Expanded List of Providers Who Can Authorize Non-Emergency Medical Transportation

Date: 06/26/18

Effective for dates of service on or after January 1, 2018, the list of Medi-Cal providers that can authorize non-emergency medical transportation (NEMT) via a Physician Certification Statement (PCS) form has expanded to include the following provider types:

 

·        Physician assistants (PAs)                 

·        Nurse practitioners (NPs)

·        Certified nurse midwives (CNMs)

·        Physical therapists

·        Speech therapists

·        Occupational therapists

·        Mental health or substance use disorder providers

NEMT necessary to obtain medical services is covered subject to the written authorization of a licensed practitioner consistent with their scope of practice. Additionally, if the non-physician medical practitioner is under the supervision of a physician, then the ability to authorize NEMT also must have been delegated by the supervising physician through a standard written agreement.

 

PAs, NPs and CNMs may sign authorization forms required by the department for covered benefits and services that are consistent with applicable state and federal law and are subject to the supervising physician and PA/NP/CNM being enrolled as Medi-Cal providers pursuant to Article 1.3 (commencing with Section 14043) of Chapter 7 Part 3 of Division 9 of the Welfare and Institutions Code (W&I Code).

 

PAs, NPs or CNMs may not sign authorization forms for the following covered benefits and services due to restrictions in Title 42 of Code of Federal Regulations Section 440.70 for home health services, Section 418.00 for hospice care or any other federal restriction for Medicaid. Restrictions include the following benefits and services:

 

·        For hospice care, a physician's authorization is required for patient certification (at the beginning of the first 90-day period) and recertification (at the beginning of each subsequent period of care) of terminal illness.

·       For home health services, a physician’s authorization is required for durable medical equipment, medical supplies, enteral nutrition, and other medical services provided through home health agencies, such as physical therapy, occupational therapy, speech pathology, and audiology services.

PHYSICIAN CERTIFICATION STATEMENT
The attached PCS form replaces the form previously distributed by California Health & Wellness Plan (CHWP).

 

ADDITIONAL INFORMATION
Relevant sections of CHWP’s provider operations manual have been revised to reflect the information contained in this update as applicable. To access CHWP’s provider operations manual, visit the CHWP website at www.CAHealthWellness.com and navigate to For Providers > Provider Resources > Manuals, Forms and Resources.

 

Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

 

If you have questions regarding the information contained in this update, contact your Provider Relations representative or call 1-877-658-0305.