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MEDICAID TRANSPORTATION

MEDICAID TRANSPORTATION. December 2011. ANNOUNCEMENTS. Introductions Housekeeping Purpose of Training. DIRECTIVES. 42 CFR 431.53 requires that states provide necessary transportation (if no other resources available) NC Medicaid policy – transport must be:

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MEDICAID TRANSPORTATION

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  1. MEDICAIDTRANSPORTATION December 2011

  2. ANNOUNCEMENTS • Introductions • Housekeeping • Purpose of Training

  3. DIRECTIVES • 42 CFR 431.53 • requires that states provide necessary transportation (if no other resources available) • NC Medicaid policy – transport must be: • by the least expensive mode appropriate • to the nearest appropriate medical provider • to a Medicaid-covered service provided by an enrolled NC Medicaid provider 3

  4. WHY THE CHANGES • 2007 Quality Assurance Audit Findings • 9.89% error rate • By far, the top error was “no evidence that a medical service was received on the date of transport” • Others included transport to non-covered service, individuals not eligible for Medicaid transportation, reimbursement claimed for no-shows 4

  5. WHY THE CHANGES? • Recent DMA Quality Assurance Transportation Record Review Error Trends (Record Sample March 2008) • Not transported to Medicaid covered service • Not receiving Medicaid • No assessment completed • No notice • No evidence of vehicle insurance 5

  6. WHY THE CHANGES? • 2008 CMS Compliance Review • DMA cited for not conducting adequate oversight of the NEMT program • Resulted in corrective action plan 6

  7. OVERVIEW OF MEDICAIDTRANSPORTATION PROCESS • Assistance with NEMT is available to specified Medicaid recipients who are unable to arrange/provide their own transportation • Prior to receiving assistance, an assessment must be completed to ascertain the transportation resources and needs of the recipient 7

  8. OVERVIEW OF MEDICAIDTRANSPORTATION PROCESS • The DSS (or its agent) completes the assessment and determines the need. This includes evaluation of: • Recipient’s resources and whether NEMT assistance is needed • Nearest appropriate provider(s) • Least expensive means appropriate • Medicaid covered services 8

  9. OVERVIEW OF MEDICAIDTRANSPORTATION PROCESS • The recipient is notified of the outcome of the assessment. • The DSS (or its agent) then arranges and/or provides transportation as needed, assuming that services were approved. 9

  10. OVERVIEW OF MEDICAIDTRANSPORTATION PROCESS • The recipient contacts the DSS (or its agent) for each needed trip and all authorized trips are logged by the DSS (or its agent) • Subsequent assessments must be completed at each Medicaid certification period and when changes are reported • For SSI recipients, subsequent assessments must be completed every 12 months and when changes are reported 10

  11. OVERVIEW OF MEDICAIDTRANSPORTATION PROCESS • DSS transmits information regarding approved trips to the Transportation provider • Transportation providers must submit invoices to the DSS (or its agent) • Invoices must be compared to the transportation log to ensure that all billed trips were authorized • The DSS pays the providers and requests reimbursement from the state for costs related to NEMT. 11

  12. OLD DSS was required to maintain a list of available transportation resources NEW DSS is required to establish and maintain a list of all transportation resources, including free and other community resources, with related costs indicated for use in determining least expensive means POLICY CHANGES FOR January 2012 12

  13. OLD Policy did not stipulate that a separate transportation file be maintained NEW County must maintain a transportation file which includes: DMA-5046 Notice of Rights DMA-5047 Assessment DMA-5048 Exception Form Prior approval notices/documentation All notices POLICY CHANGES FOR January 2012 13

  14. OLD DSS director assigned responsibility for Medicaid transportation NEW DSS Director is required to designate a Transportation Coordinator (contact person), supply contact information to DMA, and report changes POLICY CHANGES FOR January 2012 14

  15. OLD County was not required to verify that a Medicaid covered service was received on date of transport NEW County must verify that a Medicaid covered service was received on the date of transport using the DMA-5118, a phone call to the provider, or other documentation POLICY CHANGES FOR January 2012 15

  16. OLD Policy recommended that each county self-audit by pulling a sample of trips to ensure compliance (nearest appropriate, Medicaid service, Medicaid recipient) NEW County must randomly review 3% of trips per month to ensure compliance (nearest appropriate, Medicaid service, Medicaid recipient) POLICY CHANGES FOR January 2012 16

  17. OLD DMA-2056 (Transportation Log) was contained on one written page; included date, recipient, MID, MA eligible, covered service, destination, number of trips, type and cost NEW DMA-2056 (Transportation Log) is Excel spreadsheet, containing much more information, including billing codes that correspond to type of expense POLICY CHANGES FOR January 2012 17

