1. Non-Emergency Medical Transportation (NEMT) Broker Model Community Forum

2. Purpose of Forum
Provide information on Non-Emergency Medical Transportation (NEMT) changes and NEMT Broker Model.
Seek input regarding the Broker Model
Listen to and document concerns
Many specifics of the Broker Model are still under development, (i.e., member choice, rate and operational structure).
Reaching across Arizona to provide comprehensive quality health care for those in need

3. Today’s Agenda Why the NEMT Changes? What are the Changes?
Has There Been Outreach to Tribes?
What is a Broker?
What Does the Broker Model Look Like?
What is the Expected Outcome?
What are the Benefits to Tribes?
What is the RFI and RFP Timeline?
Reaching across Arizona to provide comprehensive quality health care for those in need

4. Why the NEMT Changes?
Reaching across Arizona to provide comprehensive quality health care for those in need

5. Issues
“We have been inundated with non-tribal NEMT providers operating on our reservation without tribal authority.” (Tribe)
“The NEMT company I work for closed their office and left town without paying me.” (Provider)
“I was left in the middle of town in my wheelchair by an NEMT driver who refused to drive me home because he didn’t want to drive onto the reservation.” (Member)
Reaching across Arizona to provide comprehensive quality health care for those in need

6. Background Quality of service concerns
High error rate during CMS audit and tribal concerns around member safety and labor issues
Prompted program integrity and oversight changes
Workgroup formed May AHCCCS & tribal representatives
Workgroup submitted recommendations for change
NEMT Implementation Plan
Reaching across Arizona to provide comprehensive quality health care for those in need

7. Background Cont.
Several Providers suspended by AHCCCS for credible allegations of fraud.
Tribe has issued Cease & Desist orders against non-tribal Providers.
Tribe has stopped issuing tribal business licenses to Providers.
Providers not licensed or authorized by Tribes to operate on tribal lands.
Reaching across Arizona to provide comprehensive quality health care for those in need

8. Background Cont.
Approximately 175 NEMT Providers are registered with AHCCCS.
NEMT services account for an annual spend of $65M:
NEMT Provider Type 28 (NEMT) accounts for $43M of this total
NEMT Provider Type 77 accounts for $6M of this total
Other Provider types billing for this service:
Attendant care agencies and mental health clinics
Reaching across Arizona to provide comprehensive quality health care for those in need

9. Current NEMT Providers by County
List of registered NEMT Providers:
Apache - 24
Mohave - 4
Cochise – 2
Navajo – 15
Coconino – 13
Out-of-State – 7
Gila – 1
Pima – 25
Graham – 1
Pinal – 3
La Paz – 2
Yavapai – 3
Maricopa – 86
Yuma - 1
Reaching across Arizona to provide comprehensive quality health care for those in need

10. What are the NEMT Changes?
Reaching across Arizona to provide comprehensive quality health care for those in need

11. 2013 NEMT Changes Per the NEMT Implementation Plan: 7/1/2013
Companies submit copies of insurance for each vehicle. Upon expiration, updated insurance copy submitted to AHCCCS.
Proof of vehicle insurance required for individuals not employed by a company.
For metered vehicles required copy of licensure from the Department of Weights and Measures.
Reaching across Arizona to provide comprehensive quality health care for those in need

12. 2013 NEMT Changes Cont.
7/1/2013
New or re-enrolling Providers must complete online training module and submit training certificate for applications to be processed.
Trip tickets required
Copy of registration for each vehicle required.
Reaching across Arizona to provide comprehensive quality health care for those in need

13. 2013 NEMT Changes Cont.
8/1/13
Claims denied if submitted without trip tickets.
11/1/13
Notice posted prohibiting the issuance of gift and snack cards as enticement (Federal law).
Date-of-Birth added to trip tickets.
Reaching across Arizona to provide comprehensive quality health care for those in need

14. 2014 NEMT Changes
2/12/14
Registration for federal vehicles accepted (internal policy update).
4/1/14
Tribal business license required of NEMT Providers. (IHS/638 Providers exempt)
Logo or company name on each vehicle required.
Federal database check for driver criminal activity/traffic violations.
AHCCCS will verify Tribal business licenses with Tribes.
Reaching across Arizona to provide comprehensive quality health care for those in need

15. 2014 NEMT Changes Cont.
6/1/14
Re-certification of existing NEMT Providers.
Site visits will begin in July and are conducted to ensure AHCCCS requirements are being met.
Reaching across Arizona to provide comprehensive quality health care for those in need

16. 2013 NEMT Changes 2014 NEMT Changes 7/1/13:
New or re-enrolling Providers must complete on-line training and submit training certificate.
Trip tickets required
Copy or registration required for each vehicle
Companies submit copies of insurance for each vehicle. Updated insurance copy submitted to AHCCCS by Companies.
Proof of vehicle insurance for individuals not employed by a company.
Metered vehicles provide copy of licensure from Dept. of Weights & Measures.
2/12/14:
Registration for federal vehicles accepted (internal policy update)
8/1/13:
Claims denied if submitted without trip tickets.
4/1/14:
Tribal business license required of NEMT Providers
Logo or company name required on each vehicle
Federal data base check for driver criminal activity/traffic violations.
AHCCCS will verification Tribal business licenses with Tribes
6/1/14:
Recertification of existing NEMT Providers.
11/1/13:
Notice posted prohibiting issuance of gift and snack cards as enticement (federal law)
DOB added to trip tickets
7/14:
Site visits begin and are conducted to ensure requirements are being met

