NonEmergency Transportation

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Non-Emergency Transportation

• Alabama Medicaid Agency
• April 2004

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Building A Bridge to Medical Care for Medicaid
Beneficiaries Without Transportation
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Overview of Need

• The Alabama Medicaid Agency recognizes the
  importance of transportation services in
  accessing medical care.
• We have examined the options available and
  established a plan for ensuring that
  transportation needs are met. In determining
  access we consider and act on these factors
• the existing transportation resources and
  infrastructure
• the rural/urban components of the state
• the ability of the county and local
  jurisdictions to play a role in developing,
  coordinating, implementing, or operating aspects
  of the transportation system
• the capacity of the state Department of
  Transportation (DOT) or other agencies to assist
  in developing alternatives
• the possible consequences of an inadequate
  non- emergency transportation (NET) program
• the outcomes desired by the agency that each
  Medicaid beneficiary with a transportation need
  will have access to their medical care.

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Administrative Expense or Medical Service Option?

• In order to claim federal matching funds, states
  may cover necessary transportation either as an
  administrative expense or a State Plan option
  of medical service, or under both categories.
• Alabamas NET program uses both categories. The
  majority of NET is operated as an administrative
  expense at a 50 federal match rate. (NET
  voucher program and Mental Health NET). However,
  NET ambulance transports are operated under the
  medical service match, billed fee for service,
  and administered by the Ambulance Program.

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Why the Administrative Match?

• More flexibility to design a program tailored to
  the diversity of the geographical nature of
  Alabama, transportation infrastructure and the
  beneficiary population.
• Less federal regulations than the Medical
  Services Option. NET is generally a small
  percentage of most state Medicaid programs. Costs
  associated with the medical services options such
  as independent assessment for waivers, etc.
  quickly drive up the costs of administering a NET
  program.
• Better value to taxpayers by including all the
  various types of transportation including gas
  vouchers for own car, free transportation,
  volunteer drivers, negotiated rate, rural and
  urban transportation authorities as well as the
  commercial and ambulance transporters.
• Better ability to control inappropriate or
  fraudulent provider billing as with other NET
  programs by utilizing a recipient voucher system
  of payment.

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Regional Coordinators-NET Voucher System

• Ten regional coordinators familiarize themselves
  with their area, learning of all the various free
  and fee transportation services.
• They establish relationships with local
  transporters, local medical and human service
  agencies and are valuable in coordinating service
  for clients. Some clients prefer to select their
  own transporter and other clients ask for total
  assistance in finding, scheduling and obtaining
  transportation.
• A directory contains all the various transport
  source information and is constantly updated when
  coordinators find new sources of transportation.
  
• By having these 10 coordinators placed throughout
  the state, we believe we are able to find the
  least expensive appropriate transportation best
  suited to the needs of our beneficiaries without
  compromising quality of service.

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Beneficiaries-NET Voucher System

• Beneficiaries contact NET state staff to request
  a voucher for non emergency transportation via an
  800 number at central office or directly to a
  coordinator office in the ten regions. (Does not
  apply to NET ambulance service or most Dept. of
  Mental Health transportation services).
• Beneficiaries are instructed to request
  transportation to their medical appointment at
  least 5 days before the ride is needed.
  Accommodation is available if the beneficiary is
  unable to do this. Beneficiaries who are
  receiving dialysis, chemo, or mental health
  services, etc. generally have other arrangements.
• Eligible beneficiaries include Medicaid eligibles
  that require transportation to access covered
  medical services and have no other means of
  transportation.
• A language line service is available for Limited
  English Proficiency speaking beneficiaries.
• Beneficiaries with an emergency, whose life is in
  danger, may call 911 for emergency transport.
• Recipients may request a voucher for urgent, but
  not emergency care, they received within 24 hours
  after the covered medical service was rendered.

