Please click on the Download link that corresponds to the document you would like to view, and then click on Open or Save when prompted.

Closest Provider CertificationCPC Form for MileageDownload
CT DSS Facility NEMT BrochureHow to Access Non-Emergency Medical TransportationDownload
CT DSS NEMT Brochure [Spanish]Como acceso No son de emergencia Transporte medico Download
State MapA Map which shows the CT DSS Husky A, C and D Medicaid members service areaDownload
Companion Referral FormForm that is used to approve medical necessity for companions and aidesDownload
Covered/Non-Covered Service ListList of most common covered/non-covered services for Non Emergent TransportationDownload
CT DSS Hospital NEMT BrochureHow to Access Non-Emergency Medical TransportationDownload
Child Consent FormChild Consent FormDownload
CT Physician Transportation Restriction FormCT Physician Transportation Restriction FormDownload
CT Single Trip RequestCT Single Trip RequestDownload
CT Standing OrderCT Standing OrderDownload
Facilities Gas Reimbursement clarification letterFacilities Gas Reimbursement clarification letterDownload
Child Consent Form - SpanishChild Consent Form - SpanishDownload
Gas Reimbursement GuidelinesGas Reimbursement GuidelinesDownload
Gas Reimbursement Invoice FormGas Reimbursement Invoice FormDownload
How to submit a complaintHow to submit a complaintDownload

Any facilities having specific questions or concerns, please contact LogistiCare's Facility Outreach Coordinator, Cheryl Smith at

Please check this web site, [portal:url] frequently for updates.

To: All CT Medical Assistance Program Providers and Members

Subject: CT Medicaid Access Monitoring Review Plan (AMRP)

Effective January 4, 2016, the federal Centers for Medicare & Medicaid Services (CMS) adopted regulations at 42 C.F.R. §§ 447.203 and 447.204 that require state Medicaid programs to ensure Medicaid members have access to covered services.  Please follow this link: to read the federal regulations.  The Department of Social Services (DSS), Connecticut’s state Medicaid agency, is committed to ensuring that Medicaid members can access the services they need.  DSS is also committed to complying with the federal access requirements.

Medicaid Access Monitoring Review Plan

The federal access regulations require DSS to prepare an access monitoring review plan (“access plan”), which must analyze how Medicaid members have access to medically necessary covered services, including analysis of data sources, methodologies, baselines, assumptions, trends, factors, and thresholds.  States must also consider information about access from providers, members, and other stakeholders.  DSS has prepared a draft access plan for Connecticut’s Medicaid program, which is posted on the Medicaid Access Monitoring Review Plan web page at: (follow the link once on this site) or for the direct PDF copy of the AMRP go to:

DSS invites providers, Medicaid members, other stakeholders, and the public to review the access plan and send comments about the plan. Instructions on submission of comments are located on the Medicaid Access Monitoring Review Plan web page.



Click here to download a free PDF reader if no PDF reader is currently installed