Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 134d - Medical Assistance › Immediate Medical Coverage for Newborn Children › Section 17-134d-33 - Medical transportation services

Current through July 10, 2024
(a)
Scope
These regulations set forth the requirements for payment of
				  Medical Transportation Services rendered to persons determined eligible for
				  such services under provisions of Connecticut's Medical Assistance Program in
				  accordance with Section 17-134d of the General Statutes of Connecticut.
(b)
Definitions
For purposes of Section 17-134d-33, the following definitions
				  apply:
(1) Additional Recipient
An additional recipient is an eligible Medicaid recipient
				  beyond the first recipient transported by a Medicaid transportation provider
				  during the same trip.
(2)
				Additional Stop
All trips have one pickup point and one drop-off point. An
				  additional stop is a pickup point or drop-off point other than the initial
				  pickup and final drop-off points. Additional stops occur when multiple
				  recipients are transported during a single trip.
(3) Air Transportation
Air transportation is transportation provided by a commercial
				  airline.
(4) Alternative
				Method of Transportation
If the most appropriate type of transportation for a
				  recipient is not available, a different type of transportation may be utilized.
				  This would be an alternative method of transportation.
(5) Ambulance
An ambulance is a vehicle for transporting the sick and
				  injured which is equipped and staffed to provide medical care during transit,
				  and which is operating as an ambulance under the authority and in compliance
				  with promulgated regulations of the Department of Health Services, Office of
				  Emergency Medical Services, and registered as such by the Department of Motor
				  Vehicles.
(6) Ambulance
				Night Call Charge
An ambulance night call charge is an additional fee that may
				  be paid when an ambulance service is dispatched between the hours of 7:00 P.M.
				  and 7:00 A.M. inclusive.
(7) Appropriate Method of Transportation
An appropriate method of transportation is the least
				  expensive type of transportation which best meets the physical and medical
				  circumstances of a recipient requiring transportation to a medical
				  service.
(8) Assistance
Assistance is when a recipient must be physically helped from
				  within or into a building and/or from within or into the medical provider's
				  site. Without such assistance it would be unsafe or impossible for the
				  recipient to reach the livery vehicle or the medical provider's site.
This assistance is provided by an employee of the livery
				  provider, the driver or a person in addition to the driver. This service is
				  beyond a door-to-door service.
(9) Attendant
An attendant is an employee of an invalid coach or wheelchair
				  accessible livery provider, and is a person in the vehicle in addition to the
				  driver, who provides assistance in the transportation of passengers.
(10) Attendant Services
Attendant services are when an attendant must physically
				  assist a recipient from within or into a building and from within or into the
				  medical provider's site. Without such assistance it would be unsafe or
				  impossible for the recipient to reach the invalid coach or wheelchair
				  accessible livery vehicle or the medical provider's site. This service is
				  beyond a door-to-door service.
(11) Available Transportation
Available transportation means that a public transportation
				  system, an enrolled Medicaid provider, organization, agency, or individual
				  offers appropriate transportation services to a recipient who requires
				  transportation.
(12) Border
				Provider
A border provider is a provider located in a state bordering
				  Connecticut, in an area that allows it to generally serve Connecticut
				  residents, and who is enrolled as and treated as a Connecticut Medicaid
				  provider. Such providers are certified and/or licensed by the applicable agency
				  in their state.
(13)
				Cancelled Call
A cancelled call is notification to the transportation
				  provider not to provide services to a recipient, prior to the time the vehicle
				  is enroute to the pickup point.
(14) Critical Care Helicopter
A critical care helicopter is an aircraft which is operating
				  as a critical care helicopter and in compliance with promulgated regulations
				  under the authority of the Department of Health Services, Office of Emergency
				  Medical Services. A critical care helicopter has mobile intensive care
				  capabilities and is called to the scenes of severe accidents or illness.
(15) Department
The Department means the Department of Income
				  Maintenance.
(16) Emergency
An emergency is defined as a medical condition (including
				  labor and delivery) manifesting itself by acute symptoms of sufficient severity
				  (including severe pain) such that the absence of immediate medical attention
				  could reasonably be expected to result in placing the patient's health in
				  serious jeopardy, serious impairment to bodily functions, or serious
				  dysfunction of any bodily organ or part.
(17) Emergency Ambulance Trip
An emergency ambulance trip is an ambulance trip made in
				  accordance with the Department's definition of emergency and has as its
				  destination:
(A) a hospital emergency
				room; or
(B) a general hospital or
				a psychiatric facility where a nonscheduled admission results; or
(C) a general hospital or a psychiatric
				facility where an emergency admission results after a recipient was seen at a
				hospital emergency room; or
(D) a
				second facility because an emergency medical service was not available at the
				original emergency room; or
(E) a
				critical care helicopter.
(18) Helicopter Assist
A helicopter assist is medical care provided at the scene to
				  a recipient when such recipient is ultimately transported by a critical care
				  helicopter.
(19) Invalid
				Coach
An invalid coach is a vehicle used exclusively for the
				  transportation of non-ambulatory patients and is operating as an invalid coach
				  under the authority and in compliance with promulgated regulations of the
				  Department of Health Services, Office of Emergency Medical Services, and
				  registered as such by the Department of Motor Vehicles, or is a wheelchair
				  accessible livery vehicle.
(20) Livery
A livery vehicle is a sedan or van type vehicle capable of
				  carrying up to ten passengers used for the transportation of ambulatory
				  patients, who may require assistance, and which is operated by a livery carrier
				  under the authority and in compliance with the statutes and regulations of the
				  Department of Transportation and/or a transit district and registered as a
				  livery vehicle by the Department of Motor Vehicles. Livery service is a
				  door-to-door service.
