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

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81 Acronyms The acronyms are presented in sections. The first section reflects general acronyms used throughout the handbook. The following sections reflect acronyms specific to each state case study in Chapter 5 or in the Appendix. General ACA Patient Protection and Affordable Care Act of 2010 ADA Americans with Disabilities Act of 1990 BHP Basic Health Program CCAM Coordinating Council on Access and Mobility CFR Code of Federal Regulations CHIP Children’s Health Insurance Program CMS Centers for Medicare and Medicaid Services DHHS U.S. Department of Health and Human Services DOL U.S. Department of Labor DOT department of transportation DRA Deficit Reduction Act of 2005 FFS fee for service FMAP Federal Medical Assistance Percentage FPL Federal Poverty Level FY Fiscal Year GAO U.S. Government Accountability Office HUD U.S. Department of Housing and Urban Development JARC Job Access and Reverse Commute Program MCO managed care organization NEMT non-emergency medical transportation NTD National Transit Database PMPM per member per month TNC transportation network company USDA U.S. Department of Agriculture Florida AHCA Agency for Health Care Administration CTC Community Transportation Coordinator CTD Commission for the Transportation Disadvantaged JTA Jacksonville Transportation Authority TD transportation disadvantaged Acronyms and Glossary

82 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Massachusetts EOHHS Executive Office of Health and Human Services MART Montachusett Area Regional Transit PT-1 Prescription for Transportation RCC Regional Coordinating Council New Jersey DMAHS Division of Medical Assistance and Health Services IPRO Island Peer Review Organization, Inc. NJ TRANSIT New Jersey Transit Corporation North Carolina CTSP Community Transportation Services Plan DSS Department of Social Services HSTC Human Service Transportation Council OIG Office of Inspector General, U.S. Department of Health and Human Services TAB Transportation Advisory Board Oregon CCO Coordinated Care Organization LTD Lane Transit District OHA Oregon Health Authority OHP Oregon Health Plan RVTD Rogue Valley Transportation District TriMet Tri-County Metropolitan Transportation District of Oregon Pennsylvania CPTA Central Pennsylvania Transportation Authority (rabbittransit) MATP Medical Assistance Transportation Program YATA York Adams Transportation Authority Texas EPSDT Early and Periodic Screening, Diagnostic and Treatment FRB full-risk broker HHSC Health and Human Services Commission MTO managed transportation organization SDA service delivery area TSAP transportation service area provider Glossary Americans with Disabilities Act of 1990 (ADA) The Americans with Disabilities Act of 1990 was signed into law on July 26, 1990, by Presi- dent George H. W. Bush and amended with changes effective January 1, 2009. ADA gives civil rights protections to individuals with disabilities similar to those provided to individuals on the

Acronyms and Glossary 83 basis of race, sex, national origin, and religion. ADA guarantees equal opportunity for individuals with disabilities in employment, public accommodations, public transportation, state and local government services, and telecommunications. Broker State Medicaid agencies or MCOs may contract with third-party managers (brokers) to be responsible for arranging transportation for Medicaid-eligible beneficiaries to approved services. Brokers are responsible for all functions of NEMT, including verifying a recipient’s eligibility, determining the appropriateness of trips, and arranging the most efficient means of transportation. Brokers are also responsible for documentation and reporting beneficiary and trip data. Brokers execute contracts with public or private transportation providers that provide trips to eligible Medicaid beneficiaries under the supervision of the broker. A broker may operate statewide or within a region and the broker may be a full-risk broker or shared- risk broker. Capitation payment Formally defined, capitation is a flat periodic payment per enrollee to a health care provider; it is the sole reimbursement for providing services to a defined population. The word capitation is derived from the term per capita, which means per person. Generally, capitation payments are expressed as some dollar amount PMPM, where member means the enrollee in some managed care plan. Carving in NEMT services Carving in NEMT services means that NEMT is included in the responsibility of the health care provider. Carving out NEMT services Carving out NEMT services means that NEMT is not included in the responsibility of the health care provider. Centers for Medicare and Medicaid Services (CMS) Part of the DHHS, CMS administers Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. Children’s Health Insurance Program (CHIP) CHIP is a program administered by the DHHS that provides matching funds to states, specifi- cally for health insurance to families with children. Comparability Comparability is one of three federal requirements that participating state Medicaid plans must meet. Service must be furnished in the same amount, duration, and scope to all individuals in a group. See also statewideness and freedom of choice. Complementary paratransit or ADA paratransit FTA is responsible for regulations to implement ADA provisions for public transportation. FTA and ADA regulations require public transit agencies that provide local fixed-route transit service (bus and rail) to operate complementary paratransit service for people with disabilities who cannot use the fixed-route bus or rail service because of a disability. A public transit agency must ensure complementary paratransit service meets the following minimum service characteristics for the service to be equivalent to local fixed-route service: • Operate within a ¾-mile corridor of local fixed routes, around stations and transit centers. • Operate during the same days and hours as local fixed routes. • Serve requests for all trip purposes. • Charge a fare no more than twice the base non-discounted adult fare for fixed route.

