Wednesday, 24 February 2016

Increasing need for non-emergency medical transportation - How is the state handling it?

The increased need for non-emergency medical transportation has led the state to devise new strategies to handle the demand more effectively. The governments in different states are organizing medical trips with other transportation providers who aim at serving similar individuals.

Several private and public agencies have been set up to administer or refer clients to human service transportation programs. They receive funds from different places; each resource comes with its own set of restrictions and rules. The accountability and eligibility standards, operating procedures, vehicle needs, routes and similar factors vary greatly across different organizations.

The greatest challenge for the state is to curb improper utilization of resources, customer inconvenience, varying safety standards, and insufficient transportation service due to the big number, dispersion and diversity of coordinated transportation programs. Fortunately, development in coordination and mobility management technology has helped in maximizing resources by managing eligibility standards and shared rides with several funding sources.

Non-Emergency Transportation: Delivery Options

After passing the DRA or Deficit Reduction Act of 2005, states have been given more choices to deliver NEMT. The DRA allows flexibility to states in how they deliver non-emergency medical transportation, without having to put together a troublesome administrative waiver process. However, all states have to submit a plan to the Centers for medicaid and medicare services (CMS) explaining thoroughly how they intend to provide NEMT services and how it shall be reimbursed—as either a medical cost or an administrative cost.

Requirements for non-emergency medical transportation under Medicaid regulations:


  • Provided with reasonable timeliness to every eligible citizen.
  • Provided to every single individual in the same duration, amount, and scope.
  • Citizen should be given the “freedom of choice” to choose their transportation provider.

Modes of delivering the service:

Following the Deficit Reduction Act of 2005, a lot of states chose to put in place a brokerage system, where either a state agency or a private company connects citizens with transportation providers in the most cost-effective and efficient way.

Public Brokerage

Some of the states in the country broker rides for citizens through state agencies. This does offer a unique challenge because if a public agency is brokering a ride using a public transportation entity, there are obstacles to providing the service.

Private Brokerage

States delivering non-emergency medical transportation through a private brokerage make use of a bidding process to acquire a private for-profit agency/business to work as an intermediate between eligible riders and transportation providers. States normally pay capitated payments to the intermediary for every eligible rider. This form of brokerage is actually the most popular as it offers financial certainty that the state only pays a set amount to the agency each year, rather than facing uncertain costs from using their own brokerage.

In some of the states that have thinly populated rural areas and concentrated urban regions, a mix of fee for service and brokered services models are used.

Conclusion

The state is continually looking for new technologies and NEMT programs to cost-effectively provide non-medical transportation services to attain better health outcomes.