May 3, Bureau of Medicaid Policy and Health System Innovation Medical Services Administration P.O. Box Lansing, Michigan

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1 MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES NOTICE OF PROPOSED POLICY Public Act 280 of 1939, as amended, and consultation guidelines for Medicaid policy provide an opportunity to review proposed changes in Medicaid policies and procedures. Please review the policy summary and the attached materials that describe the specific changes being proposed. Let us know why you support the change or oppose the change. Submit your comments to the analyst by the due date specified. Your comments must be received by the due date to be considered for the final policy bulletin. Thank you for participating in the consultation process. Director, Program Policy Division Bureau of Medicaid Policy and Health System Innovation Project Number: 1704-NEMT Comments Due: May 3, 2017 Proposed Effective Date: As Indicated Mail Comments to: Nick Norcross Bureau of Medicaid Policy and Health System Innovation Medical Services Administration P.O. Box Lansing, Michigan Telephone Number: Fax Number: Address: Policy Subject: Fee-for-Service Medicaid Provider Enrollment and Transportation Rate Changes and Clarification Affected Programs: Medicaid, Healthy Michigan Plan, MIChild, Maternity Outpatient Medical Services (MOMS) Distribution: Bridges Eligibility Manual (BEM) and Bridges Administrative Manual (BAM) Holders, Medicaid Health Plans, Medicaid Non-Emergency Medical Transportation (NEMT) Contractor, Maternal Infant Health Program (MIHP) Providers, Local Health Departments Policy Summary: This policy includes clarifications to bulletin MSA 16-05, and requires NEMT providers for MIHP beneficiaries become enrolled in the Community Health Automated Medicaid Processing System (CHAMPS). This policy also formally ties certain fee-for-service Medicaid NEMT mileage reimbursement rates to rates established by the Internal Revenue Service (IRS). Purpose: This bulletin requires MIHP transportation providers to enroll in CHAMPS for the purposes of provider screenings as required by the Affordable Care Act, and provides additional provider enrollment clarification for NEMT providers as promulgated in bulletin MSA Changes to personal and volunteer FFS NEMT mileage reimbursement rates to consistent with IRS standard mileage rates are necessary for certain NEMT providers to avoid claiming mileage reimbursement as taxable income. Public Comment Cover (06/16)

2 Michigan Department of Health and Human Services Medical Services Administration Distribution: Issued: Subject: Effective: Bridges Eligibility Manual (BEM) and Bridges Administrative Manual (BAM) Holders, Medicaid Health Plans, Medicaid Non-Emergency Medical Transportation (NEMT) Contractor, Maternal Infant Health Program (MIHP) Providers, Local Health Departments June 1, 2017 (Proposed) Fee-for-Service Medicaid Provider Enrollment and Transportation Rate Changes and Clarification As Indicated (Proposed) Programs Affected: Medicaid, Healthy Michigan Plan, MIChild, Maternity Outpatient Medical Services (MOMS) The purpose of this bulletin is to clarify and update NEMT provider enrollment requirements as promulgated by bulletin MSA and related to MIHP NEMT providers, and to notify Medicaid FFS NEMT providers and authorizing parties of changes to Medicaid NEMT reimbursement rates. Refer to the Michigan Department of Health and Human services (MDHHS) BAM 825 and the Medicaid Provider Manual for policy information regarding Medicaid FFS and MIHP transportation policy. Providers should also refer to bulletin MSA 16-05, issued September 28, 2016, for additional information related to NEMT provider enrollment. I. NEMT Provider Enrollment and Screening A. Affected Individuals and Entities In compliance with Sections 6401 and 6501 of the Affordable Care Act (ACA), all NEMT providers must consent to necessary background screenings related to criminal offense, business transaction and federal exclusion disclosures, as well as adverse action reporting. Provider screening is conducted through the CHAMPS provider enrollment process. Identification of exclusion disclosures described below must be verified monthly. Demand-responsive public transit services and commercially hailed or street taxicabs are exempt from CHAMPS enrollment requirements at this time. MSA requires all NEMT provides to be enrolled in CHAMPS and screened prior to being authorized, approved, or reimbursed to provide NEMT services through the Medicaid program. The term providers includes (1) beneficiaries who utilize a personal vehicle to transport themselves to services Medicaid covers, (2) individuals with or without a vested interest in the livelihood of the Medicaid beneficiary who

