Sunday, May 15, 2016


When participants are transported by ambulance to an emergency room for treatment and then released without admission to the hospital, the return trip is not covered under the MO HealthNet Emergency Ambulance program. Return trips to the nursing home when the participant has been discharged from a hospital stay are also not covered under the Emergency Ambulance program, 13 CSR 70-6.010(6). Additional transports not covered in the Emergency Ambulance program include:

• transportation to a physician or dentist's office or a participant's home;

• ambulance services to a hospital for the first stage of labor; or,

• transport of a participant pronounced dead before the ambulance is called.

Transport by ambulance may be covered under the Non-Emergency Medical
Transportation (NEMT) program for eligible participants if it is the most appropriate mode of transportation based on the participant's medical needs. Hospital staff, nursing home staff, social workers, case managers, family members and other related parties
may call the NEMT broker for MO HealthNet toll free at 1-866-269-5927 to arrange nonemergency medical transportation to and from medical providers for eligible participants. NEMT services are available 24 hours per day, 7 days per week. To provide adequate time for NEMT services to be arranged, a participant or someone calling on their behalf should call at least five (5) calendar days in advance. For hospital discharges it may require up to three (3) hours to arrange the appropriate mode of transportation.

Neither the participant nor MO HealthNet is responsible for payment if physicians, hospital staff, or others arrange ambulance transports for non-emergency trips that are covered under the NEMT program without authorization from the NEMT broker.

Missouri Code of State Regulations 13 CSR 70-4.030 (2) states a "service will not be the liability of the participant if the service would have been otherwise payable by the MO HealthNet agency at the MO HealthNet allowable amount had the provider followed all of the policies, procedures and rules applicable to the service as of the date provided."

The NEMT broker provides the most appropriate mode of transportation based on the patient's medical needs. If a patient is confined to a bed but does not require anymedical equipment or medical attention en route, a stretcher van may be authorized. If the patient required medical attention or equipment en route, an ambulance will be authorized. When arranging non-emergency medical transportation, notify the NEMT broker if the patient is bed confined and whether or not medical attention or equipment is needed. For more information on the NEMT program and all modes of transportation under NEMT, please refer to section 22 of any MO HealthNet provider manual located on the MHD web site.

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