SPECIAL BULLETIN COVID-19 #18: Guidelines for Non-Emergency Medical Transportation

NC Medicaid COVID-19 Bulletin #18 provides information to local Departments of Social Services (DSS) and NEMT providers on NC Medicaid’s requirements for NEMT services, and the recommended safety procedures and protocols to help reduce the spread of COVID-19 and guidance. 

During this unprecedented public health emergency, NEMT vendors are essential providers to ensure Medicaid beneficiaries receive the care that they need. People requiring covered NEMT services should expect to receive those services to access medical care and treatment. NCDHHS expects that local DSS will continue to provide contract monitoring oversight and support for this important service. 

Some NEMT vendors and their employees may have concerns about transporting Medicaid beneficiaries during the COVID-19 public health emergency. It is important to know the facts about COVID-19 and not let speculation lead to social stigma toward friends, neighbors or members of the community. Information to address this reaction is available at “COVID-19: Stigma” on the NCDHHS COVID-19 resource website at www. ncdhhs.gov/coronavirus/covid-19-stigma.

It is important that NEMT vendors understand that it is inappropriate for non-clinicians to make assessments about individuals’ health status and deny transportation services to their medical provider when the trip is necessary to maintain patient and community wellness. 

Local DSS offices can help ensure that essential NEMT services continue during the COVID-19 public health emergency by initiating the following:

• Review and implementation of NEMT emergency or business continuity plans
• Ensure necessary information and training for NEMT vendors, such as:
  • Share DSS actions in place to help NEMT drivers and riders stay safe
  • Work with NEMT vendors to develop practices and engineering controls to protect NEMT drivers
  • Provide recommended NEMT vendor and driver actions in case:
    • A  Medicaid beneficiary informs the driver that he or she is sick, or has symptoms of or has tested positive for COVID-19
    • An NEMT driver is exposed to COVID-19
    • An NEMT driver experiences symptoms associated with COVID-19 (a list of symptoms is available on the NCDHHS COVID-19 resource website at https://www.ncdhhs.gov/divisions/public-health/coronavirus-disease-2019-covid-19-response-north-carolina/what-covid-19)
  • Recommend ways that NEMT drivers can help Medicaid beneficiaries feel safer when receiving rides from an NEMT vendor
• Provide NCDHHS and NC Medicaid NEMT-related COVID-19 updates to NEMT vendors

DSS should encourage NEMT vendors to share factual COVID-19 information and discuss preparedness strategies with their staff to enhance the health and safety of their organizations and the Medicaid beneficiaries they serve.

NC Medicaid recommends DSS and NEMT vendors follow the recommendations and requirements outlined by NCDHHS and the Centers for Disease Control and Prevention (CDC). This guidance and other resources are located on the NCDHHS COVID-19 resource website at www.ncdhhs.gov/coronavirus.

NEMT vendors should be aware of steps to take that may help reduce the spread of COVID-19 at home and at work. According to the California DPH*:

• Clean frequently touched surfaces and objects, including door handles and seat belts, before transporting another client. Wear disposable gloves during cleaning and then dispose after each use.*
• Turn off air recirculation in both compartments to maximize air exchanges that reduce potentially infectious particles in the vehicle.*
• Open outside air vents in the driver compartment when transporting clients.*
• Wash your hands often with soap and water. Use alcohol-based sanitizers (at least 60% alcohol) when you cannot wash your hands.*
• Avoid touching your eyes, nose or mouth with your hands.*
• Stay home if you feel sick.*
• Dispose of used tissues immediately.*
• Consider single rider transports rather than multi-rider or ridesharing.
• Cough or sneeze into your elbow.
• Avoid shaking hands

Other helpful resources for DSS and NEMT vendors include the U.S. Department of Transportation Federal Transit Administration website for COVID Awareness and the Community Transit Association of America COVID-19 Resource Central website. These websites also encourage NEMT vendors to educate and train employees on proper hand hygiene, cough etiquette and social distancing techniques, along with  developing work practices and engineering controls that could provide additional protection to their employees and customers.

Before scheduling NEMT services, NCDHHS is encouraging Medicaid providers and beneficiaries to use telehealth services where available. Requests for NEMT should not be delayed because a beneficiary has not accessed telehealth services. Resources for telehealth information are available on the Medicaid COVID-19 webpage at www.medicaid.ncdhhs.gov/coronavirus.  

To ensure that Medicaid beneficiaries have ongoing access and availability to  NEMT services, NC Medicaid has requested additional flexibilities from the Centers for Medicare & Medicaid Services (CMS) to expand the types of providers that can provide NEMT services during the COVID-19 state of emergency. If CMS approves the request, NC Medicaid will send guidance to local DSS and NEMT providers.

If DSS has exhausted all of its local remedies and resources to address NEMT-related issues about providing services during COVID-19, Eva Fulcher, NC Medicaid Eligibility Services, is available to assist counties at eva.fulcher@dhhs.nc.gov or (919) 813-5343.