3 Page 2 of 5 transport the beneficiary to services Medicaid covers, (3) non-profit and commercial transportation agencies and their employees, and (4) Medicaid s transportation contractor and their transportation subcontractors. Valid identifying information, including name, home address, date of birth, and Social Security Number, must be provided by all providers and applicants. B. Medicaid Payment Restrictions for NEMT Providers 1) The Medicaid NEMT program shall not authorize, approve, or directly reimburse any provider (as defined above) who has been identified through the CHAMPS enrollment process as having a conviction defined as a mandatory exclusion. Mandatory exclusions are set forth in the Social Security Act (42 USC 1320a- 7[a]) and are defined as (a) criminal convictions related to the delivery of an item or service under Medicare, Medicaid, or other state health care program, (b) criminal convictions related to neglect or abuse of patients in connection with the delivery of a health care item or service, (c) a felony conviction after August 21, 1996, relating to fraud, theft, embezzlement, breach of fiduciary responsibility or other financial misconduct in connection with the delivery of health care items or services, or (d) a felony conviction after August 21, 1996 related to unlawful manufacture, distribution, prescription, or dispensing of a controlled substance. 2) The Medicaid NEMT program shall not authorize, approve, or directly reimburse any provider (as defined above) who has been identified through the CHAMPS enrollment process as having a conviction defined as a permissive exclusion, unless the beneficiary has received notification of the criminal offense(s) and chooses the individual to provide transportation. The Personal Choice and Acknowledgement Provider Selection Clarification section of this bulletin describes the process for selecting an individual with a conviction of a permissive exclusion to be a transportation provider. Permissive exclusions are the conviction of crimes directly relatable to neglect, physical and sexual abuse, financial exploitation, inappropriate involuntary restraint, providing unqualified health services and other crimes identified by MDHHS. The list of specific crimes are defined in Michigan Compiled Law a(1). Additional information on what constitutes a mandatory or permissive exclusion may be found within MSA Prior to authorizing Medicaid NEMT reimbursement for services, authorizing parties must document verification of CHAMPS provider enrollment on the date of service on the MSA-4674 (Medical Transportation Statement). A printed copy of the CHAMPS provider enrollment screen or written notation of the date enrollment was verified and any exclusions is acceptable documentation.

4 Page 3 of 5 C. Personal Choice and Acknowledgement Provider Selection Clarification Per MSA 16-05, a Medicaid beneficiary may choose to receive transportation services from a provider who has been identified through the criminal history screening process as having a permissive exclusion. A completed Acknowledgement of Provider Selection form must be completed by the Medicaid beneficiary and submitted to MDHHS, indicating informed consent by the beneficiary and receipt of notification of the criminal offense(s) prompting exclusion. The Acknowledgement of Provider Selection shall not be considered effective until the signed acknowledgement has been received, processed, and recorded in CHAMPS by MDHHS. Authorizing parties can submit the completed acknowledgement form to MDHHS by to MSAAtypicalProviders@michigan.gov, or by fax at The Acknowledgement of Provider Selection form and process described above must be completed if the beneficiary chooses an individual identified as having a permissive exclusion to provide transportation. Non-profit and commercial agencies whose ownership or controlling interests have been identified as having a permissive exclusion are not required to secure a personal choice and acknowledgement of provider selection unless the individual directly providing the transportation has also been identified as having a permissive exclusion. Providers may not be automatically disqualified from enrollment as a Medicaid NEMT provider based solely on the discovery that an applicant has a permissive exclusion. Prospective providers must be given the opportunity to secure the personal choice and acknowledgement of provider selection as described below, consistent with terms stipulated in MSA II. Maternal Infant Health Program Update In compliance with Sections 6401 and 6501 of the ACA, and consistent with all provisions outlined within MSA 16-05, the Medical Services Administration is amending MIHP transportation related policy. Beginning November 1, 2017, all MIHP transportation providers must be enrolled in CHAMPS and screened prior to being authorized, approved, or reimbursed for transportation services for FFS beneficiaries. Transportation providers may begin enrolling in CHAMPS July 1, If a prospective MIHP transportation provider does not have online access they may contact the Provider Support helpline at Additional information regarding provider enrollment is available on the MDHHS website at >> Provider Enrollment. MIHP agency providers must verify transportation provider enrollment prior to authorizing transportation services. MIHP providers will have increased access to CHAMPS to verify provider enrollment compliance.

5 Page 4 of 5 The MIHP provider must maintain documentation of transportation for each beneficiary for each trip billed. The record must specify: The name and address of the beneficiary; The date of service (DOS); The trip's starting point and destination (address, city); The purpose of the trip; The number of tokens or miles required for the trip; The amount that the beneficiary or transportation vendor was reimbursed; The provider identification information for the individual or business providing transportation; and Verification of transportation provider enrollment in CHAMPS. No changes to the claims submission process or mechanism of payment will be made as a result of this policy. An MIHP beneficiary who receives transportation services through the MIHP program may select any provider subject to the following restrictions: The provider does not have a disqualifying conviction that is defined as a mandatory exclusion. The provider is capable of providing the required services and is otherwise qualified to do so. The provider has successfully undergone a criminal history screening conducted by MDHHS and has received notification of the determination. III. Mileage Reimbursement Medicaid may authorize mileage reimbursement for NEMT rendered to beneficiaries for services Medicaid covers when policy criteria are met. Providers who may be eligible to receive reimbursement include volunteer drivers, foster care parents, individuals with a vested interest (e.g., family, legal guardian, friends, etc.), and Medicaid beneficiaries who provide their own NEMT. Beginning July 1, 2017, FFS NEMT mileage reimbursement will align with the standard mileage rates maintained by the Internal Revenue Service (IRS). Mileage rates for volunteer drivers and foster care parents will reflect the IRS standard mileage rates for business miles driven, which is currently 53.5 cents per mile. In addition, individuals with a vested interest or Medicaid beneficiaries providing their own NEMT will be reimbursed at the IRS rate for medical or moving purposes, which is currently 17 cents per mile. Medicaid will automatically increase or decrease the FFS rates to align with future IRS standard business and medical or moving mileage rates. Providers, authorizing parties and beneficiaries should refer to the MDHHS website for the most current information pertaining to NEMT reimbursement and services at >> Billing

6 Page 5 of 5 and Reimbursement >> Provider Specific Information >> Non-Emergency Medical Transportation.