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

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Presentation on theme: "Non-Emergency Medical Transportation (NEMT) Broker Model Community Forum."— Presentation transcript:

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). 2 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? 3 Reaching across Arizona to provide comprehensive quality health care for those in need

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

5 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)

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 6 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. 7 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 8 Reaching across Arizona to provide comprehensive quality health care for those in need

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

10 What are the NEMT Changes? 10 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 o Companies submit copies of insurance for each vehicle. Upon expiration, updated insurance copy submitted to AHCCCS. o Proof of vehicle insurance required for individuals not employed by a company. o For metered vehicles required copy of licensure from the Department of Weights and Measures. 11 Reaching across Arizona to provide comprehensive quality health care for those in need

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

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

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

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

16 2013 NEMT Changes2014 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 16

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

19 Tribal Outreach Webpage: o aspx aspx 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 19 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? 20 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. 21 Reaching across Arizona to provide comprehensive quality health care for those in need

22 Broker Model Implementation Year 2015: o Provider type 28 (NEMT) will be included in the Broker process. Implementation Year 2016: o Provider type 77 (BH Clinics) will be rolled into broker process. Other Provide types will be added at future dates. 22 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. 23 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 24 Reaching across Arizona to provide comprehensive quality health care for those in need

25 Just Call the Broker! 25 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? 26 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 27 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. 28 Reaching across Arizona to provide comprehensive quality health care for those in need

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

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

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

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

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

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

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

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


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