Date: February 15, 2019
To: Enrolled Transportation Providers; Hospitals; and Long Term Care Facilities
Re: HFS 2270, Physician Certification Statement for Non-Emergency Transportation
By informational notice dated November 21, 2018, the Department notified providers that pursuant to the requirements in Public Act 100-0646, a new form was developed to replace the Medicaid Medical Certification for Non-emergency Ambulance (MCA) and Certification of Transportation Services (CTS) forms. This new form, the HFS 2270, is designated as the Physician Certification Statement (PCS). This notice is being issued to clarify when the PCS is required.
The November 21, 2018 notice contained the following sentence: “Pursuant to Public Act 100-0646, the Hospital Licensing Act, the Nursing Home Care Act and the Illinois Public Aid Code have been amended to require completion of this form each time non-emergency transportation is ordered.” This sentence is being clarified to state that the PCS form is required for all non-emergency transportation originating at a hospital or LTC facility, via ground ambulance, medi-car/wheelchair van or service car transport.
The HFS 2270 (PCS) has been amended slightly for clarity and is on the Department’s website. Although February 1, 2019 is the effective date for required use of the PCS, the Department will allow providers a 60-day transition period to implement the form and will make available additional training on use of the form. The MCA and CTS forms will be accepted if needed until 60 days after February 1, 2019. As of April 1, 2019, providers must use the PCA.
The PCS certifies that the appropriate level of transportation is being requested and is necessary for payment and verification of the level of service for participants served by Medicaid, HealthChoice Illinois managed care organization plans and Medicare. The transportation provider should not complete the PCS. This certification must be completed prior to transport by appropriate hospital or LTC medical staff and a copy provided to the transportation provider at the time of transport.
Some reminders regarding the PCS:
· The PCS is required for repetitive trips. One PCS form may be valid for recurring ground ambulance transports for up to 60 days, while one PCS form may be valid for recurring medi-car/wheelchair van and service car transports for up to 180 days. However, if medical necessity or the level of transportation changes, a new PCS form will be required.
· Long term care facilities and hospitals must maintain a copy of the PCS and, upon request, furnish assistance to the transportation provider in the completion of the form if the PCS is incomplete.
· The licensed medical professional that signs the PCS must check the appropriate box indicating their certification. Licensed clinical social workers are not allowed to sign unless they are also a discharge planner.
· The PCS is only required when a patient is being transported from a facility and requires non-emergency transportation. The PCS is not required prior to transport if a delay in transport can be expected to negatively affect the patient outcome. In these cases, the form must be provided at no charge within 10 calendar days of the request of the transportation provider.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service Medicaid participants, or to the applicable HealthChoice Illinois managed care plan.
Interim Medicaid Director