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Effective: June 1, 2011 |
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28.05ar4 - Access Services (Archive) |
Archived: April 1, 2012 |
Access services cover the cost of eligible transportation and related services to help enrollees obtain covered, medically necessary health care. County or tribal agencies and MinnesotaCare Operations must provide access services to enrollees who are eligible for access services and who do not receive the services through a Managed Care Organization (MCO).
How Access Services Are Provided.
Access services must cover reimbursement for the following items for the enrollee, and when necessary, one additional responsible person:
l Cost of transportation to receive medical services.
n Enrollees must use the most cost effective available means of transportation.
n MHCP has contracted with Medical Transportation Management’s Minnesota Non Emergency Transportation (MNET) program to coordinate all Access transportation services in the 11-county metro area (Anoka, Carver, Chisago, Dakota, Hennepin, Isanti, Ramsey, Scott, Sherburne, Washington, and Wright)
MNET provides the following services for all Minnesota counties:
m Level of Need (LON) assessments.
m A recipient complaint line: (866) 436-0457.
l Lodging if necessary for the enrollee to obtain services outside the local area.
Note: The local agency must prior authorize charges over $50 per night.
l Meals if necessary to obtain services. Maximum reimbursement amounts per meal are:
n Breakfast - $5.50 (When in travel prior to 6:00 AM).
n Lunch - $6.50 (When in travel between 11:00 AM and 1:00 PM).
n Dinner - $8.00 (When in travel after 7:00 PM).
l Services that enable enrollees to have meaningful access at the local agency or from a provider including, but not limited to sign language interpreters, oral or lip-reading interpreters, interpreters for people who are deaf/blind, and foreign language interpreters.
l Documentation in support of a SMRT referral. Counties can bill DHS for the cost of medical exams required for disability determinations; submit a claim for access services with procedure code 99456 (disability exam). More information is found in the MHCP Provider Manual.
How Access Services Are Provided
Enrollees may receive access services in various ways:
l MinnesotaCare enrollees who are eligible for access services will receive those services through one of the following:
n The county agency's access plan if they receive case services through their MinnesotaCare county enrollment site.
n MinnesotaCare Operations’ access plan if they receive case services through MinnesotaCare Operations.
l MA enrollees in managed care plans may receive some services through the MCO and other services through the county or tribal agency's access plan.
l MA enrollees not in managed care plans receive services through the county or tribal agency’s access plan.
In general, MCOs must provide their members with:
l Sign language and foreign language interpreters if needed to receive medical services.
l Reimbursement for transportation and child care if needed for a state appeal hearing related to the MCO’s denial, reduction or termination of a health service.
l Common carrier transportation to receive medical services.
Managed care organizations are not required to provide:
l Reimbursement to enrollees for personal mileage or parking unrelated to an appeal.
l Lodging, meals or out-of-state airfare related to obtaining medical services.
Access plans must require prior authorization for:
l Lodging for costs that exceed $50 per night.
l Lodging and meal expenses for people accompanying the enrollee.
l Transportation and related expenses outside the local trade area, as defined by the local agency.
Note: Access plans may also require prior authorization within the local trade area at county option.
l Transportation, if the local agency determines the enrollee has misused transportation in the past.
Exception: Prior authorization is not required in emergencies. Enrollees must notify the appropriate agency of the expenses as soon as possible after the emergency.
Access services do not include emergency transportation services.
Access plans must require bills from providers or receipts and itemized statements from enrollees for all of the following:
l Commercial carrier transportation.
l Meals.
l Parking (other than parking meters).
l Lodging.