Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 407.000 - Transportation Services › Section 407.402 - Definitions

Current through Register 1525, July 5, 2024
The following terms used in 130 CMR 407.000 and Subchapter 6 of
				the
Transportation Manual
have the meanings given in 130 CMR
				407.402, unless the context clearly requires a different meaning. The
				reimbursability of services defined in 130 CMR 407.000 is not determined by
				these definitions, but by application of regulations elsewhere in 130 CMR
				407.000 and 450.000:
Administrative and Billing
				Regulations.
Additional Person
- a person traveling
				in the same vehicle with another person for the purpose of receiving services
				covered by MassHealth.
Advanced Life Support, Level 1 (ALSU
-
				when medically necessary, the provision of an assessment by an advanced life
				support (ALS) ambulance provider or supplier and the furnishing of one or more
				ALS interventions. An ALS assessment is performed by an ALS crew and results in
				the determination that the patient's condition requires an ALS level of care,
				even if no other ALS intervention is performed. An ALS provider or supplier is
				defined as a provider trained to the level of the Emergency Medical
				Technician-Intermediate (EMT-Intermediate) or Paramedic as defined in the
				National Emergency Medicine Services (EMS) Education and Practice Blueprint. An
				ALS intervention is defined as a procedure beyond the scope of an EMT-Basic as
				defined in the National EMS Education and Practice Blueprint as most recently
				published in the
Federal Register.
Advanced Life Support, Level 2 (ALS2)
- when medically necessary, the administration of at least three different
				medications or the provision of one or more of the following ALS procedures:
				manual defibrillation/cardioversion, endotracheal intubation, central venous
				line, cardiac pacing, chest decompression, surgical airway, or intraosseus line
				as most recently published in the
Federal Register
.
Ambulance
- an aircraft, boat, motor
				vehicle, or other means of transportation, including a dualpurpose vehicle,
				however named, whether privately or publicly owned, that is intended to be used
				for and is maintained and operated for the transportation of sick, injured, or
				disabled persons and that has in force a valid certificate of inspection and
				license issued by the Department of Public Health as set forth in 105 CMR
				170.000:
Emergency Medical Services System
for the
				implementation of M.G.L. c. 111C, regulating Ambulances and Ambulance Services
				(Department of Public Health).
Authorized Provider
- an individual
				authorized to sign medical necessity forms and PT-1 forms requesting
				transportation for MassHealth members. An authorized provider must:
(1) be a physician (including an intern or resident), physician
				assistant, psychologist, dentist, nurse midwife, nurse practitioner enrolled in
				MassHealth; or
(2) be a registered nurse designated and supervised by a
				physician enrolled in MassHealth.
Basic Life Support (BLS)
- when
				medically necessary, the provision of basic life support (BLS) services as
				defined in the National EMS Education and Practice Blueprint for the EMT-Basic,
				including the establishment of a peripheral intravenous (IV) line, as most
				recently published in the
Federal Register.
Broker
- an entity that, pursuant to a
				selective contract with Executive Office of Health and Human Services (EOHHS),
				procures and manages non-emergency transportation services for MassHealth
				members in a designated area.
Brokered Transportation
-
				transportation services that are provided pursuant to a selective contract as
				described in 130 CMR 407.407.
Day Habilitation Program
				Representative
- a health-care professional employed by a day
				habilitation provider who is authorized to complete and submit PT-1 forms for
				MassHealth members. A day habilitation program representative must be a
				registered nurse, a licensed practical nurse, a day habilitation service
				manager as described in 130 CMR 419.426(B), or a program director as described
				in 130 CMR 419.424:
Staffing: Program Director.
Early Intervention Program
				Representative
- a health-care professional employed by an early
				intervention program provider who is authorized to complete and submit PT-1
				forms for MassHealth members. An early intervention program representative
				must:
(1) be a registered nurse, an occupational therapist, a
				physical therapist, a psychologist, a licensed clinical social worker, or a
				speech and language pathologist; and
(2) satisfy the staff qualifications specific to his or her
				position as described in 130 CMR 440.411:
Staff
				Qualifications.
Emergency Medical Condition
- a
				medical condition, whether physical or mental, manifesting itself by symptoms
				of sufficient severity, including severe pain, that the absence of prompt
				medical attention could reasonably be expected by a prudent layperson who
				possesses an average knowledge of health and medicine, to result in placing the
				health of the member or another person in serious jeopardy, serious impairment
				to body function, or serious dysfunction of any body organ or part or, with
				respect to a pregnant woman, as further defined in § 1867(e)(1)(B) of the
				Social Security Act,
				42
				U.S.C. §
									1395dd(e)(1)(B).
