All Plan Letters (APL) Affecting Payments To Providers

APL 22-008 (May 18, 2022):

Provides guidance on payments for Non-Emergency Medical Transportation (NEMT) services.

Addresses coverage for transportation to pharmacies, requirements for transportation provider enrollment, and expenses related to transportation.

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Upon reviewing the California Department of Health Care Services (DHCS) All Plan Letters (APLs), the following documents reference "level of service" concerning Non-Emergency Medical Transportation (NEMT) and Non-Medical Transportation (NMT) service providers:

1. APL 22-008: Non-Emergency Medical and Non-Medical Transportation Services and Related Travel Expenses (May 18, 2022)

   • Overview: This APL provides guidance to Medi-Cal managed care health plans (MCPs) regarding NEMT and NMT services.

   • Key Points:

     • Physician Certification Statement (PCS) Forms: MCPs must utilize a DHCS-approved PCS form to determine the appropriate level of service for members requiring NEMT. The member's treating provider prescribes the form of transportation, and the MCP cannot modify this authorization.

Cal DHCS

1. Components of PCS Forms: The PCS form must include:

   • Function Limitations Justification: Documentation of the member's limitations that preclude reasonable ambulation without assistance or transportation by public or private vehicles.

   • Dates of Service Needed: Start and end dates for NEMT services, with authorizations valid for up to 12 months.

   • Mode of Transportation Needed: Specification of the required mode of transportation (e.g., ambulance, litter van, wheelchair van, or air transport).

   • Certification Statement: Provider's certification that medical necessity determines the type of transportation requested.

2. Reference:

   
   

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2. APL 17-010 (Revised): Non-Emergency Medical Transportation Services (October 19, 2017)

   • Overview: This APL offers guidance on the provision of NEMT services by MCPs.

   • Key Points:

     • PCS Forms: MCPs and transportation brokers must use a DHCS-approved PCS form to determine the appropriate level of service for Medi-Cal members. Once prescribed by the treating physician, the MCP cannot modify the authorization.

Cal DHCS

2. Required Components: The PCS form should include:

   • Function Limitations Justification: Documentation of the member's limitations that prevent reasonable ambulation without assistance or transportation by public or private vehicles.

   • Dates of Service Needed: Start and end dates for NEMT services, with authorizations valid for up to 12 months.

   • Mode of Transportation Needed: Specification of the required mode of transportation (e.g., ambulance/gurney van, litter van, wheelchair van, or air transport).

   • Certification Statement: Prescribing physician's certification that medical necessity determines the type of transportation requested.

3. Reference: APL 17-010