Issued: July 2, 2024

This provider alert outlines the trips that are not covered under Non-Emergency Medical Transportation (NEMT), the transportation benefit in the Tailored Plan.

What is happening?

Some rides are not covered under Non-Emergency Medical Transportation (NEMT). This provider alert serves as notice to providers of the types of trips that are not covered.

Non-Covered Trips:

  • Members on the Innovations Waiver needing transportation to Day Supports, Respite, Community Living and Support, or Supported Employment Services (Transportation is included in the Medicaid provider’s payment.)
  • Members in a nursing home or long-term care facility (The facility is responsible for providing transportation to their residents.)
  • Members receiving Intensive In-Home, Assertive Community Treatment Team (ACTT), Community Support Team (CST)
  • Members transferring between facilities and/or hospitals

Additionally, there are some populations that are not eligible for NEMT under the Tailored Plan. This includes:

  • Individuals covered under NC Medicaid Direct
  • Eastern Band of Cherokee Indians with the Tribal Option plan
  • Dual eligible individuals (with both Medicaid and Medicare)

What do providers need to do?

Providers do not need to take any action.

How can providers help members?

Providers can assist members with scheduling rides through Partners transportation vendor, Modivcare, by calling 1-833-577-2309, or by calling Partners Member and Recipient Services at 1-888-235-4673, option 3 for transportation services. Rides can be scheduled up to 30 days prior to an appointment, but no less than two days before the appointment.

Providers can also submit the NEMT Standing Order form for recurring appointments found under NEMT Forms at partnersbhm.org/tailoredplan/members/tailored-plan-transportation-services/.

Reminder: Per NC Medicaid and NEMT policy, anyone under 18 years of age must have an adult to ride with them. This can be a guardian, caretaker, or other family member.

Covered trips include:

  • Medical, dental and vision
  • Behavioral health
  • Prescription pick-up following Primary Care Provider (PCP) appointments
  • Non-medical appointments such as educational classes and weight-control classes, including Weight Watchers

Medicaid can help get members to and from appointments. This service is at no extra cost to our members.

Non-emergency transportation includes:

  • Personal vehicles
  • Taxis
  • Vans
  • Minibuses
  • Mountain area transports
  • Public transportation

Who do Providers need to contact if they have questions?

Providers can call Member and Recipient Services at 1-888-235-4673, Option 3 for transportation, with any questions.