84 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination • Operate without capacity constraints (e.g., untimely pickups, missed trips, excessive trip lengths, and excessive telephone hold times). • Accept a reservation at least a day in advance. Coordinated brokerage Under a coordinated brokerage, NEMT is coordinated with other regional or local human services transportation programs, often through a public transportation provider, human services agency, or other public or nonprofit organization acting as a regional broker or transportation coordinator. Coordinated brokerages can be established under a Section 1915(b) waiver or Section 1115 demonstration waiver. Coordinated care organization (CCO) A variation on the MCO model, CCOs are intended to improve health outcomes for Medicaid members by coordinating physical, mental, and dental care. See also managed care organization. Demand-response transportation Demand-response transportation is a form of public transportation characterized by flexible routing and scheduling of small to medium-size vehicles operating in shared-ride mode between pickup and drop-off locations according to passengers’ needs. Passengers call the transportation operator to make an advance reservation. The transportation operator then dispatches a vehicle and driver to pick up the passengers and take them to their destinations. Fee for service (FFS) Fee for service is a method for payment based on the specific service rendered to a spe- cific beneficiary. Under an FFS model, payment for transportation services is made directly to the transportation provider, or payment for mileage reimbursement is made directly to the Medicaid beneficiary. These transactions are based on a predetermined FFS rate. Under most FFS models, a state, county, or local government agency is responsible for administer- ing NEMT. Fixed-route transit Fixed-route transit is a form of public transportation characterized by set routing and scheduled stop times and locations, typically with large, high-capacity vehicles, including buses, trains, and streetcars. Fixing America’s Surface Transportation Act (FAST Act) The FAST Act is the current federal funding and authorization bill governing U.S. surface transportation programs. The FAST Act was signed into law on December 4, 2015. The act authorizes the surface transportation programs of the U.S. Department of Transportation for federal fiscal years 2016 through 2020. Flexible-route transit Flexible-route transit is a variation on fixed routes. For flexible routes, sometimes referred to as deviated fixed routes, buses operate along a fixed route but deviate from the route to go to a specific location to pick up or drop off a transit rider. This may include traveling to residences, employment locations, schools, and shopping areas. Freedom of choice Freedom of choice is one of three federal requirements that participating state Medicaid plans must meet. Freedom of choice is a requirement to make available to eligible recipients a choice of qualified providers. See also statewideness and comparability. Full-risk broker Under a full-risk broker arrangement, brokers operate for a specified capitated payment regardless of the amount of service provided. The full-risk broker takes the risk that the

Acronyms and Glossary 85 contractual rate agreement will cover all costs. Full-risk brokers carry the financial and oper- ating risk. Health care Health care encompasses all aspects of clinical work including medications, rehabilitation, preventive measures, physical therapy, nursing homes, and medical supplies—just about anything that assists in helping people to be healthy. Health care also includes what you do for yourself, such as diet, exercise, and lifestyle. Health Insurance Portability and Accountability Act (HIPAA) HIPAA is the federal statute governing transmission of medical information between providers of medical services and payers, Public Law 104-191, 42 U.S.C. Section 1320d through Section 1320d-8. Associated federal regulations are codified in 45 CFR Parts 160, 162, and 164. Human services transportation Human services transportation is transportation programs or services geared toward under- served populations, including veterans, seniors, people with disabilities, and individuals and families with low incomes. Medicaid non-emergency medical transportation is included in some state definitions of human services transportation. Managed care Managed care is a comprehensive approach to the provision of health care that combines clinical, preventive, restorative, and emergency services, in addition to administrative proce- dures within an integrated and coordinated system. Managed care aims to provide timely access to primary care and other medically necessary health care services in a cost-effective manner. See also managed care organization. Managed care organization (MCO) An MCO is an entity that administers a managed care health plan. Within the context of Medicaid, an MCO contracts with a state Medicaid agency to administer Medicaid health benefits and services under a managed care model. Medicaid Medicaid is the joint federal and state program that provides health coverage for individuals and families with limited incomes and resources, and was established by Title XIX of the Social Security Act in 1965. Medicaid beneficiary or beneficiary A Medicaid beneficiary is an individual eligible for Medicaid who has applied for and has been granted Medicaid benefits by the state Medicaid office or local administrators. Medicaid eligible A Medicaid eligible individual is one who is eligible to receive services under a state’s Medicaid program. Medical care Medical care is concerned with illnesses and cures for illnesses. Medical care pertains to doctors and nurses who are certified, licensed, and skilled, in particular to perform some specific medical functions. Medicare Medicare is the federal health insurance program for people ages 65 and over and people with permanent disabilities, regardless of income, authorized by Title XVIII of the Social Security Act.

