HomeMy WebLinkAbout9.23.19 Updated Logisticare Transportation Information - Kennelly, Scott Waugh, Melanie
From: Kennelly, Scott
Sent: Monday, September 23, 2019 4:10 PM
To: BOS
Cc: Kim, Sang
Subject: FW: Updated Logisticare Trnsportatmn Information
Attachments: Anthem LogistiCare Flyer ENG.pdf; Anthem LogistiCare Flyer SP.pdf; C4H&VV -
LugistiCare2NG.pdf; [AH&VV ' Logist[[apeSP.pdf; [HVVpcshorm.pdf
Good afternoon Supervisors,
After meeting with Supervisor Teeter this afternoon I learned that many people are struggling in Butte with
transportation issues and are not aware of an important and free service for people with MediCal (either Anthem or
California Health and Weilness).
This service is called Logisticare and is available to any Anthem/CHW members needing to get to and from an
appointment. Please see the attached forms in English and Spanish. Feel free to share this with anyone you know who
might benefit from this service. The email below also provides clarification on the CHW physician certification form.
If you have any questions please let me know.
Thanks,
Scott
Scott Kennelly L.C.S.W
Interim Director
Butte County Behavioral Health
CONFIDENTIALITY NOTICE:This e-mail transmission, and any documents or messages attached to it, may contain
confidential information that is legally privileged. If you are not the intended recipient, or a person responsible for
delivering this e-mail to the intended recipient, then you are (1) notified that any disclosure, copying, distribution,
saving, reading or use of this information is strictly prohibited, (2) requested to discard and delete this e-mail and any
attachments, and (3) requested to immediately notify us by e-mail that you mistakenly received this message
skenne||y@buttecnunty.net<rnai|to:skenne[|y@bmttecount , fax (S3O) Q9S'6549, ortelephone (538)891'l858.
Thank you.
From: Zinn, Sesha
Sent: Friday, May 03, 2019 11:10 AM
To: DBH A|[<D8HAU| buttecount .net>
Subject: Updated Logisticare Transportation Information
Hello everyone,
Since the Camp Fire, I have received calls on the Patient's Rights line that involve transportation related issues. After
doing some research, it looks like the information we are providing to our consumers about Logisticare is a bit outdated.
Attached you will find the English &Spanish versions of the California Health &Wellness and Anthem Blue Cross
1
Logisticare information. I spoke to liaisons with both agencies and they tell me that the client just needs to follow the
instructions on these brochures/flyers to access transportation services through Logisticare.
As for the California Health & Wellness Physician Certification form (also attached):The liaison tells me that the member
does not need to take this form with them.The Logisticare representative setting up the initial request for transport will
check to see if they have one on file already for that member and if they don't then they will confirm who they should
fax it to, usually the PCP. if they do have one on file, and it's still valid and for the requested level of service, no further
action is needed.
Please let me know if you have any questions, I am happy to assist in any way I can. Thank you!
Bianca Wilson, LMFT
Patient Right's Advocate/Language Access Coordinator/BI IC III
Butte County Behavioral Health
Quality :Management & Beneficiary Protections
.)6 I,assen Ave St, 130
Chico, CA )5973
Main 530-879-2/156
I)irect 530-879-3931.
Cell 530-693-5020
Fax 530-879-3932
CoNFIDENTIALITY NOTICE,:This e-mail transmission,and any documents or messages mached to it, may conmin confidential
information that is legally III i\ II you ate Hot the intended recipient„or a person ECtip011Sible 161"delivering this e-mail to the
it inlet] lecipicut,Illicit you ue (I) notified dial tti disclosure, copying, distribution, ivin., reading 01use of this information is strictly
Iwohiliited, (2) requested to discard and delete this e-mail and any attachments, and (3) requested to immediately no*its hy tliat
you mistakenly received this message biwilson@buttecouniv.net, or call (,5 )0) 879-3931.Thank you
2
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We can translate this at no cost. Call the customer service number on your member ID card. Engfish
Podemos traducir esto gratuitamente. Llame al numero de servicio de atencien al cliente quo aparece en
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inc.The B'ue Cross name and symbol are registered marks of the Blue Cross Association.Blue Cross of California is contracted with
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Podemos traducir esto gratultannente. Llame al namero de servicio de atencidn al cliente que aparece en
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Depending on your location and condition, 114.01 4 lia 1 ,II , 1 What If My Appointment Ills Cancelled or
types of transportation scheduled can be: 111111111 11111111111111 IIII11111111111111111111111111111111111111111111 1
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1111111111111 least one hour before your scheduled pick up
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health&wellness
PHYSICIAN CERTIFICATION STATEMENT FORM — Request for Transportation
This form provides LogistiCare or other authorized transportation provider with information on the appropriate level of
transportation needed for this Medi-Cal member.
Patient name:
Patient ID#/CIN#: Patient DOB:
Non-Emergency Medical Transportation (NEMT)
Choose one of the following levels of service:
0Wheelchair van OGurney/litter van Ambulance: OALS OBLS DCCT
['Air transportation (requires prior authorization from the plan)
JUSTIFICATION: NEMT under Medi-Cal is covered only when the patient's medical and physical condition does not allow
him or her to travel by bus, passenger car, taxi, or other form of public or private conveyance.
NEMT requires a function limitation justification, The physician is required to document the patient's limitations and
provide specific physical and medical limitations that preclude the patient's ability to reasonably ambulate without
assistance or be transported by public or private vehicles:
What prevents the patient from traveling by bus, passenger car,taxi, or other form of public or private conveyance?
Non-Medical Transportation (NMT)
NMT includes transportation for medically necessary appointments and may be provided via taxi, sedan, paratransit (such as
Access), or fixed-route transportation, such as buses. No signature is required for NMT,
Choose one of the following levels of service:
OMass(public)transit ElParatransit services (patient must qualify for services.) DSedan/taxi(curb-to-curb)
0Sedan (ambulatory door-to-door) DSedan with folding wheelchair(patient is able to transfer without assistance) (curb-to-
curb)
Duration of services (based on continued health plan eligibility): 030 days 060 days 090 days 01 Year
CERTIFICATION
The physician, dentist or podiatrist responsible for providing care for the patient is responsible for determining medical
necessity for transportation. This certificate can be completed and signed by a participating physician group (PPG),
independent practice association (IPA), primary care physician (PCP), MD, LVN, RN, PA, NP, CNM, PT, OT, ST, mental
health or substance use disorder provider, or discharge planner who is employed or supervised by the hospital,facility or
physician's office where the patient is being treated and who has knowledge of the patient's condition at the time of
completion of this certificate. PAs, NPs or CNMs may NOT sign this certificate for hospice care or home health care due to
restrictions listed below. NMT services do not require a physician signature and will be approved based on the least
costly method of transportation that meets the patient's needs.
Restrictions:PAs,NPs and CNMs may not sign PCS form for the foilowing covered 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.
Staff/physician's name(print):
Staff/physician's signature: Title:
Date: Contact telephone: (
Please return form by fax to Log istiCare, Attention: Utilization Review at 1-877-457-3352.
18-387a/OTH020371EHOO