure and must retain all documentation supporting it.

Qualifications for Foreign Language Interpreters

There is not a licensing process in Wisconsin for foreign language interpreters. However, Wisconsin Medicaid strongly recommends that providers work through professional agencies that can verify the qualifications and skills of their foreign language interpreters.

A competent foreign language interpreter should:

• Be at least 18 years of age.
• Be able to interpret effectively, accurately, and impartially, both receptively and expressively, using necessary specialized vocabulary.
• Demonstrate proficiency in English and another language and have knowledge of the relevant specialized terms and concepts in both languages.
• Be guided by the standards developed by the National Council on Interpreting Health Care.
• Demonstrate cultural responsiveness regarding the LEP language group being served including values, beliefs, practices, languages, and terminology.

The Non-Emergency Medical Transportation Manager

The Wisconsin DHS has contracted with the NEMT manager to provide NEMT services for Medicaid and BadgerCare Plus members. NEMT includes transportation provided by ambulance, SMV, or common carrier to a covered service.

The DHS NEMT manager arranges and pays for rides to covered Medicaid and BadgerCare Plus services for members who have no other way to receive a ride. Rides can include public transportation such as a city bus, rides in SMVs, or rides in other types of vehicles depending on a member's medical and transportation needs.

The NEMT manager is under contract with DHS and has a HIPAA business associate agreement in place.

This does not affect emergency transportation services under Wisconsin Medicaid or BadgerCare Plus. Claim submission and reimbursement for emergency transportation by ambulance is not affected by the NEMT manager.

Meals and Lodging Member Reimbursement Policy

When a trip is coordinated by the NEMT manager contracted with the Wisconsin DHS, there are certain circumstances when meals and lodging may be reimbursable for members. For more information, refer to the DHS fact sheet titled "Can I get paid for meals and overnight stays" or the NEMT manager website.

Members Exempt From the Non-Emergency Medical Transportation Management System

The NEMT management system does not affect the following members:

• Members who are residing in a nursing home and who have not elected to receive hospice services. These members have their NEMT services coordinated by the nursing home. Exceptions for members enrolled in an HMO or who are dually eligible with Medicare and Medicaid are available.
• Members who are enrolled in Family Care, Family Care Partnership, or PACE. Members enrolled in these benefit plans have their NEMT services coordinated by their MCO.

Members Not Eligible for Non-Emergency Medical Transportation

NEMT services are not covered for members enrolled in the following programs:

• The WWWP
• WCDP
• QMB-Only
• QI-1
• QDWI
• SeniorCare
• Alien emergency services
• SLMB

Members Required to Ride a Bus

The NEMT manager contracted with the Wisconsin DHS will pay for a member to ride a bus to their covered appointment if the member if all of the following are true:

• Lives within one-half mile of a bus stop.
• Attends an appointment within one-half mile of a bus stop.
• Does not meet any of the exceptions listed below.

The following individuals will not be required to ride a bus to their covered appointment:

• A member who does not live within one-half mile of a bus stop or have an appointment within one-half mile of a bus stop.
• A member who is unable to ride a bus or get to a bus stop due to a physical or mental health condition (for example, if the member is going to a dialysis appointment). The NEMT manager will verify with the health care provider that the member is medically unable to ride a bus.
• A parent or caregiver who is traveling with a member age 4 or younger to their appointment.
• A member age 15 or younger who is traveling alone.
• A member age 70 or older who uses a walker, crutches, and/or a cane.

The NEMT manager will mail a bus pass or ticket to members who are required to ride a bus prior to their scheduled covered appointment.

Members Who May Receive Non-Emergency Medical Transportation Services Through the NEMT Manager

Members enrolled in the following programs may receive NEMT services through the NEMT manager contracted with the Wisconsin DHS if they have no other way to get to their covered appointments:

• Wisconsin Medicaid (including IRIS)
• BadgerCare Plus
• Family Planning Only Services
• Tuberculosis-Related Medicaid
• Express Enrollment for BadgerCare Plus

Pickup Details and Requirements

The NEMT manager contracted with the Wisconsin DHS has resources available to help a member who is required to ride a bus to their appointment. The NEMT manager can help the member find the right bus to get to an appointment and learn the general rules about riding the bus if they are not familiar with taking the bus.

For a member getting picked up by a vehicle, the transportation provider will call the day before the appointment to confirm the ride, including the time the member is scheduled to be picked up for their appointment. A member who has not heard from the transportation provider the day before the scheduled pickup time may call NEMT manager at 866-907-1493 (711 TTY).

