Medical Assistance Transportation Program An Overview MATP 101

Medical Assistance Transportation Program An Overview MATP 101

Basis For the Medical Assistance Transportation Program (MATP) MATP 101

Federal Regulations: Title XIX of the Social Security Act requires states participating in Medicaid to assure non-emergency medical transportation (NEMT) is available for eligible recipients to and from eligible medical providers MATP 101

MATP Authority and Operations: • Title XIX of the Social Security Act • 55 Pa. Code § 2070 • The MA State Plan • MATP Standards and Guideline (formally Instructions & Requirements) MATP 101

NEMT in Pennsylvania: Provided through The Medical Assistance Transportation Program (MATP) MATP 101

MATP Definition in Pennsylvania: A non-emergency medical transportation service provided to eligible persons who need to make trips to or from any MA service for the purpose of receiving treatment, medical evaluation, or purchasing prescription drugs or medical equipment. MATP 101

Operational Background MATP 101

MATP Operations: • County based • Under Grant Agreement with the Commonwealth • With advise and oversight by the Pennsylvania Department of Public Welfare, Bureau of Managed Care Operations MATP 101

MATP Recipients: • 2, 352, 955 --- average unique MA recipients per month • 112, 599 --- average unique MATP recipients per month • 5% of MA eligible recipients are MATP users • 80 --- average trip/recipient MATP 101

Verifying Eligibility MATP 101

MATP Recipient Eligibility: • At the time of each trip, the MATP Grantee verifies that a recipient is MA eligible. • The MATP Grantee will use the Department’s Eligibility Verification System to verify MA eligibility. MATP 101

Authorizing Transportation MATP 101

Determination of Mode • The MATP Grantee must assure that transportation for a recipient is not otherwise available and the trip is to an MA covered service. • The MATP Grantee will not authorize transportation, if they could have arranged transportation for the recipient at no cost to MA or if other options other than MA funded transportation is available. MATP 101

Determination of Mode • Once the MATP Grantee establishes eligibility and need, they are required to determine on a case-by-case basis which mode of transportation is the least costly and most appropriate for a recipient. • When determining the most appropriate mode of transportation for a recipient, the MATP Grantee must consider the recipient’s current level of mobility and functional independence. MATP 101

Coordinating Transportation MATP 101

MATP Transportation modes: At a minimum, the selected Offeror shall provide the following modes of transportation services: • Mass transit • Paratransit • Mileage reimbursement MATP 101

Coordinating Transportation: The county MATP Grantee can arrange through the following: • Directly provide van service or contract with service providers • Recruit and use volunteer drivers • Provide tickets, passes, or tokens for public transportation • Reimburse recipients for cost of mass transit • Reimburse recipients directly for the use of their own automobile MATP 101

MATP does not include Transportation as part of inpatient treatment Transportation to non-medical services Exceptional transportation services* Attendants, stretcher service, door-through-door service Transportation for visitation purposes * Transportation during severe weather when deemed unsafe Air travel, lodging, meals* * CAO may provide the service/reimbursement MATP 101

Coverage Areas: The MATP Grantee will provide transportation to any qualified, in network or approved by network, provider of the recipient’s choice who are generally available and used by other residents of the community. MATP 101

Choice of Providers: Pharmacy: The MATP will provide transportation to the choice of two pharmacies closest to the recipient’s residence or two pharmacies closest to the recipient’s prescribing physician’s office Methadone Maintenance: Pennsylvania code requires transportation only to closest Methadone Clinic to the recipient’s residence MATP 101

Urgent Care: Urgent care transportation may be provided: • Upon a physician’s verification of the need (must meet medical definition) • If discharge from a hospital will be delayed • Or a recipient’s ability to avoid hospitalization depends upon prompt approval of services MATP 101

Level of Service: Curb to Curb is the standard. • Door to door service is available based on the level of service that is appropriate for the recipient’s physical and mental capacities • availability shall be communicated to all recipients at the time they apply for services and anytime they request a change to paratransit service MATP 101

Level of Service • Door to door service requires verification from a medical provider. • May be obtained by the recipient or the MATP directly. • Need not be in writing if obtained by the MATP 101

Escorts If a recipient cannot travel independently, because of age, disability, or language; an escort must be allowed to accompany the recipient on the MATP trip MATP 101

MCO Referrals When the MATP Grantee identifies a trip request that falls outside the scope of the program or identifies a recipient with a special need a referral will be made to the MCO using the proper form and the established process. MATP 101

Director Tyrone Williams 717. 346. 3937 tywilliams@pa. gov Program Manager Northeast/Southcentral Southeast Ken Porter 717. 265. 7832 kenporter@pa. gov 12/7/2020 Program Manager Southwest Northwest Mike Cvetan 717. 257. 7795 mcvetan@pa. gov Program Monitor Northeast and Southeast Sundee Klopach 717 -409 -3358 sklopach@pa. gov Program Monitor Northwest Ron Minnich 717. 705. 8259 rominnich@pa. gov Program Monitor Southcentral Daphne Simeonoff 717. 214. 1352 ccwatkins@pa. gov Program Monitor Southwest Eira Andrade-Hall 717. 214. 1351 eandradeha@pa. gov MATP 101