86 Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination Mobility management Mobility management is services that include a number of roles and functions aimed at help- ing individuals find the most appropriate transportation for their needs. Moving Ahead for Progress in the 21st Century Act (MAP-21) MAP-21 is the 2012 funding and authorization bill to govern U.S. federal surface transportation spending. The act authorized the surface transportation programs of the U.S. DOT for federal fiscal years 2013 through 2015. Patient Protection and Affordable Care Act of 2010 (ACA) Two separate pieces of legislation—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010—made changes to both Medicaid and the Children’s Health Insurance Program, and expanded Medicaid coverage to millions of low-income Americans. The Affordable Care Act added an estimated 20 to 25 million formerly uninsured adults to the Medicaid rolls, many of whom have unique transportation needs that were unforeseen 50 years ago. Ridesourcing Ridesourcing is a type of transportation that provides a vehicle for hire on demand from a pool of private passenger vehicles. Passengers source rides through a smartphone app. These vehicles are typically driven by non-professional drivers who use their own personal vehicles for ridesourcing activities. Ridesourcing companies are sometimes called TNCs or ride-hailing services. Safe, Accountable, Flexible, Efficient Transportation Equity Act—A Legacy for Users (SAFETEA-LU) SAFETEA-LU is the 2005 funding and authorization bill for U.S. federal surface transportation spending. The act authorized the surface transportation programs of the U.S. DOT for federal fiscal years 2006 through 2012. Section 1115 demonstration waiver Section 1115 of the Social Security Act gives states the ability to test demonstration projects that fulfill the objectives of the Medicaid program. This authority, provided through a Section 1115 demonstration waiver, allows states to implement major changes to their Medicaid programs such as coordinated care or accountable care models. Under Section 1115 demonstration waivers, non-emergency medical transportation programs can also implement major changes. Section 1902(a)(70) state plan amendment The Deficit Reduction Act of 2005 allows states to establish transportation brokerages by amending their state management plan. This authority is codified under Section 1902(a)(70) of the Social Security Act and is therefore referred to as a Section 1902(a)(70) state plan amendment. Section 1915(b) waiver Section 1902 of the Social Security Act stipulates that states may not restrict a recipient’s freedom to choose a provider for eligible Medicaid services so long as that provider is qualified. However, under Section 1915(b), states may waive this requirement. These so-called freedom- of-choice waivers allow states to assign recipients to designated transportation pro viders, estab- lish brokerages, or restrict the delivery of non-emergency medical transportation in other ways. Shared-risk broker Brokers that do not assume all the risks of operating at a fixed rate for a specific period are known as shared-risk brokers. Payments are more directly tied to actual costs. If the anticipated costs are either less than or greater than anticipated, adjustments in the rate of pay occur.

Acronyms and Glossary 87 State Medicaid plan By default, each state’s Medicaid plan assures access to covered Medicaid benefits on a fee- for-service basis. Under this authority, non-emergency medical transportation is administered as either a medical or administrative service according to the terms of the state Medicaid plan. Statewideness Statewideness is one of three federal requirements that participating state Medicaid plans must meet. Service must be available in all political subdivisions of the state (referred to as state- wideness in Medicaid policy). See also comparability and freedom of choice. Transportation network companies (TNCs) TNCs arrange one-time shared rides on demand, usually arranged through a smartphone app. The type of transportation provided by a TNC is also known as ridesourcing or ride-hailing services.