Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination (2018) / Chapter Skim
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A-1 This appendix provides seven state case study summaries. The purpose of the case study research was to document the effects of different models for providing non-emergency medical transportation (NEMT)
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A-2 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Key Data Source Demographic Features • State Population (2015)
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State Case Study Summaries A-3 NEMT Description Change from county-based coordinated transportation. Prior to 2014, the Florida Agency for Health Care Administration (AHCA)
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A-4 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination The CTC in each of 67 Florida counties provides transportation services for those who are eligible for the Transportation Disadvantaged Program and have no other access to transportation. Transportation Disadvantaged Trust Fund The Florida Legislature established the Transportation Disadvantaged (TD)
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State Case Study Summaries A-5 Medicaid beneficiaries who were not participating in managed care as of May 2014 continued to receive NEMT through Florida's CTD. In February 2015, CTD transitioned NEMT recipients to one of the brokers, concluding CTD involvement in NEMT.
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A-6 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination demonstration pilot program for managed care in 2006. Other than the fare for ADA paratransit, JTA received no reimbursement or shared costs from the broker or the MCO.
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State Case Study Summaries A-7 References for the Florida Case Study Commission for the Transportation Disadvantaged. An Introduction to Florida's Coordinated Transportation System.
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A-8 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination NEMT Description NEMT as a coordinated transportation program. In Massachusetts, the state Medicaid agency is MassHealth, a part of the Executive Office of Health and Human Services (EOHHS)
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State Case Study Summaries A-9 adequate funding of approved transportation services, as well as reimbursing the brokers for consumer trip costs. For example, MassHealth provides oversight for NEMT services, including determining eligibility for Medicaid beneficiaries and providing funding for authorized transportation to medical services.
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A-10 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination • Program-based: Transportation is authorized by the funding agency for a specific destination, frequency, and time, usually operating on a regularly scheduled basis. This type of transportation is used for daily travel to rehabilitation or developmental programs.
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State Case Study Summaries A-11 • Demand for MassHealth PT-1 increased 66 percent from 2.1 million trips in FY 2009 to 3.5 million trips in FY 2015. Cost for MassHealth PT-1 increased 71 percent from $37.1 million in FY 2009 to $63.4 million in FY 2015.
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A-12 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination in FY 2009 to $0.87 per trip in FY 2014. Human services transportation increased the broker management fee to $1.00 per trip (23 percent)
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State Case Study Summaries A-13 Statewide and Regional Coordinating Councils. Executive Order 530 (EO530)
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A-14 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination seven case studies, Massachusetts reported the second lowest average cost per NEMT passenger trip. • Coordination with human services transportation: – The Human Service Transportation Office sets consistent service standards and monitors service quality for coordinated transportation services.
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State Case Study Summaries A-15 Human Service Transportation Office, Executive Office of Health and Human Services. FY2013 Annual Report.
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A-16 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination broker with capitated payment. The current statewide broker is a private company operating similar services nationally.
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State Case Study Summaries A-17 Public Transportation and Community Transportation in New Jersey The New Jersey Transit Corporation (NJ TRANSIT) is a public transportation corporation providing service throughout the state of New Jersey and connecting to New York City and Philadelphia.
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A-18 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Positive Results of the Change to a Statewide Broker. According to DMAHS, the following improvements have occurred since the change to a statewide broker: • Improved cost control.
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State Case Study Summaries A-19 • Drivers are not familiar with the service area. Drivers do not know local routes or destinations, leading to late pickups and drop-offs or excessive travel times.
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A-20 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination 23.5 percent of NEMT trips. In some counties, the broker has successfully negotiated the purchase of bulk tickets and passes at fare rates for NJ TRANSIT fixed-route bus, light rail, and commuter rail services.
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State Case Study Summaries A-21 – The broker has negotiated per trip reimbursement rates with some public transportation providers for demand-response NEMT. Several public transportation providers are satisfied with the rates; others say the rates do not cover the cost to provide the service.
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A-22 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination NEMT Description NEMT is part of community transportation. The North Carolina Department of Health and Human Services (NCDHHS)
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State Case Study Summaries A-23 • Early collaboration. Coordinated transportation services date back to 1975 and the earliest days of federal funding for transportation for seniors and people with disabilities, now the FTA Section 5310 program.
