The Birth of a Brokerage The Transition to Brokered Statewide NEMT in Kansas

Transcription

1 The Birth of a Brokerage The Transition to Brokered Statewide NEMT in Kansas Patricia Weaver Kansas University Transportation Research Institute CalACT Spring Conference Indian Wells, California April 20, 2011

2 The NEMT Brokerage Journey in Kansas NEMT challenges in a rural state History of NEMT brokerage efforts in Kansas How the brokerage was established Successes? Challenges? Next steps

3 Kansas is a large state with low density population. Distances to services, particularly in the west, can be long. As an example, dialysis clinics. A huge part of the state does not have services available in close proximity.

4 Kansas Medicaid Program Operated by Kansas Health Policy Authority (KHPA) Prior to 2007, no brokerage at all. In 2007, two Medicaid Managed Care Organizations for children s services (CHIP) contracted for brokers 2008 recommended outsourcing management and provision of transportation to a broker. (Projected 5 year savings - $2m) In 2009, Approval from HHS/CMS in 2009 RFP issued with contract awarded to MTM in Summer year contract with 2 1-year extensions. Service began under brokerage November 1, 2009

5 NEMT Transportation Expenditures in Kansas Prior to the Brokerage

6 Setting Up the Brokerage Began operation in November 2010 Fully capitated contract with KHPA paid per Medicaid member per month (PMPM). Risk-based MTM pays the transportation costs Find efficiencies by eliminating fraud and assigning appropriate modes. 90 days to prepare for implementation for 120,000 eligible members

7 Duties of the Broker Arranges transportation for Medicaid-eligible to services covered by Medicaid and provided by Medicaid-enrolled provider. Arrange rides through Customer Service Center Contract with/verify credentials of transportation providers. Monitor service quality Provide care management services to major Medicaid providers.

8 Insurance Requirements for Providers Auto liability - $300k combined single limit General liability - $300k Workers Comp MTM listed as Certificate holder and additional insured Driver information Copy of driver s license Criminal background check, updated yearly Motor vehicle report, updated yearly Drug test. Section 5311 providers in state testing pool exempt from additional requirements Additional certificates (CPR, defensive driving, etc.)

9 Notable Changes from Previous System Use of public transportation as first choice, with exclusions. Minor cannot travel alone (<16) Providers must contract with broker for payment Vehicles inspected annually; current registration and insurance Driver requirements Quality assurance (customer satisfaction and provider satisfaction surveys) Grievance Process

10 All brokerage services are not created equal. Requirements vary significantly from one state to another even when provided by same broker. Terms dictated by state contract. Kansas No trip limits Mileage reimbursement $.30/mile Notice 48 business hours for routine medical No co-pay requirement. Education/Outreach Program Provided Missouri Limited to 3 one-way trips per day Mileage reimbursement $.19/mile Notice - 5 calendar days for routine medical May be subject to $2 co-pay per trip. Education/Outreach Program Excluded

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12 Four Types of Transportation Providers Commercial Medical Transportation Provider Transports all Trip schedule by member Commercial Sole Source Provider Full Transports only its members Trips scheduled with MTM Care Management Coordinator Commercial Sole Source Provider Reduced Only facility s members, or community agency utilizing volunteers Scheduled by provider Non-Commercial Medical Transportation Individual family members or friends transporting with reimbursement ($.30 per mile)

13 Kansas Transit Agencies and the Brokerage 18 Sole source providers who transport their own clients (Some may be 5311 providers) 7 public transit agencies providers have contracts 6 Public Transit Agencies (for bus passes - no contract required) Providers Less than 1% provided by public transportation so far. 8% of trips require vehicles with lifts

14 Performance Summary of Operation (SFY 2011 Membership Currently at 119k Unique members utilizing transportation 4,000 4,500 per month (3.75% of membership) Utilization rate ~30 percent Trips Total trip legs completed per month 34,000 or approximately 400,000 per year In 2002, estimated 83,000 trips provided Trip purpose Counselor, psychologist, social worker (~30 %) Dialysis (~ 20%) Physician services (~10 %) Community pysch rehab (~ 7%)

15 Successes in the First Year More people accessing health care than prior to the contract, particularly in rural areas. Utilization much higher than in the past due to 1-call plus statewide coverage. Medicaid members transported by drivers with background checks Transportation in vehicles that have been inspected. Access to customer service representative to set up trips for eligible persons. Transit bus pass program a reality Greater flexibility in what can be paid than under the prior system.

16 Member Satisfaction Rates Approximately surveys completed per month 91% phone service satisfaction rate reported 97% transportation service satisfaction rate reported

17 Challenges Communication communication communication Lack of specialized medical providers and dialysis clinics. Some trips as long as 375 miles one way to specialists. Broker paid at the same capitated rate as those less than 10 miles. Lack of medical transportation providers in rural communities. Lack of commercial providers. Small rural transit providers difficulty participating in the program.

18 Additional Challenges Process viewed as cumbersome by transit providers, particularly by those providing service prior to brokerage Qualifications Billing and reimbursement process Selection of providers Program changes over time Who to credit/who to blame??

19 Outreach efforts RTAP hosted two how to contract sessions from CTAA. Broker representatives have attended CTD meetings, presentation at state association meeting. Broker web site Developed Kansas Facility Provider Manual WebX training broker has hosted United We Ride Regional Conference Calls Mobility management Senior transportation Volunteer transportation

20 Next Steps Looking for strategies for coordination between NEMT broker and regional transit. Warm hand-off to provide greater coordination between two systems. In-home dialysis Investigating potential for broker payment of meals and lodging Medicaid pays only for training and transportation to training but not the 1-3 weeks needed for training. KHPA is being reorganized under Kansas Department of Health and Environment (July 1)

21 Thank You For more information: Pat Weaver Program Manager Kansas Rural Transit Assistance Program Kansas University Transportation Research Institute Christy Lane Kansas NEMT Brokerage Program Director MTM, Inc. (785) Tracy Conklin Kansas NEMT Program Manager Kansas Health Policy Authority (785)