MassHealth Transportation Changes

As you are probably aware, under certain circumstances MassHealth Standard and CommonHealth provide members with taxi transportation to medical appointments. The release of a new Prescription for Transportation form (PT-1) in December 2004 gives us the opportunity to review the changes and clarify policy.

What has not changed is the process. The PT-1 form is required to get MassHealth prior approval for transportation. Once approved, MassHealth refers the case to a contracted provider who then either provides the transportation or subcontracts out to another transportation provider. The patient must make transportation arrangements in advance through the contracted provider.

Major changes to the PT-1 form include a language/policy change. Old PT-1 forms ask “Is the treatment facility more than 20 miles from the member’s home?”. Now the geographic threshold for closer inspection is if the treatment facility is outside the member’s “locality”. “Locality” is defined as the member’s community and immediately adjacent communities. If we request transportation to MGH for a MassHealth member who lives in a community that does not abut Boston, specific medical documentation must be provided as to why the medical services or equipment needed cannot be obtained locally.

One policy simplification involves situations when a patient needs to get treatment in more than one area of the hospital, or needs transportation to or from an address other than his/her permanent residence. In the past, for each drop-off or pick-up address an additional form was required. There is now a space on the form to indicate an “alternate pick-up address” (see question 7).

Other Tips:

Staff may not be aware that MassHealth regulations specify that “members must use personal transportation resources such as family or friends whenever possible.” And that MassHealth will pay for transportation “only when public transportation suitable to the member’s medical condition is unavailable.” This must be supported by documenting a specific physical or mental disability on the form.

A physician is not the only one who can sign the form. It can also be signed by: a physician assistant, nurse midwife, dentist, nurse practitioner or managed care representative.

The new form is available on the department’s website (www.mghsocialwork.org, Staff Access > For Social Services Staff, Professional Resources > Forms & Policies > Transportation, OR Staff Access > Community Resource Center > Basic Needs > Transportation). Please note that there was a previous change in forms just a couple of months ago. The current forms have “PT-1 (Rev. 12/04)” at the bottom left. Please discard any outdated forms.

01/2005