Bill > A1005

Introduced Session

This bill would establish vehicle, staffing, and performance standards in association with the State's Medicaid transportation brokerage program. Under the State's Medicaid transportation brokerage program, the Department of Human Services (DHS) contracts with a Medicaid transportation broker to manage the provision of non-emergency medical transport to Medicaid beneficiaries in the State. The transportation broker is responsible for: developing and maintaining a non-emergency medical transport provider network for use by Medicaid program beneficiaries; verifying beneficiary eligibility for non-emergency medical transport; determining and authorizing the appropriate mode of transport for each beneficiary on the basis of medical necessity; and dispatching an appropriate provider vehicle to transport the beneficiary. The current Medicaid transportation broker in the State is LogistiCare Solutions, LLC. Although the Medicaid transportation brokerage program has been in operation in the State since 2009, recent reports issued by the Office of Inspector General and the Office of the State Auditor have indicated that there are significant performance deficiencies in the provision of non-emergency transport under the brokerage program. This bill is designed to address the issues raised in those reports. Specifically, the bill would clarify the requirements that are to be applicable to the DHS, the Medicaid transportation broker, and the individual providers within the broker's network, under the Medicaid transportation brokerage program; and it would further establish a procedure for the performance review of the broker and its authorized providers, and the review of complaints that are submitted about the brokerage program. The bill would clarify, for instance, that the Medicaid transportation broker is obligated to: 1) require a person requesting transportation services to certify that the transportation services are necessary for the person to receive a covered medical service under Medicaid; and 2) require a person requesting transport through the use of a mobility assistance vehicle (MAV) to submit a medical necessity form justifying the use of the MAV. Individual providers of transportation services under the brokerage program would be required by the bill to comply with the vehicle, staffing, and service delivery requirements specified therein. In particular, each provider would be required to: 1) ensure that transport services are provided within 15 minutes of the scheduled arrival time; 2) be covered by a workers' compensation policy, a general liability insurance policy, and an automobile insurance policy that covers all vehicles used in the provision of services; 3) register each vehicle as a "commercial" or "livery" vehicle, as appropriate, and maintain a current inspection report for each vehicle; 4) ensure that drivers and staff members are appropriately licensed or certified, as required by law; 5) prohibit the employment of any person who is convicted of a disqualifying offense, as specified in department regulation, regardless of the date of the person's offense or conviction; 6) transport a Medicaid beneficiary to and from a medical provider only in order to receive a covered medical service, and for no other purpose; and 7) ensure that drivers and other staff members who engage in direct contact with transportation recipients have completed sensitivity training, as provided by the bill, as well as any medical and safety training required by the department. In addition, any vehicle that has been driven more than 150,000 miles would be required to undergo an enhanced inspection process, as provided by the bill, before commencing or continuing operations as a livery or mobility assistance vehicle. Any vehicle that fails the enhanced inspection would need to be immediately withdrawn from service, and would have its inspection medallion removed, until such time as the vehicle has been repaired and re-inspected, and is deemed safe to operate. The bill requires individual providers to maintain, and daily update, a monthly transportation services log that contains the basic facts associated with each transportation request. Such facts would include the date and time for which pick-up was scheduled, the date and time at which pick-up actually occurred, the actual number of miles traveled, the location of the medical provider, the model year and registration number of the vehicle, and whether the beneficiary was transported as part of a multi-passenger load. Each provider would also be required to maintain records regarding the licensure and training status of its employees, and the licensure, registration, and inspection status of its vehicles. Whenever an individual provider submits a claim for reimbursement under the Medicaid program, it would be required to include with the claim, a copy of its transportation service log. The department or the broker would also be authorized to access the provider's other records, upon request. The Medicaid transportation broker would similarly be required, under the bill, to maintain certain records, including: 1) a daily and monthly log showing each transportation service that