Long Island Medicaid Ride

Downloads

 TitleDescription 
Enrollee Introduction LetterNYS DOH introduction letterDownload
Definitions, Acronyms & StandardsCommon terms, acronyms, criteria definitions, and standards used in Non-Emergency Medicaid TransportationDownload
Enrollee Responsibilities and ConductRules and guidelines for using Non-Emergency Medicaid TransportationDownload
List of Essential ContactsList of key ModivCare contactsDownload
Policy for Travel Related Expenses / Reimbursement GuideLong Island Department of Health policy regarding travel related expenses for Medicaid Enrollees.Download
Public Website LinksInternet links for key public servicesDownload
What to expect from your transportation provider.NY State Expectations for Quality Transportation Services.Download
Determining the Appropriate Type of TransportationUtilization Review of Requests and Determining the Appropriate Type of TransportationDownload
What ModivCare is responsible for.Describes ModivCare responsibilities for enrollees and how Medicaid enrollees can request transport.Download
Mileage Reimbursement FormsForm(s) that are required to be completed by the enrollee, the driver and the physician in order to receive mileage reimbursement.Download
NYS DOH Care Plan Grid for Transportation of TBI Waiver ParticipantsCare Plan Grid required by NYS DOH to be submitted for Transportation of TBI Waiver Participants .Download
Social Transportation Guidance for the Traumatic Brain Injury (TBI) Waiver ProgramGuidelines for Approving Requests for Social Transportation of Persons Enrolled in the Traumatic Brain Injury (TBI) Waiver Program.Download
2021 Mileage Reimbursement Schedule.2021 Mileage Reimbursement Payment Schedule for Medicaid EnrolleesDownload
Outside Common Medical Market Area FormNYDOH .form necessary to approve trip requests Outside the Nassau and Suffolk Counties Medical Market AreaDownload