Medical Transportation. Transportation To and From a Medical Facility or Provider

Full text

(1)

Medical Transportation : Today

Overview of Medical Transportation Today

and the Important Role played by Medicaid

Rex Knowlton, CCTM

Coordination Ambassador Regions 3 & 8

Executive Director Wheels of Wellness

(2)

Medical Transportation

Medical Transportation

Transportation

Transportation

To

To

and

and

From

From

a Medical

a Medical

Facility or Provider

(3)

Components

Components

Non Emergency Medical Transportation

Non Emergency Medical Transportation

-

-

Overview

Overview

Medicaid

Medicaid

Public Transportation

Public Transportation

Answer to Medicaid

Answer to Medicaid

Transportation?

Transportation?

Current Means of Addressing Medicaid

Current Means of Addressing Medicaid

Transportation

(4)

Non Emergency Medical Transportation

Non Emergency Medical Transportation

Overview

Overview

Class

Class

Types

Types

Means

Means

Modes

Modes

(5)

Class

Class

Invisible

Performed Independently

Part of the General Public Ridership

Visible

Funded through on of 11 Federal fund streams;

62 agencies

(6)

Types

• General

• Disease Specific

– Kidney Dialysis

– HIV

– Cancer

• Age Specific

– Medicare

• Economic

– Medicaid

• Health Related

– Physical

– Behavioral

– Mental

• Under the Radar of

Any Specific Funding

(7)

Means

• Private Automobile

– Yours, Paid, or Volunteer

• Public Fixed Route Transit

• Public Paratransit

– ADA or Specialized

• Private Paratransit

– Community based fee or no

fee

– Taxi

• Public Ambulance

– Community based fee or no

fee

(8)

Modes

Modes

„

„

AMBULANCE

AMBULANCE

„

„

STRETCHER

STRETCHER

„

„

NON AMBULATORY

NON AMBULATORY

„

„

AMBULATORY

AMBULATORY

„

„

PUBLIC

PUBLIC

TRANSPORTATION

TRANSPORTATION

TAXI

(9)

Limiting Factors

• Degree of Assistance Required

•Door to Door vs. Curb to Curb

•Escorts

–Attendants

• Mobility Limitations

• Shedding

(10)

Medicaid

Medicaid

™

™

Program

Program

™

™

Transportation

Transportation

™

™

Deficit Reduction Act of 2005

Deficit Reduction Act of 2005

™

(11)

Transportation: Definition

Medical Transportation

Medical Transportation

z

Transportation to any Medical Assistance

reimbursable service for the purpose of

receiving treatment, medical evaluations

or purchasing prescription drugs or

(12)

Transportation: Assurance and

Elements

42 CFR Section 431.53

z

“Assurance of Transportation” means:

“A state plan must specify that the Medicaid agency

will ensure necessary transportation for recipients to

and from providers; and describe the methods that

the agency will use to meet this requirement.”

z

“Transportation” includes:

Expenses for transportation and other related travel

costs determined to be necessary by the Medicaid

agency to secure medical examinations and

(13)

Program

Title XIX

of the Social Security Act

z

Federal / State matching program

Nationally, 14% of the population receives

Medicaid assistance

Medicaid services are provided annually to more

than 38.5 million people at a cost of nearly $179

billion

(14)

Transportation: Extent of Program

Medicaid Non-Emergency

Transportation Funding

z

Annually, Non-Emergency Medical

Transportation (NEMT) provides more than

111 million trips at a cost of nearly $1.8 billion,

for an average cost of $16 per trip

10% of Medicaid-eligible population uses NEMT

services

By 2010, Medicaid NEMT expenditures are

(15)

Deficit Reduction Act of 2005

Deficit Reduction Act of 2005

‹

‹

Signed by President Bush February 8, 2006

Signed by President Bush February 8, 2006

‹

‹

States no longer required to obtain a Section

States no longer required to obtain a Section

1915 (b) Waiver

1915 (b) Waiver

Can provide NEMT through a contracted broker

Can provide NEMT through a contracted broker

Must select brokers through a competitive

Must select brokers through a competitive

procurement process

procurement process

(16)

Challenges

Challenges

State based

State based

(50 Different Programs)

(50 Different Programs)

Funding

Funding

-

-

reality of state

reality of state

budget pressures

budget pressures

Eligibility Varies

Eligibility Varies

(17)

Public Transportation

Public Transportation

Answer to

Answer to

Medicaid Transportation?

