Medi-Cal Update

Medical Transportation | November 2018 | Bulletin 518

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1. Non-Medical Transportation: Enrollment and Application Fee Updates

Changes have been made to the following non-medical transportation (NMT) policy since its first release in June 2018. Updates are shown in bolded type (excluding the subheading).

NMT policy became a covered Medi-Cal benefit effective July 1, 2018.

Pursuant to Welfare and Institutions Code (W&I Code) Section 14132 (ad)(1), NMT is covered, subject to utilization controls and permissible time and distance standards, for eligible full-scope Medi-Cal fee-for-service recipients and pregnant women during pregnancy and for 60 days postpartum, including any remaining days in the month in which the 60th postpartum day falls. NMT includes transporting recipients to and from Medi-Cal covered medical, mental health, substance abuse or dental services.

W&I Code 14132 (ad)(2)(A)(i) defines NMT as including, at minimum, round trip transportation for a recipient to obtain covered Medi-Cal services by passenger car, taxicab, or any other form of public or private conveyance.

NMT does not include the transportation of sick, injured, invalid, convalescent, infirm or otherwise incapacitated recipients by ambulances, litter vans or wheelchair vans licensed, operated and equipped in accordance with state and local statutes, ordinances or regulations, as these would be covered as non-emergency medical transportation (NEMT) services.

Registering NMT Vehicles and Enrolling as an NMT Provider
Based upon the authority granted to the director of the Department of Health Care Services (DHCS) in accordance with W&I Code, Section 14132 (ad)(8), the director is establishing Medi-Cal provider enrollment requirements for the provision of NMT services by currently enrolled Medi-Cal NEMT providers that request to provide NMT services by passenger vehicle and for enrolling transportation providers for NMT only. These requirements implement W&I Code, Sections 14043.15 and 14043.26, and as such have the full force and effect of law.

Transportation providers who are currently enrolled in Medi-Cal as NEMT providers and who wish to provide NMT services may request to become NMT providers and provide NMT services, as defined by W&I Code, Sections 14132 (ad)(2)(i) and 14132 (ad)(2)(ii). Current NEMT providers must submit a completed Medi-Cal Supplemental Changes (DHCS 6209) form. NEMT providers requesting to add NMT services should state so in the “Other Information” section of the DHCS 6209 form. NEMT providers wishing to use already reported NEMT vehicles to provide NMT services must also report that to the department in the “Other Information” section of the DHCS 6209.

Currently enrolled providers may add new NMT vehicles or NEMT vehicles for NMT on page 13 of the DHCS 6209. Copies of the Department of Motor Vehicles (DMV) commercial vehicle registration and proof of commercial vehicle insurance must be included.

Transportation providers who wish to newly enroll in Medi-Cal for NMT will need to submit a completed Medi-Cal Transportation Provider Application package, which includes a Medi-Cal Medical Transportation Provider Application (DHCS 6206) form, a Medi-Cal Provider Agreement (DHCS 6208) form, a Medi-Cal Disclosure Statement (DHCS 6207) form and an application fee.

All applicable information must be completed on the DHCS 6209 or DHCS 6206, which includes:

The NMT organizations/entities shall ensure that all NMT drivers comply with all applicable state and federal licensing and certification requirements and any and all applicable state and federal statutes and/or regulations relating to the operation of a motor vehicle and/or transportation of passengers.

Only enrolled providers who have been approved by DHCS to render NMT services may bill for NMT. The effective date of enrollment for approved NMT services will be retroactive to the date a complete application was submitted.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Medical Transportation mc tran gnd (21)
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2. Sign Language Interpreter Services Code Conversion Reminder

The sign language interpreter services code conversion will replace HCPCS Level III local codes, commonly referred to as local codes, with HIPAA-compliant HCPCS Level II national codes. This billing requirement for sign language interpreter services is mandated by HIPAA and is effective for claims with dates of service on or after January 1, 2019.

For claims with dates of service on or after January 1, 2019, the sign language interpreter services code conversion will be replacing HCPCS Level III local codes Z0324 and Z0326 with HCPCS Level II national code T1013 (sign language or oral interpretive services, per 15 minutes).

As of January 1, 2019, HCPCS Level III local codes Z0328 and Z0329 used to bill for sign language interpreter services will no longer be reimbursable.

Sign language interpreter services are a benefit to facilitate effective communication with deaf or hearing-impaired Medi-Cal recipients. Recipients are not eligible to receive sign language interpreter services in a health facility that is required by law to provide sign language interpreter services.

Providers are encouraged to watch for sign language interpreter service updates in the NewsFlash area of the Medi-Cal website and in the monthly Medi-Cal Update. Providers may complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to sign language interpreter services.

For additional information, providers may:

Questions regarding the sign language interpreter services code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.

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3. Electronic SAR Now Supports Attachments

California Children’s Services (CCS) and Genetically Handicapped Persons Program (GHPP) providers can now submit Service Authorization Requests (SARs) in an electronic format (eSAR) with attachments. Attachments must be in format of PDF, JPG or TIF. Attachments must be less than 15 megabytes (MB) in size, with the sum of all attachments being less than 150 MB. This feature aims to eliminate the paper SAR process for providers with internet connectivity.

To submit eSARs, providers must:

Then, select one of the available options to submit:

Registered providers and clearinghouses can complete and submit the eSAR requests on behalf of the providers and facilities in their network.

Paper SAR submissions remain an option for low-volume SAR providers or submitters who may have technical limitations or practical reasons to do so.

Providers interested in learning more about eSAR submissions should contact the CMS Net Help Desk at cmshelp@dhcs.ca.gov or 1-866-685-8449 for helpful guidance and additional information.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
Chronic Dialysis Clinics
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Home Health Agencies/Home and Community-Based Services
Inpatient Services
Local Educational Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child sar (12); genetic (4)
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4. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form

  2. Enter your email address and ZIP code and select a subscriber type

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

For more information about MCSS, please visit the MCSS Help page.

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5. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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