was requested and provided under the brokerage program during the period, and additionally identifying both the individual provider who provided each transportation service, and the type of vehicle that was dispatched; 2) a copy of each medical necessity form submitted by a beneficiary who is seeking the use of an MAV; 3) a record showing the date and time on which a beneficiary certified that transportation was necessary to receive a covered medical service; 4) a log of cases in which the waiting time for a transportation service was in excess of 15 minutes; and 5) a record showing the types of insurance coverage possessed by each individual provider. The DHS would be required, under the bill, to designate an employee to engage in the ongoing monitoring and oversight of the Medicaid transportation brokerage program. The designated evaluator would be responsible for: 1) receiving, cataloguing, and submitting a monthly report to the department, the Director of the Division of Medical Assistance and Health Services, and the broker, on all complaints that are submitted about the brokerage program; and 2) regularly reviewing the records of the Medicaid transportation broker and individual transportation service providers in the broker's network, in order to ensure compliance with applicable vehicle, staffing, and performance standards. (Any complaints that are submitted directly to the transportation broker, or to an individual provider, would need to be forwarded to the department's designated evaluator.) The designated evaluator would also be authorized to make recommendations to the DHS about the proper amount of liquidated damages to impose on the broker in response to identified performance failures. In conducting a performance review under the bill, the department's designated evaluator would be required to determine whether: 1) vehicles used to transport Medicaid beneficiaries are fully compliant with all statutory, regulatory, and contractual requirements; 2) transport personnel are properly licensed and qualified to provide non-emergency medical transportation services; 3) prior authorization is being obtained, and medical necessity is being documented, for beneficiaries who require MAV service; 4) individual providers consistently maintain requisite insurance policies; 5) transportation recipients actually receive a covered medical service on the date of transport; and 6) the transportation services provided to each beneficiary are adequately documented, as required by the bill. The bill would require any monthly capitation fees, which are paid by the DHS to the broker, to be offset by the amount of any liquidated damages that are assessed by the department against the broker for failing to comply with, or failing to ensure that the individual providers in its network comply with applicable vehicle, staffing, or performance standards. The amount of liquidated damages imposed is to be based on the reports prepared by the department's designated evaluator, is to be consistent with the evaluator's recommendations, and is to be sufficient to deter future non-compliance. The amount of liquidated damages is to be increased, on a monthly basis, until full compliance with vehicle, staffing, and performance standards is achieved. The bill would further require the DHS to endeavor to reduce unnecessary State expenditures under the brokerage program. Specifically, the department would be required to develop a system that allows it to identify when capitation fee payments have been duplicated or made in excess to the broker, so that it may properly recover such excess or duplicate payments. The review of monthly capitation payments, and the recovery of excess or duplicative payments would need to occur at least once per year. The bill would additionally provide that mileage reimbursement payments made by the DHS under the Medicaid transportation brokerage program are to be based on the actual number of miles driven by the driver. The mileage reimbursement provided to a driver who is engaged in the provision of multi-passenger transportation services would be based on the number of miles actually driven for the one passenger in the multi-passenger load who was transported over the farthest distance. Mileage reimbursement is to be authorized, moreover, only if the transportation recipient actually received a covered medical service on the date of transport. The bill would require the DHS to file an annual report on the Medicaid transportation brokerage program with the Governor and Legislature. The report would also be posted on the DHS website. The report would include relevant statistical data, a description of existing performance or compliance issues, a list of actions that have been undertaken to address previously identified performance and compliance issues, and recommendations for executive and legislative action necessary to improve the brokerage program.

AI Summary

Committee Categories

Daniel Benson (D)*,  Nicholas Chiaravalloti (D)*,  JoAnn Downey (D)*,  Mila Jasey (D),  Gordon Johnson (D),  Yvonne Lopez (D),  Carol Murphy (D),  Cleopatra Tucker (D), 

Introduced, Referred to Assembly Human Services Committee (on 01/14/2020)

Official Document