17. Has There Been Outreach to Tribes?
Reaching across Arizona to provide comprehensive quality health care for those in need

18. Tribal Outreach
Tribes informed and input received via Tribal Consultation meetings.
May
January 22, 2014
April 17, 2014
June 12, 2014
Information distributed by Tribal Relations Office
NEMT Workgroup Meetings held each month from July to December 2013.
Reaching across Arizona to provide comprehensive quality health care for those in need

19. Tribal Outreach Webpage: Regional Tribal Broker Forums
Regional Tribal Broker Forums
July 21, 2014: 1-3 pm, Phoenix
July 24, 2014: pm, Tucson
July 31, 2014: 12-2 pm, Flagstaff
Continue to update and obtain input from tribes
Reaching across Arizona to provide comprehensive quality health care for those in need

20. What Is A Broker and What Does the Broker Model Look Like?
Reaching across Arizona to provide comprehensive quality health care for those in need

21. What is a Broker?
“One who works as an agent for others in negotiating contracts, purchases or sales”
“A person who buys and sells goods or assets for others” Merriam-Webster
A Broker is not an NEMT Transportation Provider.
Reaching across Arizona to provide comprehensive quality health care for those in need

22. Broker Model Implementation Year 2015: Implementation Year 2016:
Provider type 28 (NEMT) will be included in the Broker process.
Implementation Year 2016:
Provider type 77 (BH Clinics) will be rolled into broker process.
Other Provide types will be added at future dates.
Reaching across Arizona to provide comprehensive quality health care for those in need

23. Broker Model Broker will: Operate statewide
Coordinate NEMT transportation for Fee-for-Service members as appropriate to meet member needs.
Will not provide NEMT services
Contract with Providers to complete services.
Be required to have a Tribal Liaison (representing an Arizona Tribe) on staff.
Reaching across Arizona to provide comprehensive quality health care for those in need

24. Broker Model Cont. Broker will:
Serve as single point-of-contact to request transportation.
Ensure NEMT Providers meet AHCCCS & Broker requirements to be considered for inclusion into the NEMT Provider Network.
Be in compliance with AHCCCS oversight standards
Ensure that Providers have tribal business licenses
Reaching across Arizona to provide comprehensive quality health care for those in need

25. Just Call the Broker!
Reaching across Arizona to provide comprehensive quality health care for those in need

26. What is the Expected Outcome and What Are the Benefits to Tribes?
Reaching across Arizona to provide comprehensive quality health care for those in need

27. Expected Outcome
Improved accountability and oversight of NEMT Providers.
Better transportation service to AHCCCS members.
Culturally competent Broker
A “one-stop shop” for AHCCCS members. Member will just call the Broker.
Tribal enforcement of licensing procedures
Reaching across Arizona to provide comprehensive quality health care for those in need

28. Benefits to Tribes
Opportunity for Tribes to select new Providers to operate in their communities.
Tribes can determine which Providers will receive Tribal business licenses.
Strong tribal input, in collaboration with Broker, will result in appropriate Provider network.
Tribe/member issues quickly resolved with assistance of Broker and AHCCCS.
Reaching across Arizona to provide comprehensive quality health care for those in need

29. What is the Broker RFI & RFP Timeline?
Reaching across Arizona to provide comprehensive quality health care for those in need

30. Step 1:NEMT Request for Information (RFI)
RFI published August 2013
6 Vendors responded:
Medical Transportation Management (MTM)
Logisticare
Total Transit
Veolia Transportation
Access2Care
National Medical Transport
3 Vendor presentations March 2014
Reaching across Arizona to provide comprehensive quality health care for those in need

31. NEMT RFI (cont.) Sample questions from the RFI:
What types of vehicles are used for general and special populations?
How would you operationalize transportation services?
Are different approaches utilized for urban vs. rural populations?
How would the vendor ensure appropriate billing and tracking of mileage?
Describe the workflow of an approval for transportation
Describe the population and widely utilized services in rural area and on Tribal lands
Reaching across Arizona to provide comprehensive quality health care for those in need

32. Step 2: NEMT RFP Timeline
July 1, 2014 – August 29, 2014
RFP/ scope of work development
August 29, 2014
RFP document final
September 1-30, 2014
CMS approval of RFP (30 days)
October 1, 2014
Publication of RFP
October 23, 2014
Questions from Offerors due
October 23-October 30
AHCCCS gathers answers to questions
 October 31, 2014
Solicitation Amendment posted with answers
December 3, 2014
Proposals Due
December 4 -31, 2014
Evaluation of Proposals
January 5-16, 2015
Vendor Presentations
January 19-30, 2015
Final scoring and Recommendation for award
February 1-28, 2015
Send to CMS for Review and Approval of Award
 March
Award
March  - August
Implementation Period
 September 1, 2015
Contracted NEMT services begin
Reaching across Arizona to provide comprehensive quality health care for those in need

33. Step 3: Transition Implementation Plan
Member education/outreach
Data exchange
Transition timeline
Continuous tribal consultation
Member notification
Reaching across Arizona to provide comprehensive quality health care for those in need

34. AHCCCS Contact:
Rebecca Fields: Fee-for-Service Management,
Patricia Garcia: Provider Registration
Bonnie Talakte: Tribal Relations
Reaching across Arizona to provide comprehensive quality health care for those in need

35. Questions?
Reaching across Arizona to provide comprehensive quality health care for those in need

36. Thank You.
Reaching across Arizona to provide comprehensive quality health care for those in need