  18. OLD DSS reported total transportation costs on DMA-2055 (Reimbursement Request Form) NEW DSS must report numbers of unduplicated recipients, trips*, and costs by procedure code on DMA-2055 POLICY CHANGES FOR January 2012 18

  19. *Trip – One way trip is transportation of a recipient either to a medical service or from a medical service. Each leg of the trip is a one way trip, regardless of number of destinations. 19

  20. OLD No requirement for telephone availability during non-working hours NEW DSS must provide 24-hour answering machine or other message-taking device for transportation requests/cancellations POLICY CHANGES FOR January 2012 20

  21. OLD Written notification was required for all approved trips NEW Notices are required at assessment. Trips may be approved verbally. POLICY CHANGES FOR January 2012 21

  22. OLD Policy was not specific regarding logging and notification requirements for denials NEW All requests must be logged AND Written notification is required for all denials of requests from Medicaid recipients in all categories POLICY CHANGES FOR January 2012 22

  23. OLD DMA-5024 (Transportation Request Notification) was the only notice NEW DMA-5024 has become the Transportation Assessment Notification and must be accompanied by reminders of transportation request policy, no-show and conduct policies POLICY CHANGES FOR January 2012 23

  24. OLD Each county had its own advance notice requirements for requesting trips NEW No more than 3 business days can be required for in-county trips and 5 business days for out-of-county trips Urgent requests are exempt POLICY CHANGES FOR January 2012 24

  25. OLD Each county had its own no-show policy NEW Uniform No-show policy must be followed POLICY CHANGES FOR January 2012 25

  26. OLD Transportation could be approved by individual trip, series of appointments or blanket approval NEW Trips must only be approved individually or for series of appointments with the same provider (No more blanket approvals) POLICY CHANGES FOR January 2012 26

  27. OLD Mileage reimbursement rate limited to current state/county reimbursement rates NEW Mileage reimbursement rate to the recipient/FRP cannot exceed one-half of the current IRS business rate. Mileage reimbursement rate to non-recipient/non-FRP drivers cannot exceed the current IRS business rate POLICY CHANGES FOR January 2012 27

  28. OLD Policy required that, during the assessment, client’s ability to pay for his own transportation be evaluated NEW Policy no longer requires this evaluation. Accept the client’s statement that he is unable to pay for his own transportation POLICY CHANGES FOR January 2012 28

  29. NEW REQUIREMENTS • Provider logs • Background checks • Medicaid/Medicare exclusions • Contract requirements • County files for other drivers 29

  30. Provider Logs • If the county contracts with a transportation vendor, the vendor must be required to maintain its own transportation log. • The county must review and compare the contractor’s log to the DMA-2056 (Title XIX Medicaid Transportation Log) to ensure an accurate count of trips. 30

  31. BACKGROUND CHECKS The county and its vendors shall perform criminal background checks on all employed or agency volunteer drivers prior to enlistment and quarterly thereafter. 31

  32. Medicaid/Medicare Exclusions The county must check state and federal databases monthly to assure that each transportation vendor, including owners/managers, and subcontractors, has not been excluded from participation in federal health care programs. 32

  33. Medicaid/Medicare Exclusions • Each vendor must furnish sufficient information to allow the county to complete the exclusion inquiries • Complete and sign the DMA-5124 annually and complete the DMA-5124A monthly • The county must check all organization and business names and managers’ names • The county must designate one employee to maintain OLV access to complete the monthly exclusion inquiry 33

  34. CONTRACT REQUIREMENTS • A written contract, signed by the vendor, must be obtained by the agency when purchasing transportation. • See Handout 14 for a list of specific contract requirements 34

  35. CONTRACT REQUIREMENTS • Site visits: Vendors must allow State and County officials, employees and their agents to visit vendor facilities to monitor compliance • Includes unannounced visits during normal hours of operation • Failure to cooperate may result in contract termination 35

  36. SAFETY AND RISK MANAGEMENT • County DSS is required to maintain a file on drivers, other than those under contract, who receive mileage reimbursement • This includes friends, neighbors, relatives, agency staff, and agency approved volunteers • This does not include the recipient or his financially responsible persons (FRPs) 36

  37. IMPLEMENTATION • Report Contact person/Transportation Coordinator to DMA by 1/17/12 • Submit access sheets (DHHS/PPTD) to DMA by 1/17/12 • Gather information for exclusion checks by 2/1/12 and complete initial checks by 2/15/12 • Contract Review by 1/31/12, Contract Amendments by 2/29/12 • All other changes must be implemented effective 1/1/12 37

  38. QUESTIONS?? Please submit questions on index cards provided and questions and answers will be posted on the DMA website after all training sessions are complete. 38

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