Wisconsin Medicaid and BadgerCare Plus Glossary of Terms

Abuse: (A) Physical and verbal abuse; the willful infliction of intimidation or injury resulting in physical harm, pain, or mental anguish. (B) Program abuse; member and contractor practices that are not medically necessary and consequently result in an unnecessary cost to the Medicaid program; improper or excessive use or treatment (e.g., no shows).

Accident: An unexpected and unfortunate medically important bodily event causing loss or injury to a person. Accidents may involve loss of property (e.g., automobile).

Bariatric Transport: Motorized winch and ramps for loading passengers. Designed to provide safe transportation for people with body weight in excess of standard equipment limitations (800 lbs).

Cancelled Trip: A trip that a member cancels prior to the scheduled pick-up time.

Curb-to-Curb Service: Transportation from curb at origin to curb at destination. Includes providing assistance to passengers entering and exiting the vehicle if necessary.

Demand Response: Transportation that involves using contractor-dispatched vehicles in response to requests for individual or shared one-way trips.

Destination: The location or point to which a member has been authorized to travel to obtain medical services.

Door-to-Door Service: Transportation provided to people who need help to move safely from the door of the vehicle to the door of the pick-up point or healthcare location.

Emergency Transportation: A service that includes providing medical care while the individual is being transported.

Escort: An adult or service animal that accompanies a person receiving a ride to provide necessary mobility, or personal assistance during the time that transportation and healthcare services are provided.

Excessive Trip Time: Travel time two hours or more over the standard travel time.

Fixed Route: Designated public transportation on which a vehicle is operated along a prescribed route according to a fixed schedule.

Incident: An allegation substantiated by commission records, transportation or medical provider records, and witnesses.

Long Distance Trip: Transportation by demand response service outside of a member’s local medical market for the purpose of receiving healthcare services that are not available in the member’s community.

Manager: Transportation vendor responsible for establishing a network of transportation providers, operating a central call center, implementing screening to validate eligibility of member and trip for coverage, determining the most appropriate mode of transportation, maintaining quality assurance, reporting encounter data, and paying transportation claims for a NEMT program.

Mass Transit: Public transportation by bus, rail, air, ferry, or intra-city bus either publicly or privately owned, which provides general or special service transportation to the public on a regular and continuing basis.

Members: Individuals covered by Medicaid and/or BadgerCare Plus who do not have any other means of transportation to covered, medically necessary healthcare services and receive NEMT under this program.

Network of Providers: An entity or group of providers set up by a transportation manager to transport eligible members to authorized healthcare appointments.

No Show: (A) A member who does not respond within ten minutes of the time the transportation provider arrives at the designated pick-up point and scheduled time and announces his/her presence. (B) A transportation provider who fails to perform agreed services resulting in the member missing their appointment, including if the provider does not show up within 15 minutes after the scheduled pick-up time.

One-Way Trip: Transportation of a person from point of origin to destination.

Origin: The location at which the transportation provider is authorized to pick up the member at the start of the trip.

Passenger Assistance: Assistance which enables a member to walk, enter or exit a vehicle, or transfer from a wheelchair; does not include lifting or carrying the member.

Routine Medical Transportation: Prior authorized medical transportation trips that do not have priority status to and/or from a facility where healthcare needs will be met.

Service Animal: A trained guide dog, signal dog, or other animal to provide assistance to an individual with a disability.

Shared Ride: Transportation, excluding mass transit, for multiple passengers traveling in the same direction with appointments set up within one hour of each other.

Stretcher Service: Service for members who cannot be transported in a taxi or wheelchair van but do not require the medical services of an ambulance, and generally cannot use a seat in the vertical position and must use a stretcher during transport. Members must be medically stable to be transported by stretcher service.

TDD: Telecommunications device for the deaf.

TTY: Teletype writer.

Urgent Request: An urgent trip is an unscheduled episodic situation in which there is no immediate threat to life or limb, but the member must be seen on the day of the request and treatment cannot be delayed until the next day. This may include hospital discharges as well. Valid requests for a ride to an urgent appointment will be provided in three hours or less.