On the day of the appointment, the member must be ready and watching for their ride at least 15 minutes before the scheduled pickup time. Generally, the driver will not come to the door. A member who is more than 10 minutes late for their scheduled pickup time may miss the ride. Any member waiting for more than 15 minutes after the scheduled pickup time should call the NEMT manager at 866-907-1493 (711 TTY) to inquire about the status of the ride.

Members can also access MTM's mobile-friendly portal and mobile app for managing and scheduling rides. The portal and app also allow members to request pickup for their ride home after an appointment, to view the real-time location of their ride, and, if available, to view driver photos and vehicle information.

The member will need to bring their own travel equipment for the ride, such as a car seat or a wheelchair.

The member will be asked by the driver to sign a driver log for the ride to their appointment. Members will sign the form again when leaving the appointment.

Policy for Additional Passengers and Car Seats

Individuals Who May Ride With a Member to an Appointment

Per federal statute 42 C.F.R. § 440.170, members may travel to a covered appointment with the following additional riders who are considered medically necessary:

• Medically necessary escorts (the NEMT manager contracted with the Wisconsin DHS will verify medical necessity with the member's health care provider)
• A parent or other relative, guardian, caregiver, or foster parent if a member is a minor
• A newborn traveling with the member to the member's post-partum visit

Additionally, when space is available, DHS allows members to travel with the following additional riders who are not considered medically necessary under the following circumstances:

• Additional rider(s) requested by the health care facility
• Additional rider(s) under the care of the member
• Additional rider(s) who is a legal dependent of the member
• An additional rider acting as a support person for the member

If members drive their own car, they may take additional passengers.

Car Seat Requirements

Parents or caretakers must provide car seats or booster seats for the ride. Car seats are required for children until they are at least age 4 and 40 pounds. Booster seats are required for children up until the child reaches one of the following:

• 8 years old
• 80 pounds
• 4 feet, 9 inches tall

If the parent or caretaker does not have a car seat or booster seat for any children who need them at the time of the ride, the member will not be able to take their ride.

Policy for Requesting Extra Stops

Additional stops will only be allowed for covered health care services, like an extra stop at the pharmacy to pick up a prescription on the way home from an appointment.

For a member who is getting a ride in a vehicle, all extra stops must be approved by the NEMT manager contracted with the Wisconsin DHS ahead of time. The member must call the NEMT manager to request an extra stop before the stop is needed. The driver will not make any stops that are not approved.

Requesting Non-Emergency Medical Transportation Services

Members or providers should have the following information available when calling the NEMT manager contracted with the Wisconsin DHS to request NEMT services:

• Member's full name, home address, and telephone number
• ForwardHealth ID number
• The pick-up address with zip code and the telephone number at which the member may be reached
• Name, telephone number, address, and zip code of the Medicaid-enrolled provider
• Appointment time and date
• The end time of the appointment, if available
• Any special transportation needs (for example, if the member needs someone else to ride with them, if the member requires life support services, or if the member requires transport in a supine position)
• General reason for the appointment (doctor's visit, checkup, eye appointment, etc.)

A member or provider who calls to schedule a ride and does not have all of this information may not be able to schedule a ride and may have to call the NEMT manager back.

For NEMT requiring life support services, the medical provider arranging the transportation must fax a copy of the prescription from the physician, physician assistant, or nurse practitioner to the NEMT manager.

For members eligible to receive a ride through the NEMT manager to their covered appointments, the NEMT manager is required to schedule the least costly type of ride that meets the member's medical and transportation needs per 42 C.F.R. § 447.200.

At the end of the call, the NEMT manager will give the caller information about the ride. If the member is taking the bus, the NEMT manager will explain how they will mail the bus ticket or pass. For members getting picked up, the NEMT manager will notify the caller of the name of the transportation provider who will be picking the member up and when the member should be ready for their ride. The transportation provider will call the member the day before the appointment to confirm the ride, including the time the member is scheduled to be picked up for their appointment.

Health care facilities can also access a dedicated portal to quickly book and manage rides for members. This portal can be used for one or multiple facilities, is accessible via web browsers, and does not require any software installation. For more information and to sign up for a demonstration, go to mtm-inc.net/wisconsin.

