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Provider Notice Issued 04/22/2022

Date:    April 22, 2022

To:       Enrolled Transportation Providers and Physicians

Re:      Reinstatement of the Certificate of Transportation Services (CTS) as the HFS 2271 Form Effective May 1, 2022

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This notice informs providers of the Department of Healthcare and Family Services' (HFS) decision to reinstate the Certificate of Transportation Services (CTS) form for all non-emergency transports originating at a customer's private residence, effective with service dates on and after May 1, 2022. HFS has standardized the CTS as the HFS 2271 form. The HFS 2271 form will be used for prior and post approval purposes to determine the appropriate level of medically necessary transport for participants covered under the Medicaid fee-for-service (FFS) plan, as well as HealthChoice Illinois (HCI) managed care plans and the Medicare/Medicaid Alignment Initiative (MMAI) plans.  

The CTS was obsoleted with the adoption of the HFS 2270 - Physician Certification Statement on May 1, 2019. However, to address capacity issues and ensure medical necessity is supported for utilization of non-emergency ambulance, medicar/wheelchair van and service car transports, HFS is requesting the CTS for all non-emergency transports originating at a customer's private residence. The CTS should be completed by a qualified medical professional on behalf of the customer prior to transport. A copy of the CTS should be provided to the transportation provider at the time of transport.

Additional Information:
 

  • The CTS may be utilized for repetitive trips. One CTS form may be valid for recurring non-emergency ground ambulance transports for up to 60 days and recurring medicar/wheelchair van and service car transports for up to 180 days. However, if medical necessity or the level of transportation changes, a new CTS form will be requested.
  • The customer or requestor of transportation services should maintain a copy of the CTS and, upon request, furnish assistance to the transportation provider in the completion of the form if the CTS is incomplete.
  • For non-emergency ambulance, medicar/wheel chair van or service car transport originating from a long-term care facility or hospital, an HFS 2270 - Physician Certification Statement should be completed instead of the HFS 2271 CTS.

 
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service Medicaid participants, or to the applicable HCI or MMAI managed care plan.

 
Kelly Cunningham, Administrator
Division of Medical Programs



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Illinois Department of Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director