Transcript 2012 CTD Annual Meeting Presentation

Gate Keeping
for NET Providers
Presenter: Mike Bolin, AHCA Administrator
Bureau of Medicaid Services
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What is Gate Keeping?
Ensuring the transportation service is appropriate
and medically necessary, while employing the
most efficient and cost effective means available.
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Eligibility Determination
• Determined by interview when Medicaid
recipient requests services
• Rule Out:-Alternate resources for transport
-Available public transportation
• Is the trip Medicaid compensable?
CTD Medicaid Beneficiary Intake Form on website:
http://www.dot.state.fl.us/ctd/programinfo/medicaid/medicaidinfo.htm
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Is This Trip Medicaid Compensable?
Contact the medical service provider, or the
local area Medicaid office and ask if the
appointment is for a Medicaid compensable
service; or,
Verify with medical provider if the recipient has
an appointment.
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Gate Keeper Responsibilities
Accept requests for Transportation Services
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Directly from recipients;
Adult family members on behalf of minor recipients;
Guardians responsible for recipients; and
Providers/Licensed Health Care Professionals on
behalf of recipients.
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Gate Keeper Responsibilities
Determine if there is a reason why the recipient cannot
utilize his/her own transportation (such as the vehicle
needs repair, out of gas, etc.).
• If the recipient is unable to utilize his/her
transportation, the CTC/STP may assist the recipient
in utilizing his/her own means of transport (repair
vehicle, supply gas, etc.).
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Gate Keeper Responsibilities
Determine if a member of the recipient’s household can
reasonably (i.e., both willing and able) provide
transportation.
• Services cannot be denied because transportation may be
available from a source outside of the recipient’s
household.
• Relatives or household members may not be reimbursed
for recipient transportation.
Exceptions will be made in the case of foster parents
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Gate Keeper Responsibilities
Use public transportation where available and when
medically appropriate for recipients who are able to
understand signs and directions.
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Gate Keeper Responsibilities
Nursing facilities, group homes, and personal care homes may
have vehicle(s) intended to facilitate the general administration of
the facility and not necessarily to provide for resident
transportation.
• The availability of a vehicle for resident transportation must be
determined on a case-by-case basis. If not available for resident
transportation at the time required, as represented by the nursing
facility administrator, such vehicles must be excluded as an
alternate form of available transportation.
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Gate Keeper Responsibilities
Consider each request for NET services separately,
regardless of any previous denials of service.
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Out of State Transportation
AHCA reviews all requests for out of state services to
determine if the services are necessary (e.g., there is no
one in Florida who can treat the recipient).
CTC/STP will determine the most appropriate and cost
effective means of transportation to and from.
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Medicaid Compensable Trips
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It is not appropriate to reschedule a trip for the
following types of treatment:
Urgent Care;
Dialysis;
Chemotherapy;
Wound Treatment;
Behavioral Health Care;
Prescribed Pediatric Extended Care centers (PPECs);
Other trip that AHCA determines is in the best
interests of the Medicaid recipient.
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Holmes Jackson Washington
Jefferson
Escambia
Walton
Columbia
Hamilton
Madison
Gadsden
Leon
Bay
Santa Rosa
Area 1-John Vinski
Pensacola, FL
850-595-2307
1-800-303-2422
Calhoun
Nassau
[email protected]
Baker
Liberty
Okaloosa
Area 4-DeWeece Ogden
Jacksonville, FL
904-798-4267
1-800-273-5880
Suwannee
Wakulla
Taylor
Gulf
Clay
Lafayette
Franklin
Dixie
Union
Alachua
St. Johns
Putnam
Flagler
Gilchrist
[email protected]
Bradford
Ocala, FL
352-369-2129
1-877-724-2358
[email protected]
Marion
Levy
Area 3B-Donna Mitchell
Volusia
Area 2A-Faye Basiri
Panama City, FL
850-412-4175
1-800-226-7690
Area 2B-Faye Basiri
[email protected]
[email protected]
Tallahassee, FL
850-412-4175
1-800-248-2243
Citrus
Lake
Seminole
Sumter
Hernando
Orange
Area 7-Benjamin Akinola
Orlando, FL
407-420-2483
1-877-254-1055
[email protected]
Pasco
Area 3A-Alana McKay
Alachua, FL
386-462-6229
1-800-803-3245
Polk
Pinellas
Indian
River
Manatee
[email protected]
Medicaid Transportation
Specialists
5/22/12
Osceola
Area 5-Jim Callaway
St. Petersburg, FL
727-552-1906
1-800-299-4844
Sarasota
Hardee
Martin
Glades
Charlotte
Lee
Area 6-Donnette Waul
Tampa, FL
813-350-4851
1-800-226-2316
[email protected]
St.
Lucie
DeSoto
[email protected]
Area 9-Cindy Barnes
W. Palm Beach, FL
561-712-4338
1-800-226-5082
Hendry
Palm Beach
Area 10-Karen Porter
Ft. Lauderdale, FL
954-958-6535
1-866-875-9131
[email protected]
Broward
Collier
[email protected]
Area 8-Joseph Martinez
Fort Myers, FL
239-335-1268
1-800-226-6735
[email protected]
Dade
Area 11-Maria Hernandez
Doral, FL
305-593-3031
1-800-953-0555
[email protected]
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Questions?
Thank You!
Enjoy the Conference!
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