Mobility Determination for Non-emergency Medical Transportation Universal Form for All Medicaid Plans - New Hampshire

Mobility Determination for Non-emergency Medical Transportation Universal Form for All Medicaid Plans is a legal document that was released by the New Hampshire Department of Health and Human Services - a government authority operating within New Hampshire.

FAQ

Q: What is the Mobility Determination for Non-emergency Medical Transportation Universal Form?
A: The Mobility Determination for Non-emergency Medical Transportation Universal Form is a standardized form used in New Hampshire for Medicaid plans.

Q: What is the purpose of the form?
A: The form is used to determine an individual's eligibility for non-emergency medical transportation services under Medicaid.

Q: Who can use the form?
A: The form can be used by any individual who is enrolled in a Medicaid plan in New Hampshire and requires non-emergency medical transportation.

Q: What information is included in the form?
A: The form includes information about the individual's medical condition, the type of transportation needed, and any necessary accommodations.

Q: How do I fill out the form?
A: The form should be filled out by the individual or their representative, providing accurate and complete information about their medical condition and transportation needs.

Q: What happens after I submit the form?
A: After you submit the form, the Medicaid agency will review your eligibility for non-emergency medical transportation services and notify you of their decision.

Q: Are there any fees for non-emergency medical transportation?
A: No, non-emergency medical transportation services are generally covered by Medicaid and do not require any additional fees from the individual.

Q: Can I appeal a decision regarding non-emergency medical transportation?
A: Yes, if your request for non-emergency medical transportation is denied or if you disagree with the decision, you have the right to appeal the decision.

Q: Who should I contact if I have questions about the form or non-emergency medical transportation?
A: You can contact the New Hampshire Medicaid office or your Medicaid plan representative for assistance with any questions or concerns.