Transit Agency Participation in Medicaid Transportation Programs (2006) / Chapter Skim
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Pages 10-21
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From page 10... ...
Survey questions explored the working relationship of the state agencies. In all but one of the states that responded to the survey, the coordination of transportation services between NEMT and public transit has been discussed and is encouraged at the state level.
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Separate services in Baltimore. There are regularly scheduled meetings of the Maryland Coordinating Committee for Human Services Transportation.
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There are regularly scheduled meetings between the DOT, state Medicaid agency, and Vermont Public Transit Association (the program administrator)
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standards for service for NEMT providers as compared with public transit providers, the survey asked the Medicaid state program managers to indicate if they had standards and, if so, to describe them. The results indicated that in about half of the responding states there are statemandated standards in place with regard to driver training, driver qualification, vehicles, and, in some cases, insurance levels.
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Michigan Administrative Local brokerages, locally arranged contracts with private and public transportation providers, and public fixed-route transit. State level staff and local level staff The Michigan Medicaid Program has an intradepartmental agreement with the Michigan Department of Human Services (MDHS)
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State and local staff State level staff and upper management Legislature Designated regional broker determines the best approach for NEMT using the least expensive appropriate mode. The regional brokers and their contractors determine eligibility.
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Services are monitored through annual customer surveys, field monitoring, and the quarterly submission of complaint logs. Michigan Local Contractually required service standards are left to the discretion of the local Michigan Department of Human Services offices.
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Other financial concerns listed included the business decision of whether the reimbursement rate is too low for Medicaid trips and would cause transit agencies to lose money by subsidizing the trip. In cases where a third-party administrator State State or Local Monitoring Contractually Required Service Standards How Are Services Monitored?
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• There are jurisdictional issues for small urban transit providers who operate in towns where there are not major medical facilities -- the small fixed-route providers are not always able to travel out of their service area. Financial Issues • The state's billing and reimbursement mechanism requires expensive software customization, contractual services for electronic eligibility verifications, fulltime monitoring, and the payment for services is not always processed in a timely manner.
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This cost shifting has led to transit vehicle capacity problems, especially for rural transit providers. • Medicaid limits eligibility to those with no other means of transportation.
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Operational Barriers One transit agency reported that the provision of NEMT can cause significant disruption to all facets of an established ADA paratransit agency for a number of reasons, including the intake process, the billing system, the customer service staffing, the no-shows and cancellations, and the database maintenance. It was also reported in one state that NEMT has a 30-min will-call/return pick-up requirement that requires that transit providers have their drivers wait with the client, rather than using the driver's time more productively by undertaking trips for other programs or by taking other NEMT trips to different destinations.
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From page 21... ...
Confidentially of records is also a potential barrier, because public transit agencies may not be equipped to keep the medical information necessary to provide the trip as confidential. One survey respondent indicated that the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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