Emergency Services
- medical services
				that are provided by a provider that is qualified to provide such services, and
				are needed to evaluate or stabilize an emergency medical condition.
Escort
- an escort can be a parent,
				guardian of a child, a caretaker, a guardian of a mentally incompetent member,
				or an individual who physically assists a member with ambulating to and from a
				medical appointment.
Fee-for-service Transportation
-
				transportation services that are not provided pursuant to a selective
				contract.
Locality
- the town or city in which a
				member resides and the surrounding communities within 25 miles of the town or
				city in which the member resides.
Managed-care Representative
- a
				clinical employee of a MassHealth managed-care organization (MCO) or other
				MassHealth managed-care entity who has been designated to handle the
				transportation requests of enrolled members, including a physician or nurse
				practitioner; or a registered nurse, licensed practical nurse, or licensed
				social worker under the supervision of a physician or nurse practitioner. For
				MassHealth managed-care providers of mental health and substance abuse
				services, a clinical employee includes, a physician or nurse practitioner; or a
				registered nurse, licensed practical nurse, or licensed social worker under the
				supervision of a physician or nurse practitioner, or a licensed clinical
				psychologist or a licensed, independent clinical social worker.
Medically Necessary
- a service is
				"medically necessary" if:
(1) it is reasonably calculated to prevent, diagnose, prevent
				the worsening of, alleviate, correct, or cure conditions in the member that
				endanger life, cause suffering or pain, cause physical deformity or
				malfunction, threaten to cause or to aggravate a handicap, or result in an
				illness or infirmity; and
(2) there is no other medical service or site of service,
				comparable in effect, available and suitable for the member requesting the
				service, that is more conservative or less costly to the MassHealth agency.
				Services that are less costly to the MassHealth agency include, but are not
				limited to, health care reasonably known by the provider, or identified by the
				MassHealth agency pursuant to a prior authorization request, to be available to
				the member through sources described in 130 CMR 450.317(c), 503.007:
Potential Sources of Health Care
or 517.007:
Utilization of Potential Benefits.
Medical Necessity Form (MNF)
- a form
				designated by MassHealth documenting the medical necessity of fee-for-service
				transportation and its authorization by appropriate personnel.
Other Licensed Carrier
- any carrier,
				including bus, train, plane, or boat, that is licensed by the appropriate
				licensing board or agency.
Primary Care
- the provision of
				coordinated, comprehensive medical services, on both a first-contact and a
				continuous basis, to members enrolled in managed care. Services include an
				initial medical history intake, medical diagnosis and treatment and the
				communication of information about illness prevention, health maintenance, and
				referral services.
Provider Request for Transportation
				(PT-1)
- a form designated by and submitted to MassHealth, used to
				request brokered transportation for a member. The PT-1 form documents the
				medical necessity of the transportation requested and its authorization by
				appropriate personnel.
Public Transportation
- mass
				fixed-route transportation services, including bus service, subway trains,
				trolleys, and commuter rail service provided to the public in the Commonwealth
				of Massachusetts pursuant to the authority granted to the Massachusetts Bay
				Transportation Authority (MBTA) and regional transit authorities established
				under M.G.L. chs. 161A and 161B. Transportation services provided by MassHealth
				through selective contracts with regional transit authorities are not included
				in the definition of public transportation.
Shared Ride
- transportation service
				provided to two or more members traveling in the same vehicle for the purpose
				of receiving medical services covered by MassHealth.
Specialty Care Transport
- a medically
				necessary ambulance transport, for a critically injured or ill person, to
				provide a level of interhospital transportation service that exceeds the scope
				of the ambulance paramedic's clinical expertise as defined in the National EMS
				Education and Practice Blueprint. Such transportation is necessary when a
				person's condition requires ongoing care that must be furnished by one or more
				health professionals in an appropriate specialty area (for example, nursing,
				emergency medicine, respiratory care, cardiovascular care) or a paramedic with
				additional training.
Urgent Care
- medical services that
				are not primary care, and are needed to treat a medical condition that is not
				an emergency medical condition.
Verbal Authorization
- authorization
				of transportation by telephone or other oral means obtained from the MassHealth
				agency when a Provider Request for Transportation (PT-1) form has been
				submitted but has not been received by the MassHealth agency, or when urgent
				care is required.
Waiting Time
- the time spent by a
				vehicle and its driver and attendants in waiting to return a member to the
				point of trip origin. Waiting time applies only when the member is not in the
				vehicle.
Wheelchair Van
- a motor vehicle that
				is specifically equipped to carry one or more persons who are
				mobility-handicapped or using a wheelchair.