A key policy change in the letter makes long term care facilities responsible to furnish transportation in cases where medical necessity for ambulance transportation can not be supported. These costs can not be passed on to patients or their families. Furthermore, the facility is responsible for arranging or providing the transportation. Additional stipulations follow which help define the situations in which facilities must provide transportation services. To receive a service that is covered by the Medicaid program, regardless of whether or not the provider is enrolled in Medicaid or bills Medicaid for the service.
Facilities have an incentive to use ambulance services wisely.
Those agencies who use EMS to transport Medicaid patients for non-covered services will be held accountable for the expense. Occasionally, facilities receiving bills will ask us to take Medicaid numbers. Rowan County will not accept Medicaid numbers for services we know are non-covered or not medically necessary. In cases where medical necessity is questionable, a completed and signed medical necessity form must be presented at the time of transport. Furthermore, the patient must be a resident of Rowan County and the trip must begin or end inside the county.