Effective July 1, 2023, the Indiana Health Coverage Programs (IHCP) is changing its nonemergency medical transportation (NEMT) policy. For fee-for-service (FFS) Medicaid nursing facility residents, all NEMT services will be carved out from the FFS Medicaid NEMT brokerage. Nursing facilities are provider type 3 with specialty 030 or 032. The policy was changed to provide flexibility to nursing facilities to ensure NEMT transportation best serves the needs of its Medicaid FFS residents and to improve the member and provider experience (see IHCP Bulletin BT202352).
Summary of Changes
All Medicaid FFS NEMT services for residents of nursing facilities will be non-brokered services.
This policy change does not apply to FFS Medicaid members residing in assisted living facilities.
Nursing facilities are responsible for coordinating, providing, and reimbursing transportation providers for non-ALS and BLS NEMT services (including ambulatory and wheelchair van) for its FFS Medicaid residents.
For dates of service on or after July 1, 2023, transportation will no longer be arranged through Verida.
It is important to note that all standing and future orders for member transportation made with Verida will end after June 30, 2023. Nursing facilities must ensure members are transported to those appointments after this date.
Beginning July 1, 2023, nursing facilities will receive an NEMT add-on to the per diem base rate. The base rate will appear in the July 1, 2023 rate letters. This new funding nursing facilities will receive is to use in reimbursing transportation providers or to fund the nursing facility for performing the transportation.
This means that no claims for NEMT services (other than BLS or ALS) provided to nursing facility residents should be submitted to the State’s claims payor, Gainwell Technologies.
All nonemergency ambulance transports that meet medical necessity for Basic Life Support (BLS) and Advanced Life Support (ALS ) services should be scheduled directly with the transportation providers by nursing facilities and not arranged through Verida (see IHCP Bulletin BT202353). These claims for BLS and ALS should be submitted to the State’s claims payor, Gainwell Technologies.
This change applies to all transports for dates of service on or after July 1, 2023.
Reimbursement and Claim Submission
Providers of NEMT Transportation will submit claims for all transports (ie. Ambulatory and wheelchair van) directly to the nursing facility. Nursing facilities are responsible for adjudicating and reimbursing these claims.
While nursing facilities will coordinate ALS and BLS ambulance transportation for its FFS Medicaid residents, ambulance providers will bill the appropriate procedure codes for nonemergency ALS and BLS services based on the types of medically necessary services provided during the transport. Claims for these transports must be submitted to Gainwell Technologies for adjudication.
Prior Authorization
NEMT ALS and BLS transports should be scheduled directly with the transportation providers and may require prior authorization under 405 IAC 5-30-4, such as:
All out of state pick ups and destination locations, except designated sister cities; and
Interstate transportation or transportation services rendered by a provider located out-of-state in a non-designated area.
Effective July 1, 2023, all prior authorization requests for FFS NEMT ambulance services should be submitted to Kepro, the IHCP’s new FFS prior authorization and utilization management (PA-UM) vendor for the IHCP nonpharmacy services.
IHCP Bulletin BT202339 includes information on accessing Kepro’s provider portal, Atrezzo, and lists provider training sessions dates.
State Requirements
Federal law requires the State to ensure Medicaid members have necessary transportation to and from Medicaid covered services. (42 C.F.R. § 431.53). With this policy change, nursing facilities will be responsible to meet this requirement for its residents in the FFS Medicaid population. Nursing facilities must use IHCP enrolled providers to furnish quality, safe and timely NEMT for FFS Medicaid members. This can include staff working for IHCP approved nursing facilities that are qualified to provide transportation services and does not require nursing facility staff to enroll separately as IHCP providers. State and federal audits may be conducted to monitor program integrity.
What can nursing facilities do now to prepare for the policy change?
This policy change returns brokering NEMT transportation for Medicaid FFS nursing facility residents to the nursing facilities. Nursing facilities may choose to revisit how it handled FFS Medicaid residents’ needs for NEMT services before the NEMT brokerage began in 2018. Nursing facilities should be prepared to provide transportation or have agreements with transportation providers for NEMT services. Nursing facilities must establish the ability to pay for NEMT services for their residents except for medically necessary ALS and BLS.
Nursing facilities can also work with its associations for guidance. It is important that we all work to ensure member access to nonemergency transportation is successful with these changes. Providing staff education and exploring and securing avenues to meet FFS residents’ NEMT needs are crucial steps to ensure a successful transition to the new policy.
For more information
Please register for IHCP webinars at on June 8, 2023 and June 12, 2023 at https://www.in.gov/medicaid/providers/provider-education/ihcp-live/. Recordings of these webinars will be posted on this site.