Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination (2018)

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

9 The Code of Federal Regulations requires states to ensure that eligible, qualified Medicaid beneficiaries have NEMT to take them to and from medical providers. Non-emergency medical transportation (NEMT) services are sponsored by a number of agencies and organizations, but the largest NEMT program in the United States is funded by Medicaid. This handbook addresses Medicaid NEMT. Medicaid NEMT is an important benefit for Medicaid beneficiaries who need to get to and from medical services and have no other means of transportation. The Code of Federal Regula- tions requires states to ensure that eligible, qualified Medicaid beneficiaries have NEMT to take them to and from medical providers (1). Medicaid is the federal government’s largest program for human services transportation, with approximately $3 billion spent annually on NEMT for Medicaid beneficiaries (2). Throughout this handbook, Medicaid non-emergency medical transportation will be referenced as NEMT without the antecedent, Medicaid. Medicaid is jointly funded by the federal and state governments. Each state administers its own Medicaid program, consistent with federal regulations and guidelines (3). The Centers for Medicare and Medicaid Services (CMS), within the DHHS, oversees the Medicaid program for the federal government. The role of the state in administering the Medicaid program means there are significant state-to-state variations in program, policies, and operations, including NEMT. The variations reflect the flexibility that states have in designing Medicaid programs that meet each state’s policies (3). NEMT presents both opportunities and challenges for human services transportation providers and public transit agencies wishing to coordinate the passenger trips provided in various service areas. In recent years, numerous state Medicaid programs have separated NEMT from locally or regionally coordinated transportation systems by creating a statewide or regional NEMT brokerage. States often pursue the broker model for cost savings, fraud deterrence, or admin- istrative efficiency. Transportation coordination and mobility management professionals have expressed concerns about this trend, saying that it leads to less coordination of transportation resources and challenges for Medicaid beneficiaries who may be required to arrange travel with multiple transportation providers, depending on the purpose of each trip. Objectives This research was conducted to better understand what influences states to establish NEMT brokerages and the resulting impacts on customers, human services transportation, and public transportation. This handbook summarizes the research. There were three objectives for this research: • To describe the different models available to states for providing NEMT, • To use case study research to understand the effects of the different models for providing NEMT on access to Medicaid services and on coordination with other human services transportation and public transportation, and C H A P T E R 1 Introduction

10 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination • To identify opportunities to coordinate NEMT, human services transportation, and public transportation in the future. Audiences The audiences for this research include the following key stakeholders: • State-level officials responsible for relevant transportation programs, including NEMT, public transportation, and coordinated transportation services. • Regional and local transportation providers including human services transportation pro- viders and public transit agencies that currently provide or are interested in providing NEMT. • For-profit and not-for-profit brokers who qualify and authorize beneficiaries for trans- portation and then contract with transportation providers to perform the NEMT service. • Human services program managers who provide a range of services to Medicaid beneficiaries including sometimes serving as an NEMT broker. • Mobility managers who coordinate transportation resources in a community to assist individuals with arranging travel for various purposes, including for medical services. • MCOs responsible for an organized health care delivery system including transportation services. Although not a primary audience for the handbook, customers of NEMT services (Medicaid beneficiaries) are directly affected by the different models for providing NEMT and represent an important stakeholder for this research. Each of these stakeholders has different perspectives that are important to consider in study- ing the effects of the various models for providing NEMT. Understanding the differences in perspectives is fundamental to seeing opportunities to coordinate transportation programs and to achieve positive outcomes. Research Methodology Researchers used a variety of research methods to conduct this project: • Review of literature, regulations, and prior research. To understand NEMT, the researchers studied applicable laws and regulations, and reviewed literature and previous studies on the topic. • State survey. To determine how states are providing NEMT and the changes that have occurred in recent years, the researchers conducted a survey of the Medicaid agencies in all 50 states and the District of Columbia. • Case studies. The research team also conducted case study research, first by preparing mini case studies for 15 states using information from personal interviews, previous literature review, and Internet research. From the 15 mini case studies, the research team selected seven states for full case studies. These seven states represent a range of models for providing NEMT. The states selected for case studies are shown in Figure 1. The researchers visited each of the seven states to learn how NEMT is provided, the oppor- tunities and challenges faced by each of the states, and their experiences in coordinating NEMT with human services transportation and public transportation. The researchers interviewed stakeholders with different perspectives: state Medicaid agencies, state departments of trans- portation (DOTs), MCOs, customer advocacy groups, public transit agencies, human services program managers, nonprofit NEMT brokers, and for-profit NEMT brokers. The case study research provided the material to understand how states have revised their approaches to NEMT and what influenced those decisions. A summary for each of the seven

Introduction 11 case studies is provided in the appendix to this handbook. Effective practices and lessons learned from the case studies also contributed to the suggested strategies for coordinating NEMT, human services transportation, and public transportation. Purpose of This Handbook This handbook presents information about NEMT and the different models available to states for providing NEMT. This handbook also documents why human services transportation pro- viders and public transit agencies encourage coordination of transportation services. Using case study examples, this handbook discusses the effects of the different models for providing NEMT on: • Access to Medicaid services, • Coordination with human services transportation, and • Coordination with public transportation, NEMT, human services transportation, and public transportation have common desired outcomes—to improve health outcomes, to contribute to a better quality of service for customers, and to maximize transportation services delivered within available resources. This handbook presents strategies to coordinate transportation programs to contribute to the common desired outcomes. Figure 1. Case study states. This handbook documents why human services transportation providers and public transit agencies encourage coordination of transportation services.

12 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Organization of This Handbook The handbook includes the following information: • Chapter 1: Introduction introduces the subject of NEMT. • Chapter 2: Medicaid provides information on the Medicaid program in the United States and the impact of recent federal legislation. • Chapter 3: Non-Emergency Medical Transportation for Medicaid describes state options to provide NEMT and recent state trends. • Chapter 4: Coordination of Public Transportation with Human Services Transportation provides information about human services transportation, public transportation, and the opportunities and challenges to coordinate these transportation services with NEMT. • Chapter 5: Models for Providing Non-Emergency Medical Transportation examines how NEMT models have been applied in seven case study states and how the different NEMT models affect access to Medicaid services and coordination with human services transporta- tion and public transportation. • Chapter 6: Common Desired Outcomes discusses the nexus of desirable outcomes for NEMT, human services transportation, and public transportation. • Chapter 7: Strategies to Achieve Common Desired Outcomes identifies key opportunities and strategies to coordinate transportation services and move toward common desired outcomes. • Acronyms is a list of the acronyms and the full forms. • Glossary defines the key terms. • References documents works cited and other suggested references. • The appendix gives case study summaries to document how NEMT models have been applied in seven states. A companion volume, “State-by-State Profiles for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination,” presents NEMT profiles for all 50 states and the District of Columbia.