Overview of MassHealth Transportation
Non-emergency Medical Transportation Request System (PT-1)
MassHealth provides non-emergency transportation to a full range of medical services, from routine physician visits to dialysis treatment, that are paid for by MassHealth. For eligible MassHealth members, transportation is arranged through one of the six Regional Transit Authorities (RTAs) with whom the Human Service Transportation office contracts. MassHealth members submit PT-1 forms to the MassHealth office for approval for each location to which a member needs transportation. MassHealth members must use public transportation where it is available and accessible and/or transportation from family and friends whenever possible. Members must receive prior authorization for transportation service requests.
The general guidelines for non-emergency medical transportation services are:
- You must be categorically eligible for non-emergency transportation (i.e., MassHealth Standard or CommonHealth categories)
- You are not able to access public transportation and/or private means of transportation
- Your medical provider must authorize your need for transportation by completing a Prescription for Transportation (PT-1) form if you live in a community setting,
- MassHealth will only provide transportation to and from a MassHealth provider for a medical service that is paid for by MassHealth.
Medical Necessity Form System
If you reside in a nursing or rehabilitation facility, your medical provider must complete a Medical Necessity Form in order for you to receive human service transportation services to your MassHealth-covered service.
Please see the Frequently Asked Questions link below for more detailed information about PT-1 and MNF.
MassHealth Emergency Ambulance Transportation
In cases of emergencies, MassHealth also provides emergency ambulance transportation to medical services that are covered by MassHealth. No prior authorization is needed for an emergency transportation situation.
Additional information and assistance is available by calling the MassHealth Customer Service Center at (800) 841-2900, or by visiting the MassHealth web site at www.mass.gov/masshealth.
Frequently Asked Questions about MassHealth Transportation
- Who qualifies for MassHealth Transportation?
- What is a PT-1 form?
- Who can submit a PT-1 form?
- Will one PT-1 form cover all my medical transportation needs?
- Can my Primary Care Provider submit a PT-1 form for me to go to another healthcare provider?
- What information is required on a PT-1 form?
- How long does it take to process my PT-1 form?
- Will I be notified if I am approved or denied?
- What are Regional Transit Authorities?
- I would like to travel with a specific cab company because I like them the best. Can I do that?
- What is the “lowest bidder system”?
- Can I stop at the pharmacy on my way home from an appointment?
- What if I am a living in a nursing/rehabilitation facility? Can I receive transportation to medical appointments?
- How do I get transportation to a Day Habilitation Program?
Who qualifies for MassHealth Transportation?
To qualify for non-emergency transportation through MassHealth:
- A member must have MassHealth Standard or MassHealth Commonhealth.
- A member must be traveling to a MassHealth provider for a MassHealth reimbursable service.
- A member must be unable to use public transportation or have no public transportation available in their service area, nor do they have any friends or family available to drive them.
A PT-1 form is a Prescription for Transportation form that is completed and signed by your healthcare provider and e-mailed, mailed or faxed to the MassHealth Customer Service Center. Your provider can access this form online at the MassHealth website
A PT-1 form is a prescription for transportation and can only be submitted by someone who can also prescribe medication.
Will one PT-1 form cover all my medical transportation needs?
No. A PT-1 is needed for each MassHealth provider, site, and/or MassHealth reimbursable service that the member attends or receives.
Can my Primary Care Provider submit a PT-1 form for me to go to another healthcare provider?
Yes.
What information is required on a PT-1 form?
A PT-1 form must have all the sections filled out. The PT-1 form asks for the MassHealth member’s name, social security number, and correct address. Please note that P.O. Boxes are not acceptable since MassHealth needs to know where to pick the member up from, not their mailing address in case it is different.
The form also asks for the prescriber’s name, address, and provider number, and the name, address, and provider number of the doctor the member is going to see (unless it is the same as the presciber’s information, in which case the box that says “same as prescriber” should be checked), the treatment type, and special circumstances we need to know about, such as wheelchairs, and justification for going out of locality when appropriate. In order for the form to be processed, the form must be signed be signed by the prescriber.
How long does it take to process my PT-1 form?
A PT-1 form can take up to 5 days to process.
If you need transportation more quickly than that, you or your provider may call MassHealth customer service at 1-800-841-2900 for a verbal authorization. A verbal authorization is good for a maximum of two weeks. After that a standard PT-1 form must be submitted. Each MassHealth member is only allowed one verbal authorization per provider per lifetime.
Will I be notified if I am approved or denied?
You will receive notification of the approval or denial in the mail once your PT-1 form is processed. If you are approved you will also receive a letter from your Regional Transit Authority (RTA) explaining their procedures and policies for setting up rides with them.
If you are denied you have the option to appeal the denial.
What are Regional Transit Authorities?
MassHealth works with six Regional Transit Authorities (RTAs) to serve as brokers for different geographical areas throughout the state. Each RTA is responsible for coordinating human transportation services in one or more of the nine HST areas in the Commonwealth. Brokers use local vendors to facilitate human service transportation operations.
I would like to travel with a specific cab company because I like them the best. Can I do that?
No. MassHealth transportation is done through the lowest bidder system, meaning that rides are assigned based on vendor’s rates. For that reason MassHealth cannot assign a specific company or driver to a specific MassHealth Member for every ride.
What is the “lowest bidder system”?
If your PT-1 gets approved, you will be assigned to a Regional Transit Authority (RTA) in your area to serve as a broker for your transportation needs. You will call that RTA to set up your rides. The RTAs all function on the “lowest bidder system” which means that they assign transportation companies based on their rates. This also means that they cannot assign a specific transportation company or a specific driver to you. However if you have problems with a specific transportation company you may call the RTA or MassHealth to let them know about the problem and request that they not transport you any longer.
Can I stop to do an errand on my way home from an appointment?
No. MassHealth only provides transportation to and from MassHealth service providers, for MassHealth covered services. There are no stops allowed.
What if I am a living in a nursing/rehabilitation facility? Can I receive transportation to medical appointments?
Yes. The nursing/rehabilitation facility can arrange your transportation to MassHealth covered medical services with a transportation provider. The transportation provider will have a Medical Necessity Form (MNF) that the nursing facility staff or medical provider will complete and sign for your transportation.
How do I get transportation to a Day Habilitation Program?
MassHealth does not provide transportation to day habilitation programs through the PT-1 process. Transportation for MassHealth members to day habilitation programs is coordinated through the Department of Developmental Services (DDS) even for people who are not DDS consumers. To request transportation to your day habilitation program, your provider will need to fill out and submit an HST transportation request form and fax it to DDS for processing. You can obtain an HST transportation request form from any DDS regional office. For more information about day habilitation services and DDS contact information, please visit the Department of Developmental Services website.
This information is provided by Human Service Transportation.