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Requirements of TransportersNET Voucher System

• In order for a commercial transporter/motor
  carrier to be listed in our directory, and in
  order for our staff to make referrals to them or
  assist beneficiaries with obtaining
  transportation with them,
• we request that they submit verification of their
  license to operate a business. Businesses that
  operate within a local police jurisdiction are
  covered by the local County Commissioner, police,
  etc.
• Services that operate on a larger scale such as
  across county lines or statewide, must have
  registration through the Alabama Public Service
  Commission, Transportation Division.
• Ambulance providers are the only providers
  enrolled, however they are enrolled through our
  Emergency Transportation/Ambulance Program not
  the NET Voucher Program. All ambulance
  transporters must be licensed by the Alabama
  Department of Public Health. They must meet all
  the requirements for licensure by that
  Department.

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Scheduling and Payment for NET

• Scheduling appropriate transportation service is
  based upon factors such as clients physical,
  mental or medical condition whether the
  beneficiary is ambulatory or recumbent and the
  level of appropriate transportation required.
• Payment for the appropriate level of
  transportation is based upon such factors as
  mileage prevailing rates in the region
  availability of transportation resources and
  whether the beneficiary rides in
  own/family/friend car, commercial carrier, or
  ambulance transporter.
• A beneficiary voucher system is used to cover the
  cost of the transportation except for ambulance
  and most Mental Health Transports.

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Benefit to Beneficiaries

• From January 2003 through December 2003 (CY
  2003), beneficiaries received transportation
  assistance for over 368,000 round trips through
  the NET Voucher system. The NET Mental Health
  System provided 194,267 transport days.
• Because of the flexibility of the administrative
  expense option, coordinators were able to
  negotiate rates 5.00 (average roundtrip 3.70)
  for 151,305 of the 368,144 roundtrips saving the
  agency nearly 2.6 million dollars without
  compromising the beneficiaries access to
  appropriate transportation. Additionally, the
  Department of MH/MR provides a negotiated rate of
  9.00 per beneficiary per day on days
  transportation is needed.

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NET Ambulance

• Ambulance providers enroll with our fiscal agent
  EDS
• Providers must be certified for Medicare Title
  XVIII
• Providers must be licensed by the DPH
• Services 30 miles or greater and/or 5 trips or
  more are prior authorized
• Provider has 30 days after transport to request
  authorization
• Transports are billed fee for service
• Policy is found at Alabama Medicaid
  Administrative Code, Chapter 18.
• Provider Manual Chapter 8 covers requirements

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Department of Mental Health NET

• Many mental health patients require special
  assistance with transportation
• DMH/MR is the state agency that provides mental
  health services to Alabama citizens
• DMH/MR bills Medicaid and Medicaid reimburses
  DMH/MR monthly
• Medicaid pays DMH/MR a per eligible rate.
  Currently the rate is 9.00.
• Rate is based upon costs
• Rate covers all transportation needed in a day

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NET Voucher System, Costs50 Administrative Match

• FY 2003
• Personnel, benefits, travel, utilities and
  communication, supplies, materials and operating
  expenses 871,792.75
• Professional Services 124,286.84
• Benefits (vouchers) 6,765,709.69
• Total Administrative Costs 7,761,789.28
• (does not include NET ambulance or Department of
  Mental Health NET)

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NET Ambulance, CostsFFP match

• FY 2003
• Personnel, benefits, travel, utilities and
  communication, supplies, materials and operating
  expenses 9,984.00
• Cost to Process Claims 35,917.70
• Transportation Benefits
• (matched at FFP rate) 3,282,502.00
• Total Cost 3,328,403.70

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Mental Health NET, Costsbilled by the Department
of Mental Health50 administrative match

• FY 2003
• Transportation Benefits 1,748,403.00
• Administrative Costs 17,484.03
• Total 1,765,887.03

The established rate is 9.00 per day. In FY
2003, the Department of Mental Health provided
194,267 transportation days to Medicaid Mental
Health beneficiaries.
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What Did Alabama Spend on NET? Total NET
Costs-All Programsincludes personnel, overhead,
benefits, travel, utilities, communication,suppli
es, materials, operating expenses, costs to
process vouchers/ claims, and the transportation
benefit.

• FY 2003
• NET Voucher System 7,761,789.28
• NET Ambulance 3,328,403.70
• NET Mental Health 1,765,887.03
• Total NET Program 12,856,080.01