Nursing home providers have an updated NEMT rate and definition of a “trip” – please see details below provided by The Department of Health Services (DHS).

Reimbursement for non-emergency medical transportation (NEMT) was updated in the SFY23 Methods of Implementation (see section 7.50). NEMT is separately billable and will be reimbursed at $43 per trip plus $1.90 per mile.

When can nursing homes bill for NEMT?

Nursing homes can bill for transportation at this rate for members with a nursing home level of care segment on file using the codes described in ForwardHealth handbook topic #3219.

Keep in mind, reimbursement is available when nursing homes provide the transportation. There are separate billing requirements for nursing homes that contract with a common carrier, like a bus or taxi. ForwardHealth handbook topic #8477 provides additional billing information.

What is NEMT?

The Wisconsin Department of Health Services has created a clarified definition of an NEMT trip for billing purposes. A ForwardHealth handbook update will incorporate this definition soon.

An NEMT trip is defined as:

“When a transporter picks up the rider from their origin, takes them to their destination, and then the transporter leaves. This may involve one or more stops before reaching the destination, where the transporter does not leave but rather waits for the resident to complete their business at the stop, and the destination may be the same as the origin.”

When are these updates effective?

This definition and subsequent reimbursement are effective as of July 1, 2022. Managed care organizations are required to use this definition when reimbursing nursing facilities.