Note: The NEMT manager may contact a member's health care provider to verify:

• The most appropriate mode of transportation for members who have special transportation needs. This verification process is referred to as LON certification. For members who request special transportation arrangements, the NEMT manager will fax a LON form to the member's health care provider to determine the most appropriate mode of transportation.
• The urgency of rides scheduled less than two business days before a covered appointment.
• Regularly scheduled appointments for members requesting standing order rides.
• The medical necessity of escorts requested to accompany members to their covered appointments.

Members and medical providers are encouraged to contact the NEMT manager with 24-hour notice, if possible, if the member's appointment has been changed or canceled. Members and medical providers may cancel a ride by calling the NEMT manager reservation line at 866-907-1493 (711 TTY) or by accessing the NEMT manager website. If rides are not canceled, the NEMT manager may require the member to call the reservation line to confirm all future rides the day before an appointment.

Requesting a Ride Online

Health care facilities can access a dedicated portal to quickly book and manage rides for members. This portal can be used for one or multiple facilities, is accessible via web browsers, and does not require any software installation. More information is available at mtm-inc.net/wisconsin.

Members can access MTM's mobile-friendly portal and mobile app for managing and scheduling rides. The portal and app also allow members to request pickup for their ride home after an appointment, to view the real-time location of their ride, and, if available, to view driver photos and vehicle information.

Note: Requests for urgent rides must be scheduled by calling the NEMT Manager at 866-907-1493 (711 TTY).

School-Based Services Transportation

As stated in Wis. Admin. Code § DHS 107.36(1)(h), Wisconsin Medicaid will not reimburse SMVs for transporting a child to school or another location to receive IEP medical services when that transportation is in the child's IEP.

An IEP is a written statement for a child with a disability that is developed, reviewed, and revised in accordance with Wis. Stats. § 115.787. The IEP guides the delivery of special education supports and services for a child with a disability.

When SMV services are in a child's IEP, the child's school district or CESA is responsible for submitting claims to ForwardHealth for the service under the SBS benefit. The DHS Transportation Manager may reimburse SMVs for transporting a child from and to school for a medical appointment, such as a doctor's appointment, when the medical care and transportation are not in the child's IEP.

Service Complaints

Anyone, including a health care provider or a member's chosen representative, can file a complaint about NEMT services to the NEMT manager contracted with the Wisconsin DHS. Complaints may be about issues such as having a hard time getting a ride, long waiting times, or drivers who are late.

Signed Driver Log

Members or their representatives will be required to sign a driver log for each leg of the trip to verify that a ride has been provided. Members or their representatives should not sign for a leg of the trip until that leg has been completed.

Specialized Medical Vehicle Requirements

In order to be reimbursed for NEMT services through the NEMT manager contracted with the Wisconsin DHS, SMVs must maintain the following requirements:

• Be currently enrolled in Wisconsin Medicaid and meet all enrollment requirements under Wis. Admin. Code § DHS 105.39 and be contracted with the NEMT manager.
• Maintain the minimum insurance as noted in Wis. Admin. Code § DHS 105.39 (1) and (2).
• Ensure vehicles and all components comply with or exceed the manufacturers', state and federal, safety and mechanical operating, and maintenance standards for the particular vehicle used under the contract.

Copayments for Specialized Medical Vehicle Trips

SMV providers are required to request a $1.00 copay from the member each time a member is transported and a base rate is billed unless the member is exempt from making copayments.

Members are reminded they should not tip the transportation provider.

Transportation for Members to a Veterans Medical Facility

The NEMT manager contracted with the Wisconsin DHS can arrange and pay for rides for a Medicaid or BadgerCare Plus-enrolled veteran to a veterans facility if the medical appointment could be covered by Wisconsin Medicaid and BadgerCare Plus.

Transportation for Minors Traveling Alone to Their Appointments

Members age 17 and younger are minors. All reservations for transportation of minors to a covered appointment must be made by an adult. Additionally, transportation of minors usually requires a parent or caretaker who assumes responsibility for the minor, accompanies the minor for the entire trip, and stays with the minor at the destination.

Some exceptions can be made to allow a minor to ride alone if a parent or legal guardian signs a consent form. Parental Consent Forms are available at mtm-inc.net/wisconsin and may be submitted by mail or fax; submission instructions are included on the form.