A livery vehicle does not include a vehicle registered as a
				  service bus vehicle with the following exception. If the Commissioner
				  determines, in his/her sole discretion, that for access or other reasons use of
				  service bus vehicles is appropriate, equitable and in the best interests of the
				  state, he/she may authorize use of service bus registered vehicles and may
				  impose any additional insurance or other requirements or limitations which
				  he/she deems appropriate. Said authorization must be in writing.
(21) Loaded Mileage
Loaded mileage is the distance traveled by a motor vehicle
				  while carrying passengers from a pickup point to a drop-off point. Mileage
				  between Connecticut towns is determined in accordance with the Public Utility
				  Control Docket Document (PUCA) #6770-A.
(22) Noncontiguous Town
Noncontiguous town is a town which does not border the town
				  in which a provider's headquarters is housed. Noncontiguous towns are towns
				  which do not border each other.
(23) Non-Emergency Ambulance Trip
Non-emergency ambulance trip is a pre-arranged ambulance trip
				  that is not responding to an emergency injury or illness. However, ambulance
				  services are needed because a recipient may require medical care during
				  transit, which an ambulance is equipped and staffed to provide.
(24) No-show
No-show is when a recipient fails to utilize a transportation
				  service approved in writing by the Department, and which is not
				  cancelled.
(25) Not
				Ambulatory
An individual who is not ambulatory is unable to walk despite
				  the possible use of assistive devices (e.g., cane, crutch, walker) and/or the
				  assistance of an attendant.
(26) Nursing Home
A nursing home is an intermediate care or skilled nursing
				  facility (ICF, SNF, or ICF/MR) or Chronic Disease Hospital.
(27) Other Commercial Carrier
Other commercial carriers are those regulated carriers other
				  than taxi, livery, wheelchair accessible livery, ambulance, invalid coach, and
				  air transportation that transport the public for a fee and which meet all
				  applicable state and federal permit and licensure requirements to operate as
				  such.
(28) Out-of-State
				Trip
An out-of-state trip is a trip originating or ending outside
				  Connecticut that is to transport a patient to or from a medical provider that
				  is not located in Connecticut and is not a border provider.
(29) Prior Authorization
Prior authorization means approval for a service from the
				  Department or the Department's agent before the provider actually provides the
				  service. In order to receive reimbursement from the Department a provider must
				  comply with all prior authorization requirements. The Department in its sole
				  discretion determines what information is necessary in order to approve a prior
				  authorization request.
(30)
				Private Transportation
Private transportation is transportation by a vehicle owned
				  by a recipient or by a friend, relative, acquaintance or other individual,
				  provided the vehicle is not licensed for commercial carriage. Individual does
				  not mean communities, companies, corporations, societies or
				  associations.
(31) Provider
				Agreement
The provider agreement is the signed written contractual
				  agreement between the Department and the provider of services or goods.
(32) Provider Headquarters
Provider headquarters is the provider's base of operations
				  closest to the pickup point. A provider may have more than one (1)
				  headquarters.
(33) PUCA
				Document
PUCA Document is the Department of Public Utility Control
				  Docket Document #6770-A and all its supplements which specify the mileage
				  between Connecticut towns.
(34) Recipient
Recipient means a person eligible for services under the
				  Department's Medical Assistance Program.
(35) Round Trip
A round trip is the dispatching of a vehicle to the
				  recipient(s) pickup point, transporting the recipient(s) to a medical provider
				  and transporting the recipient(s) back to the pick-up point.
(36) Shared Ride
A shared ride is when more than one recipient occupies a
				  vehicle during the same trip.
(37) Special Attendant
A special attendant is a second attendant who is an employee
				  of the ambulance provider, and who is in the vehicle in addition to the driver
				  and one attendant. This attendant is needed due to the recipient's medical
				  condition.
(38) Taxi
A taxi is a vehicle operating as a taxi under the authority
				  and in compliance with promulgated regulations of the Department of
				  Transportation and/or a transit district and registered as such by the
				  Department of Motor Vehicles.
(39) Trip-Ambulance, Invalid Coach, Taxi and
				Wheelchair Accessible Livery
A trip is the dispatching of an empty vehicle to the
				  recipient pickup point and transporting the recipient to a medical provider, or
				  from a medical provider to the drop-off point.
(40) Trip-Livery
A livery trip is the dispatching of an empty livery vehicle
				  to the recipient(s) pickup point and transporting the recipient(s) to a medical
				  provider or from a medical provider to the drop-off point. A trip for livery
				  services begins when an empty vehicle picks up a recipient(s) and ends when the
				  last recipient is dropped off and the vehicle is empty.
(41) Unloaded Mileage
Unloaded mileage is the distance traveled by the motor
				  vehicle carrying no passengers, enroute to the point of pickup or, enroute from
				  the point of drop-off.
(42)
				Unpaid Health Care
Unpaid health care is a service(s) provided to a recipient
				  which is voluntary in nature, and usually provided by a family member,
				  neighbor, friend or other person(s) within the individual's support
				  system.
(43) Waiting Time
Waiting time is the time that a vehicle is waiting at a
				  medical provider's facility, to which the transportation provider transported
				  the recipient, in order to transport the recipient to another destination,
				  during the same trip.
(44)
				Wheelchair Accessible Livery
A wheelchair accessible livery vehicle is a vehicle
				  specifically designed for the transportation of wheelchair mobile patients, and
				  which is operating as a wheelchair accessible livery, under the authority and
				  in compliance with promulgated regulations of the Department of Transportation
				  and/or a transit district and registered as such by the Department of Motor
				  Vehicles. Wheelchair accessible livery vehicles are treated the same as invalid
				  coach vehicles.