Mt 10 form louisiana 2026

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The document is a comprehensive checklist and guide for enrolling as a Non-Emergency Medical Transportation (NEMT) provider in the Louisiana Medicaid Program. It outlines the necessary steps, forms, and requirements for prospective providers, including business registration, vehicle specifications, driver qualifications, insurance coverage, and criminal background checks. The document emphasizes compliance with state regulations and provides detailed instructions on submitting applications and maintaining operational standards to ensure safe transportation services for Medicaid recipients.
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  1. Click ‘Get Form’ to open the MT-10 form in our platform's editor.
  2. Begin by entering your provider name and company details in the designated fields. Ensure that all information matches your business registration.
  3. In the affidavit section, confirm that you are engaged in transporting passengers for compensation and specify that your vehicles will be used exclusively for non-emergency medical transportation.
  4. Have the affidavit notarized. You can easily add a digital signature or upload a scanned copy of the notarized document using our editor.
  5. Review all entries for accuracy before saving. Once completed, download the form or send it directly from our platform to the Public Service Commission at the provided address.

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The Louisiana Medicaid contractor for non-emergency medical transportation is Southeastrans, and this organization authorizes NEMT trips. Southeastrans authorizes non-emergency medical transportation for Medicaid recipients not enrolled in a Health Plan - those who are in regular Medicaid/fee for service.
Medicaid covered transportation is available to Medicaid beneficiaries when: The beneficiary is enrolled in a Medicaid benefit program that explicitly includes transportation services; and. The beneficiary or their representative has stated that they have no other means of transportation.
LaCHIP provides Medicaid coverage for primary care doctor visits as well as preventive and emergency care, immunizations, prescription medications, hospitalization, home health care and other health services.
COVERED SERVICES: NEMT provides an eligible beneficiary transportation to and/or from medical services covered by Medicaid when no other means of transportation is available. Transportation to additional services may be approved depending on the beneficiarys health plan.
Currently, Louisiana sets a rate floor. NEMT rates were increased in 2014 and, most recently, in July 2020. The 2020 rate increase set the base and per-mile rates for ambulatory trip legs at $9.50 and $1.10 and the base and per-mile rates for wheelchair trip legs at $17.50 and $1.30.

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Business License: Obtain a business license from your local county or city government. NEMT Provider Certification: If you plan to serve Medicaid recipients, you will need certification from the Louisiana Department of Health (LDH). This involves meeting specific vehicle, driver, and insurance requirements.
Register your business and its name with the Louisiana Secretary of States office. Obtain an IRS Taxpayer Identification Number in your business name. Open a checking account in the name of your proposed transportation business entity. Obtain a suitable vehicle (no pick up trucks or two door sports cars).

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