Non-Emergency Medical Transportation

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Non-Emergency Medical Transportation
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Federal Requirement

• Section 6083/1902(a) of the Deficit Reduction Act
  of 2005 (DRA) provides States the authority to
  establish a non-emergency medical transportation
  brokerage program.
• Under such a program, the State contracts with
  one or more brokers to manage the provision of
  non-emergency transportation services for
  Medicaid recipients who need transportation to or
  from medical providers.

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What Is A Transportation Brokerage Program?

• Brokerage programs provide administrative
  oversight and coordination of human services
  transportation through a contract with the State.
• Brokers act as gatekeepers, ensuring recipients
  receive the most efficient, cost effective and
  appropriate mode of transportation.
• Brokers verify recipient eligibility for
  transportation, schedule trips, and dispatch
  trips to transportation providers.
• Brokers contract directly with transportation
  providers in local communities to transport
  recipients to and from medical facilities.
• Transportation providers are paid by the Broker.
  

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Current Transportation Costs in NC

• Approximately 43M for State Fiscal Year 2010
• Overall Medicaid Budget 9,450,000,000
• Required Budget Reductions
• 356,151,356 (state)
• 2 rate reduction
• Reductions in utilization of services limits on
  services
• 90 m thru CCNC
• Increased PI recoupments
• Assessments
• More Prior authorization
• Must meet budget targets or additional cuts will
  occur such as
• Additional rate cuts
• Elimination of services

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2007 Medicaid Quality Assurance Review Findings

• 1,068 reimbursements for transportation without
  evidence of a medical service provided on day of
  transport.
• 164 reimbursements for transportation provided
  for non-covered services.
• 113 reimbursements for individuals transported
  that were not authorized for Medicaid.

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2007 Medicaid Quality Assurance Review Findings

• 91 reimbursements for individuals ineligible for
  transportation services.
• 77 reimbursements claimed for cancelled medical
  appointments.
• Transportation Logs were incomplete or contained
  incorrect information regarding who was
  transported and when.
• Overall Findings 9.65 payment error rate based
  on the dollar amount of ineligible reimbursement
  claims.

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Current Transportation Issues

• Each of the one-hundred county DSS offices are
  responsible for assessing the need for
  transportation, arranging for, and providing
  non-emergency transportation services to
  recipients in their counties.
• Rural counties experience difficulty in
  administering transportation due to the lack of
  available resources to provide the transportation
  in remote areas.
• Smaller counties experience difficulties where
  there are limited resources available for
  recipients who must be transported after hours
  and on weekends. They often have no resources
  other than the county van system.

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Current Transportation Issues

• Larger counties with a high number of recipients
  needing transportation state that the amount of
  paperwork and documentation is time consuming on
  a daily basis.
• Very few counties have staff devoted to
  transportation only. As a result, clerical
  staff, case workers, social workers, and others
  in the agency handle transportation, in addition
  to other duties.
• Overall lack of documentation to support
  transportation claim reimbursements
  inconsistency in the application of
  transportation policy statewide.

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Transportation Brokerage Program Will Provide

• Administrative oversight of non-emergency
  transportation services through a contract.
• Consistency in access to Medical transportation
  in all areas of the state.
• A higher level of accountability for
  transportation service providers.
• More effective and efficient system for Medicaid
  recipients to request non-emergency
  transportation services as Broker will be
  required to establish a call center with 24/7
  access.
• More detailed reporting of costs, number of
  unduplicated recipients served, methods of
  transportation utilized, average cost by type,
  etc.

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Transportation Brokerage Program Will Provide

• Ability to handle all non-emergency medical
  transportation, including medically necessary
  non-emergency ambulance transportation currently
  billed as a Medicaid covered service as well as
  transportation currently handled by the county
  departments of social services.
• Utilization of county/and DSS public
  transportation systems as well as private
  transportation providers currently available in
  local communities.
• Elimination of county share in administrative
  cost of non-emergency medical transportation.
• Projected cost savings in administration of
  medical transportation with statewide controls
  and policy administration.

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Other State Brokerage Programs Cost Savings

• Kentucky reduced transportation costs from 60M
  in 2002 to 43M in 2003.
• Oregons cost per ride dropped from 7.98 per
  ride to 6.20 per ride in the first year.
• Washington state reports that before the
  implementation of a brokerage system, the cost of
  a single trip averaged 30. The cost is now 17.
• Missouris brokerage program reduced costs from
  12 per trip to 7 per trip.
• Georgia saw costs cut in half during the first
  year of its brokerage program, and reports
  budget savings of 25M due to implementing a
  brokerage program.

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Concerns From Transportation Providers Regarding
Brokerage

• Decreased transportation provider income.
• Quality of service will decrease for the
  recipient.
• Transportation provider insurance costs will
  increase.
• Broker may not be located in state.
• Start-up issues experienced by other states going
  to brokerage.
• Lack of understanding of unique needs of
  recipients
• Will cause loss of funding source for
  transportation infrastructure in the county
  (non-Medicaid transportation)

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Benefits of Brokerage

• Brokerage is a single managed system for
  arrangement, oversight and payment of
  non-emergency medical transportation services.
• The brokerage system is the most accepted
  alternative model for managing non-emergency
  medical transportation services around the
  country.
• Brokerage provides a network of transportation
  providers that provide transportation services
  to Medicaid recipients who need access to medical
  care or services in an efficient and effective
  manner.

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Benefits of Brokerage

• Approximately 30 states have brokerage systems in
  place.
• Improves service delivery efficiency.
• Avoids service duplication by coordinating
  transportation services.
• Determines the least costly, most appropriate
  mode of transportation.
• Verification that transportation providers meet
  vehicle and driver standards.

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Comments and ConcernsDiscussion