7/26/2023
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Posted by Provider Relations
Medicaid covers the transportation of eligible, enrolled persons who need transportation to and from Medicaid-covered services. When traveling to medical appointments Medicaid enrollees are expected to use the same mode of transportation used to carry out daily activities. In some instances, an enrollee’s medical condition necessitates a specific mode of transportation such as taxi/livery, ambulette, or ambulance. The Medicaid Transportation program will pay for the lowest cost, most medically appropriate mode of transportation as justified by an enrollee’s medical provider.
As of June 6, 2022, the Form-2015 must be submitted through the transportation manager’s online portal. Forms submitted through any other method will not be processed and must be resubmitted through the online portal.
Medical providers are required to complete the Verification of Medicaid Transportation Abilities (Form-2015) to provide a medical justification when requesting a specific mode of transportation for an enrollee.
To be approved, the Form-2015 must:
• Be fully completed.
• Clearly describe the diagnosis/medical condition which necessitates the requested mode of transportation.
• Include the anticipated length of time the enrollee requires the requested mode of transportation.
The Form-2015 must be reviewed and signed by one of the following licensed medical providers:
• Physician
• Physician’s Assistant
• Dentist
• Registered Nurse
• Nurse Practitioner
• Occupational Therapist
• Physical Therapist
• Licensed Master Social Worker (LMSW)
• Licensed Clinical Social Worker (LCSW)
• Mental Health Counselor
An approved Form-2015 can cover one trip or multiple trips, including recurring appointments known as standing orders. The Form-2015 must be updated by the medical provider when the enrollee’s status changes in any way. The Form-2015 does not replace the requirement for obtaining prior authorization from the Department’s transportation manager. Rather, the Form-2015 is used in conjunction with a prior authorization to support the request for a specific mode of transportation.
The Form-2015 may be rejected if:
• It is not fully completed.
• It is not signed and dated by the enrollee’s medical provider using their own NPI number.
• It is signed by a medical provider other than the titles listed above.
• It is illegible.
• The medical justification does not adequately support the need for the requested mode of transportation.
• The medical justification contains only a diagnosis or diagnosis code without speaking to the individual’s ambulatory needs.
• Not submitted through the managers/brokers secure portal.
For further information please reference the NYS Medicaid Program: Transportation Manual and the Medicaid Transportation – Verification of Medicaid Transportation Abilities (Form-2015) Policy and Procedure.
If you have any questions or concerns, please contact your Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.