Downloads

Please click on the Download link that corresponds to the document you would like to view, and then click on Open or Save when prompted.

 TitleDescription 
Member Information BrochureHow to Access Non-Emergency Medical Transportation (NEMT) for CT Husky A, C and D Medicaid MembersDownload
Member Information Brochure (Spanish)Cómo acceso No son de emergencia Transporte médico (NEMT) para CT Husky A, C y D Los miembros de MedicaidDownload
Closest Provider CertificationCPC Form must be completed by your medical providerDownload
Physician Transportation Restriction Form (PTR)PTR form must be completed by your medical physician forDownload
Gas Reimbursement GuidelinesReimbursement GuidelinesDownload
Gas Reimbursement Invoice FormGas Reimbursement Invoice FormDownload
Companion Referral FormForm that is used to approve medical necessity for companions and aidesDownload
Parental Consent to Travel FormAuthorization form for Children under the age of 16 to travel aloneDownload
Parental Consent to Travel Form - SpanishAuthorization form for Children under the age of 16 to travel alone - SpanishDownload
Covered/Non-Covered Service ListList of most common covered/non-covered services for Non Emergent TransportationDownload
How to submit a complaintHow to submit a complaintDownload

To: All CT Medical Assistance Program Providers and Members

Subject: CT Medicaid Access Monitoring Review Plan (AMRP)

Effective January 4, 2016, the federal Centers for Medicare & Medicaid Services (CMS) adopted regulations at 42 C.F.R. §§ 447.203 and 447.204 that require state Medicaid programs to ensure Medicaid members have access to covered services.  Please follow this link: https://www.gpo.gov/fdsys/pkg/FR-2015-11-02/pdf/2015-27697.pdf to read the federal regulations.  The Department of Social Services (DSS), Connecticut’s state Medicaid agency, is committed to ensuring that Medicaid members can access the services they need.  DSS is also committed to complying with the federal access requirements.

Medicaid Access Monitoring Review Plan

The federal access regulations require DSS to prepare an access monitoring review plan (“access plan”), which must analyze how Medicaid members have access to medically necessary covered services, including analysis of data sources, methodologies, baselines, assumptions, trends, factors, and thresholds.  States must also consider information about access from providers, members, and other stakeholders.  DSS has prepared a draft access plan for Connecticut’s Medicaid program, which is posted on the Medicaid Access Monitoring Review Plan web page at: http://www.ct.gov/dss/cwp/view.asp?Q=580926&A=4125 (follow the link once on this site) or for the direct PDF copy of the AMRP go to: http://www.ct.gov/amrp.

DSS invites providers, Medicaid members, other stakeholders, and the public to review the access plan and send comments about the plan. Instructions on submission of comments are located on the Medicaid Access Monitoring Review Plan web page.

 

Click here to download a free PDF reader if no PDF reader is currently installed