The purpose of this Medical Assistance Letter (MAL) is to transmit to counties the changes to the Enhanced Medicaid and At Risk Pregnancy Transportation program.

The department has made these changes in order to be responsive to requests by counties for the elimination of the county Enhanced Medicaid Transportation Program Implementation Plan and the simplification of data collection and reporting. Our hope is that these changes will ease the administrative requirements and streamline the reporting process while maintaining local accountability for the program.

In lieu of the implementation plan, counties must continue to collect and maintain data in a data collection system that allows for the reporting of the following information: the month, day and year in which the recipient is transported to/from a Medicaid reimbursable service; the first, middle initial and last name of the specific individual who was transported to/from a Medicaid reimbursable service; the twelve digit billing number of the recipient who was transported; the name of the entity transporting the Medicaid recipient to/from the Medicaid reimbursable service; the total number of one way trips a Medicaid recipient is transported; and the method of service delivery, These requirements are now set fort in Ohio Administrative Code rule 5101:3 24 04 . Counties must also maintain on file a description of how requests will be processed within the CDHS and criteria utilized to decide which mode of transportation is the most cost effective, cost efficient and addresses the recipient's medical condition and timeliness concerns.

In order to monitor this program more effectively, review of this program will be a component of the regularly scheduled county audit. During the course of the audit records will be examined by the audit staff to: verify an accurate, unduplicated count of recipients served through the EMT program; confirm that an accurate Medicaid financial claim was made; determine that accurate trip information was recorded and maintained; and establish that the eligibility process was followed correctly.

In the event that an eligible recipient was transported to/from a Medicaid reimbursable service, however, for some unforeseen reason (e.g., the physician was called away on an emergency) that service was unable to be provided at that time, the trip would be considered reimbursable although there would be no corresponding Medicaid claim. In the event that the individual has Medicaid spend down, until the spend down amount has been incurred the individual would not be eligible for transportation services provided through the EMT program. Counties should not be providing transportation services through the EMT program if the person is not eligible for Medicaid services on the date of the transport.

Please note that notwithstanding the provision of transportation services by certain managed care plans (MCPs), Medicaid recipients enrolled in MCPs are eligible for transportation services through the EMT program. Clients enrolled in MCPs are not to be denied services if they meet all the eligibility requirements set for in the Ohio Administrative Code.

Questions regarding this MAL can be directed to your regional Medical Assistance Coordinator.