Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination (2018) / Chapter Skim
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Pages 23-34
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23 The assurance of transportation to necessary medical care is an important feature that sets Medicaid apart from traditional health insurance. This chapter describes how the Deficit Reduction Act of 2005 (DRA)
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24 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Lack of Transportation Can Affect Health Outcomes Interviews with research and advocacy groups confirm that the lack of transportation for Medicaid beneficiaries can impede their ability to access medical services, particularly for individuals living in rural or medically underserved areas, as well as those with chronic health conditions (21)
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Non-Emergency Medical Transportation for Medicaid 25 • The NEMT trip is authorized in advance by the appropriate agency or broker. • The NEMT trip is to the nearest qualified medical provider as authorized by Medicaid.
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26 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination program regardless of the statutory requirements for statewideness, comparability, and freedom of choice (26)
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Non-Emergency Medical Transportation for Medicaid 27 state plan amendment to obtain authority to provide NEMT as a medical service through a broker (28)
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28 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination • Lowest cost. The governmental broker must document that its service (or the service contracted to another governmental entity)
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Non-Emergency Medical Transportation for Medicaid 29 DRA Provision DRA Impacts NEMT in the Following Ways: NEMT brokerage A state Medicaid agency can establish an NEMT brokerage through a Section 1902(a)
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30 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination What Are the Models for Providing NEMT? After examining the different models to provide NEMT in the 50 states and the District of Columbia, the research team identified the following principal NEMT models: • In-house management, • Brokers, – Statewide broker and – Regional broker • MCOs, and • Mixed NEMT models.
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Non-Emergency Medical Transportation for Medicaid 31 Statewide Broker Under a statewide broker NEMT model, the broker manages service statewide, centralizing call centers, eligibility determination, and trip authorization. Statewide brokers are typically for-profit, national brokers.
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32 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination payment adjustments occur. Shared risk is less predictable and may lead to unanticipated, increased costs to the state Medicaid agency; however, the transportation provider has an opportunity to document and request a payment adjustment based on actual cost.
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Non-Emergency Medical Transportation for Medicaid 33 • Reduce fraud and abuse (19 percent) , • Other (10 percent)
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34 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Summary More than any other legislation, including the ACA, the DRA has influenced how states have decided to deliver NEMT services. The DRA amended the Social Security Act by adding a new section that provides states the flexibility to establish an NEMT brokerage program.
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