MATP 101 Medical Assistance Transportation Program An Overview

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

MATP 101 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 Federal Regulations:

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

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

MATP 101 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 Definition in Pennsylvania:

MATP 101 Operational Background

MATP 101 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 Operations:

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

MATP 101 Verifying Eligibility

MATP 101 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 Recipient Eligibility:

MATP 101 Authorizing Transportation

MATP 101 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. Determination of Mode

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

MATP 101 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 Coordinating Transportation:

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

MATP 101 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. Coverage Areas:

MATP 101 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 Choice of Providers:

MATP 101 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 Urgent Care:

MATP 101 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 Level of Service:

MATP 101 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. Level of Service

MATP 101 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 Escorts

MATP 101 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. MCO Referrals

MATP /5/2016 Director Tyrone Williams Director Tyrone Williams Program Manager Northeast/Southcentral Southeast Ken Porter Program Manager Northeast/Southcentral Southeast Ken Porter Program Manager Southwest Northwest Mike Cvetan Program Manager Southwest Northwest Mike Cvetan Program Monitor Northeast and Southeast Sundee Klopach Program Monitor Northeast and Southeast Sundee Klopach Program Monitor Southcentral Daphne Simeonoff Program Monitor Southcentral Daphne Simeonoff Program Monitor Northwest Ron Minnich Program Monitor Northwest Ron Minnich Program Monitor Southwest Eira Andrade-Hall Program Monitor Southwest Eira Andrade-Hall