The following members may travel without a parent or caretaker:

• Minors age 16–17 years old when traveling by a bus or vehicle
• Minors age 12–15 years old with a signed Parental Consent Form on file with the NEMT manager when traveling by a vehicle only
• Minors age 4–11 years old with a signed Parental Consent Form on file with the NEMT manager when traveling by a vehicle only with at least one other child to the same day treatment or center-based behavioral treatment program

Policy Regarding Transportation for Pickup of Prescriptions and Disposable Medical Supplies

Members needing to fill a prescription or pick up DMS following a covered appointment should do so en route to their return destination. In this case, providers or members must call the NEMT manager contracted with the Wisconsin DHS to request transportation to the pharmacy or other destination in advance of the actual return portion of the trip. This may be done at any time prior to the trip to the pharmacy, including while the member is at the covered appointment. If the trip to the pharmacy or other destination is not requested through the NEMT manager, the additional stop will not be accommodated.

Members needing to refill a prescription when there is no doctor's appointment scheduled are encouraged to use a mail-order service. Wisconsin state law permits Medicaid-enrolled pharmacies to deliver prescriptions to members via the mail. Medicaid-enrolled retail pharmacies may dispense and mail prescriptions or over-the-counter medications to a member at no additional cost to the member or to ForwardHealth. When filling prescriptions for members, providers are encouraged to use the mail delivery option, if requested by the member; however, providers cannot charge a member mailing expenses. Certain medications, such as pre-filled syringes, medication that must be refrigerated, or medication that must be stabilized, are not recommended to be mailed to the member. Information for the conveyance of these medications to the member's home is available.

As a reminder, ForwardHealth allows certain drugs to be dispensed in a three-month supply. Pharmacy providers should work with the member and the prescriber to determine whether it is clinically appropriate to dispense a three-month supply.

If prescriptions for drugs or DMS items cannot be filled during a scheduled trip and mail order is not an option, the NEMT manager can schedule a ride for the member to fill their prescription or pick up their DMS. The NEMT manager may pay for the member to ride a bus. For a member unable to ride a bus, the NEMT manager will schedule the most appropriate type of ride based on the member's medical and transportation needs.

Note: Transportation to pick up, repair, or fit DME and hearing aids is also covered and can be scheduled by calling the reservation line or scheduling online.

Types of Non-Emergency Medical Transportation Rides

Three types of transportation rides are covered for members who have no other means of transportation going to and from covered services provided by a Medicaid-enrolled provider:

• Standing order rides
• Urgent rides
• Routine rides

The NEMT manager contracted with the Wisconsin DHS schedules and pays for these rides.

Standing Order Rides

A standing order ride is defined as regularly recurring transportation for members who have no other way to get a ride to a covered service. A standing order ride has the same pick-up point, pick-up time, destination, and return. To eliminate the need to call the reservation line to schedule every ride, the standing order process allows members or providers to arrange regularly recurring rides for three months at a time. Standing order rides to dialysis appointments can be scheduled for six months at a time.

Providers may refer to the NEMT manager website for information on scheduling standing order rides.

Members can also access MTM's mobile-friendly portal and mobile app for managing and scheduling rides. The portal and app also allow members to request pickup for their ride home after an appointment, to view the real-time location of their ride, and, if available, to view driver photos and vehicle information.

Routine Rides

A routine ride is a ride to an appointment that does not require a member to be seen right away, such as a yearly check-up or a vision exam. Most rides are considered routine.

Routine rides must be scheduled at least two business days before an appointment and can be scheduled for the current month and the following month. Routine ride scheduling is available 24/7 and can be scheduled by calling 866-907-1493 (711 TTY) or online on the NEMT manager website.

The member or health care provider can contact the NEMT manager to schedule regularly recurring rides for up to three months at a time. The member or health care provider can schedule regularly recurring rides for dialysis appointments for six months at a time.

Urgent Rides

An urgent ride can be one of the following:

• A health care situation in which the member does not need to call 911 for immediate help but cannot wait two business days before seeing a health care provider
• A hospital discharge
• A ride to a follow-up appointment if the follow-up appointment is for the same health care issue and is scheduled within two days of the previous appointment

A ride to an urgent appointment will be provided in three hours or less.

Providers and members can schedule an urgent ride by calling the reservation number at 866-907-1493 (711 TTY) 24 hours a day, seven days a week.

Note: If an urgent ride is requested by a member, the NEMT manager may contact the member's health care provider to confirm the urgency of the appointment.

Health care facilities can also access a dedicated portal to quickly book and manage rides for members. This portal can be used for one or multiple facilities, is accessible via web browsers, and does not require any software installation. For more information and to sign up for a demonstration, go to mtm-inc.net/wisconsin.