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A-24 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination to establish a Transportation Advisory Board (TAB) to guide the community transportation program and recommend the CTSP.
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State Case Study Summaries A-25 Estimating the Costs of NEMT NCDHHS documented total NEMT expenditures 2007 through 2012 in a report to the North Carolina General Assembly in October 2012. The expenses and annual NEMT recipients are summarized in Table A-7.
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A-26 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Cost Allocation Methodology. The methodology was a variation on the fully allocated cost analysis, prepared for the U.S.
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State Case Study Summaries A-27 titled Non-Emergency Medical Transportation Services Management Report to the Joint Legislative Oversight Committee on Health and Human Services and the Joint Legislative Oversight Committee on Transportation in October 2012. NCDHHS solicited proposals from NEMT brokers in the fall 2012.
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A-28 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination – Some DSSs lacked required supporting documentation to support the services claimed or to verify that the NEMT service provider transported the beneficiary to a location where the individual received a Medicaid-covered service. • DSSs did not meet safety and risk management policy requirements by ensuring that transportation contracts contained guarantees that all contractors would meet safety, liability, and other program requirements.
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State Case Study Summaries A-29 NEMT contributed the following benefits to the community transportation system: (a) increased operating efficiencies for shared-ride demand-response transportation services, and (b)
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A-30 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Garrity, R An Overview of North Carolina's Community Transportation System: An Examination of the Effectiveness of the Organizational Model in Today's NEMT Brokerage Environment.
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State Case Study Summaries A-31 involves consolidation of health-supportive services under the umbrella of a coordinated care organization (CCO)
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A-32 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination and person-centered care. CCOs have flexibility within their budgets to provide services with the goal of meeting the Triple Aim of better health, better care, and lower costs for the population they serve.
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State Case Study Summaries A-33 CCO Brokers. Statewide, 12 CCO NEMT brokers were active as of November 2015, as listed in Table A-9.
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A-34 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination The case study information is based on interviews with stakeholders from OHA, ODOT, CCOs, NEMT brokers, transportation providers, public transit agencies, and customer advocates. The purpose of the interviews was to hear different perspectives and learn from diverse experiences.
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State Case Study Summaries A-35 longer provided technical support for the Oregon Brokerage Scheduling System used by other brokers in Oregon. Following the transition of NEMT services to CCOs, OHA contracted with a private company, First Transit, Inc., to provide broker services for the small percent of Medicaid enrollees in the OHP FFS program in Clackamas, Multnomah, Washington, and Yamhill Counties.
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A-36 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Lane County The population of Lane County, Oregon, is estimated as 362,900 in 2015. Eugene is the urbanized area in Lane County with a population about 260,000.
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State Case Study Summaries A-37 demand. RideSource also now provides mileage reimbursement to CCO members.
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A-38 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination access data, financial data, and progress toward reaching benchmarks. Key elements of Oregon's health system transformation include: • Using best practices to manage and coordinate care.
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State Case Study Summaries A-39 rides, arriving late for pick-up leading to late or missed appointments, and lack of communication, creating barriers to receiving care. • Timeliness.
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A-40 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination information under privacy provisions of the Health Insurance Portability and Accountability Act. CCO relationships with medical providers have also helped to schedule more efficiently medical trips to dialysis centers and substance abuse treatment clinics.
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State Case Study Summaries A-41 includes Portland. TriMet worked in collaboration with ODHS and ODOT to coordinate public transit ADA paratransit and NEMT beginning in 1994.
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A-42 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination � In southern Oregon, the multiple CCOs and introduction of new NEMT brokers create challenges for coordination. Because not all CCOs elected to continue with the established regional community broker (TransLink)
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State Case Study Summaries A-43 Owens, J., Marshall, N., Mayfield, D., Landsman, C., and Larson, C Transportation-Human Services Coordination Study.
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A-44 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination for eligible Medicaid beneficiaries to approved medical services using fixed-route public transportation, mileage reimbursement, or local transportation providers for shared-ride transportation. Each county is reimbursed for costs either directly or indirectly related to MATP transportation.
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State Case Study Summaries A-45 seniors, individuals with disabilities, and people with lower incomes who cannot afford private transportation. Often, these individuals live in rural communities with limited or no public transportation, further restricting options for mobility.
