An approved Certification of Need Form is required before a member can receive and be reimbursed for any special transportation services and are good for up to one year.
This form is to be completed by a healthcare professional only. Minnesota State Law prohibits reimbursement of special transportation for Minnesota
Health Care Program recipients without a current and approved Certification of Need Form that has been completed by a healthcare professional.
The following health care providers directing the healthcare of the member may complete the form:
- Attending Physician (MD)
- Clinical Nurse Specialist (CNS)
- Physician Assistant (PA)(PAC)
- Advanced Practice Registered Nurse (APRN)
- Nurse Practioner (NP)
- Certified Nurse Midwife (CNM)
- Physician Extender
- Licensed Independent Clinical Social Worker (LICSW)
- Licensed Marriage and Family Therapist (LMFT)
- Licensed Professional Clinical Counselor (LPCC)
- Licensed Psychologist (LP)
- Mental Health Rehabilitative Professional
- Psychiatric Mental Health Nurse Practitioner (PMHNP)
- Psychiatrist or Tribal Certified Professional
Note: Care Coordinators working on behalf of Medica may not complete the Certification of Need form.
Questions about Special Transportation
Healthcare providers with questions should contact the Medica Provider Service Center at 800-458-5512.
Medica members and member representatives should call the Customer Service number located on the back of their member ID card.
As of June 1, 2018 this Certificate of Need form must be submitted electronically by clicking the Submit button at the end of the form. Other forms of submission are no longer accepted.