Medicaid Transportation?

COORDINATION OF EXISTING PROGRAMS

COORDINATION OF EXISTING PROGRAMS

CRITICAL

CRITICAL

SAFETEA

SAFETEA

LU

LU

ENCOURAGES

ENCOURAGES

(18)

Coordination of Existing Programs

Critical

Confusing Array of Programs & Funding

State Governors

&

Cabinet Secretaries

Federal

Agencies

&

Grant

$

Education Labor Employment Training Agency Office of Disability Employment Policy Labor Employment Training Agency Office of Disability Employment Policy Centers for Independent Living Disability Rehab and Research Rehabilitation Services Administration Office of Special Education Programs Substance Abuse M ental Health Temporary Assistance for Needy Families Family Assistance

HH S M edicaid Svcs M edicare & Aging Health Resources & Services Community Services Child Care Bureau Development Disabilities M edicaid Program Head

Start Soc. ServicesBlock Grant Children & Families Transportation Office of the Secretary National Highway Traffic Safety Administration Federal Transit Administration Assistant Secretary for Transportation Policy Departmental Office of Civil Rights United M ethodist Church Ride Inc M edicaid Early Learning Center Office of the Secretary Assistant Secretary Planning Evaluation Clayton School District Rural Transit O perators ABC’s Transit

Blue Top Taxi M etro Access Elderly & Disability Program Job Access Reverse Commute Program Rural Grant Program Urbanized Grant Program DART Easter Show s Family Employment Shopping Independence Education

Local

Government

H ealth Care

?

?

?

?

?

?

Recreation

(19)

SAFETEA-lu Encourages

Coordinated Planning – Locally Developed

Self Assessment Tool

Questions to Ask:

½ Is there a mechanism for coordinating funding for cost-effective

service delivery?

½ Are local funding allocations based on demonstrated evidence of

coordinated activities?

½ Are there consistent cost reporting procedures across programs and

agencies? Are human service transportation expenditures isolated

from other program expenditures and easily identified?

½ Is there a method for defining allocated transportation costs across

programs and agencies?

(20)

SAFETEA

SAFETEA

-

-

lu

lu

Encourages

Encourages

‹

‹

Promotes

Promotes

a seamless transportation system in which

a seamless transportation system in which

transportation modes are efficiently connected;

transportation modes are efficiently connected;

‹

‹

Continues

Continues

a major emphasis on improving public

a major emphasis on improving public

transportation

transportation

‹

‹

Encourages

Encourages

private sector participation

private sector participation

‹

‹

Expands

Expands

the sources of funds for the non

the sources of funds for the non

-

-

federal

federal

match to include amounts a grantee receives under a

match to include amounts a grantee receives under a

service agreement with a social service agency

service agreement with a social service agency

(21)

United We Ride

Legislative Proposals

Transportation Equity Act-21

Older American Act

(22)

Current Means of Addressing

Current Means of Addressing

Medicaid Transportation

Medicaid Transportation

„

„

Regions 3 (Mid Atlantic)

Regions 3 (Mid Atlantic)

and 8 (Upper Midwest;

and 8 (Upper Midwest;

West)

West)

Twelve

Twelve

States

States

Five

Five

no coordination with

no coordination with

PT; no brokerage

PT; no brokerage

One

One

limited coordination

limited coordination

with PT; no brokerage

with PT; no brokerage

Two

Two

totally separate

totally separate

statewide system;

statewide system;

statewide brokerage

statewide brokerage

One

One

totally separate

totally separate

statewide system; no

statewide system; no

brokerage

brokerage

Three

Three

local coordination;

local coordination;

local or regional brokerage

local or regional brokerage

„

„

Fully coordinated

Fully coordinated

statewide Medicaid

statewide Medicaid

integrated with PT

integrated with PT

Florida

Florida

„

„

Emerging coordination of

Emerging coordination of

Medicaid with PT

Medicaid with PT

(23)

Today

Today

NMET

Figure

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References

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