MLTC Policy 24.01: Non-Emergency Medical Transportation and Social Adult Day Cares

Office of Health Insurance Programs
Division of Health Plan Contracting and Oversight

Managed Long Term Care Policy 24.01: Non-Emergency Medical Transportation and Social Adult Day Cares

Date of Issuance: July 1, 2024

Date of Effective: January 1, 2025

Purpose: The purpose of this policy is to provide an update to non-emergency medical transportation guidance and instructions to Managed Long Term Care (MLTC) Partial Capitation Plans (MLTCP) and Medicaid Advantage Plus (MAP), and their contracted Social Adult Day Care (SADC) service providers. This policy does not apply to PACE plans nor to the Social Adult Day Care service providers that only contract with PACE plans.

Background: Effective March 1, 2024, the non-emergency transportation benefit was carved out the of the MLTC Plan benefit package and is now provided fee-for-service by the New York State Department of Health (the Department) Transportation Broker, Medical Answering Services (MAS).

Prior to March 1, 2024, SADC transportation was provided by MLTC plans in one of three ways:

  • Plans had arrangements with SADC programs to provide SADC managed transportation;
  • Plans managed transportation to and from SADC sites for their members; or
  • Plans offered a hybrid of SADC-managed and Plan-managed transportation.

As of March 1, to facilitate the non-emergency transportation carve out, the Department implemented a hybrid transitional period, which will end on December 31, 2024. During this hybrid period, SADC trips are provided in one of two ways:

  • SADCs manage their own transportation (either with SADC-owned or -leased vehicles or through a transportation vendor); or
  • MAS arranges SADC transportation for those SADC programs who do not manage their own transportation.

Effective January 1, 2025, SADC transportation will remain a covered benefit under MLTC Plans and SADCs will no longer have the option of their transportation being carved out to fee-for-service. All SADCs will be responsible for managing their own transportation. SADC Programs can opt to use their own vehicles or contract directly with transportation vendors to secure transportation of SADC members to SADC programs. The Department is providing this policy in advance of the implementation date to allow MLTC Plans time to educate and assist their SADCs with implementing these changes and initiating new contracts with vendors.

Before January 1, 2025, SADCs must transition any members whose trips to and from the SADC are arranged through their contracted MLTCP, MAP plan or through MAS to having their trips arranged and paid for by the SADC they are attending.

SADCs that do not currently provide transportation must initiate one of the following:

  • Obtain their own vehicles in order to provide transportation of their members to/from their SADC program; or
  • Contract with a transportation provider for provision of transportation services for their members to/from their SADC program. SADC programs can request a geographic specific list of transportation providers by contacting medtrans@health.ny.gov with the subject line: SADC list of transportation providers.

Reminder: MLTC Plans are still responsible for ensuring the SADC has appropriately established transportation for all of their members attending the contracted SADC.

Questions should be directed to medtrans@health.ny.gov or (518)473-2160.