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A-46 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination 2. Regional pilot.
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State Case Study Summaries A-47 the county goes back to 1983 when Wheels, Inc., a nonprofit transportation provider, served as the MATP broker for Philadelphia County. At that time, Wheels was already coordinating paratransit services for the Southeastern Pennsylvania Transportation Authority, Philadelphia's public transit agency.
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A-48 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination counties in south-central Pennsylvania asked to examine the potential benefits of an integrated regional transportation authority providing both fixed-route and shared-ride services. Act 89 further supported the establishment of regional transit operations by providing incentives for local municipalities to pursue such regionalization.
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State Case Study Summaries A-49 Customer and health care provider satisfaction. The most recent documentation of customer satisfaction was reported by the Pennsylvania Department of Public Welfare (now PA-DHS)
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A-50 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination MATP coordinator or a local transportation provider may be the public transportation agency for the county. For example, CPTA (rabbittransit)
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State Case Study Summaries A-51 – Transportation service should be easy to use; however, the unique attributes of each county's human services transportation and the complexities of the various programs may make it difficult for local human services agencies and consumers to understand. – In case study research, discussions with health care providers and patient advocates revealed that these stakeholders want MATP to be held to higher standards of performance (than other shared-ride human services transportation programs)
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A-52 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Pennsylvania General Assembly, Legislative Budget & Finance Committee. A Performance Audit of Pennsylvania's Medical Assistance Transportation Program for Methadone Maintenance.
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State Case Study Summaries A-53 and arranged other transportation services (e.g., call center operations, mileage reimbursement to individuals, payments for meals and lodging, and airline travel)
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A-54 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination 2009 The 81st Texas Legislature included Rider 55 to the Appropriations Act to implement a regionalized FRB using a pre-payment methodology (capitation) to reimburse the broker or brokers.
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State Case Study Summaries A-55 available for persons from birth through 20 years of age. These obligations include, among others, the requirement to meet stricter call center standards for NEMT.
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A-56 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination • Attempt to contract with providers that are considered significant traditional providers, meet the minimum quality and efficiency measures determined by HHSC, and agree to accept the prevailing contract rate of the MTO (HHSC sets the contract rate)
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State Case Study Summaries A-57 terminated the agreement with the broker in Region 4 in November 2015. HHSC now manages NEMT in Region 4 in house on an FFS basis.
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A-58 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination condition and driver qualifications and training for each NEMT demand-response transportation provider. These requirements mean that brokered transportation services are required to meet at least a minimum standard of safety that is comparable for all public, nonprofit, and private transportation providers.
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State Case Study Summaries A-59 human services transportation and public transportation. House Bill 3588 created Chapter 461 of the Texas Transportation Code, titled Statewide Coordination of Public Transportation.
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A-60 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination may own, operate, and maintain a fleet of vehicles or contract with an entity that owns, operates, and maintains a fleet of vehicles. Two MTO brokers own and operate a fleet of vehicles and are approved to provide transportation services under a Section 1915(b)
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State Case Study Summaries A-61 MTO model resulted in an increase in trips on complementary ADA paratransit. The transit authorities reported that demand for paratransit increased over the time reviewed.
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A-62 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination – NEMT clients do not have the ability to arrange transportation for multiple trip purposes with one call, one click. • Coordination with public transportation: – Rural transit districts reported data show that NEMT ridership and revenues have decreased 41 percent from 2014 to 2016 after the change to regional brokers.
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State Case Study Summaries A-63 State Case Study and Models for NEMT Effects on Access to Medicaid Services Florida Change to managed care with carved-in NEMT • The change to managed care with carved-in NEMT has enabled private brokers to increase NEMT coverage across multiple regions. • From the perspective of the state Medicaid agency, the change to managed care has curtailed the increase in the costs of Medicaid.
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A-64 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination State Case Study and Models for NEMT Effects on Coordination with Human Services Transportation Florida Change to managed care with carved-in NEMT • CTD reports a decline in coordination of NEMT trips with other transportation services since the change to managed care. • The CTCs report higher per passenger trip costs with fewer NEMT shared rides.
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State Case Study Summaries A-65 Table A-17. Effects on coordination with public transportation.
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