Urgent care is care for any illness or severe condition which, under reasonable standards of medical practice, would be diagnosed and treated within a 24-hour period and if left untreated, could rapidly become a crisis or emergency.
#Medical transportation dispatch upgrade#
Approve the one-time upgrade when the medical service is urgent, the member’s condition changes due to the treatment received immediately prior to transport, a medical provider who has seen or spoken with the person that day requests the medical service, or as required when a hospital discharges a member from their care. One-time assessments are completed when members with temporary conditions or sudden changes in condition require a higher level of transport service than they are currently approved to receive. The MHCP medical review agent may authorize requests for state-administered NEMT and Mode 4 of the Local Agency Administered NEMT. The local county or tribal agency may authorize upgrade requests for county or tribal agency-level NEMT. One-time assessment is for same-day service upgrade requests. One-time Transport Assessments and Upgrades NEMT providers may have hours that are different from those listed here. After-hours transportation is a covered service under MHCP however, MHCP does not require providers to provide transportation services outside of their business hours. and after 6 p.m., Monday through Friday and all day on weekends and holidays. Transportation after hours is for transportation that is before 7 a.m. If a member lives within three-fourths of a mile of a public transit route and his or her appointment is within three-fourths of a mile of a public transit route, and it is an appropriate mode of transportation for them, then they must use public transportation. It is preferable to submit requests for transportation up to five days before the member needs public transportation and at least three days for all other modes of transportation to allow transport to be scheduled.
The school district is responsible for transportation when the services to or from which the member is being transported are part of an individualized education program (IEP). Members can arrange for transportation as one-way or round trip within the 30- or 60-mile limit criteria (30 miles for a trip to a primary care provider or 60 miles for a trip to a specialty care provider).
For member transportation to waiver program services, see HCBS Waiver Services and Elderly Waiver (EW) and Alternate Care (AC) Program sections in the manual. Transportation to services provided for a waiver program is the responsibility of the waiver program. All other NEMT transports are accessed through the health plan.
MinnesotaCare members enrolled in a managed care plan with dates of service on and after January 1, 2017, will only receive or be reimbursed for personal mileage (mode 1), unassisted transport- out-of-state airfare only (mode 3), and out-of-state transport and ancillary services (lodging, meals, parking or tolls) through the local county or tribal agencies. Members enrolled in a managed care organization (MCO) must contact the appropriate MCO for the process and procedures for obtaining transportation services.
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