Bill > A5032

Introduced Session

This bill establishes vehicle, staffing, and performance standards in association with the State's non-emergency medical transportation brokerage program. Under the State's non-emergency medical transportation brokerage program, the Department of Human Services (DHS) contracts with a non-emergency medical 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. 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 clarifies the requirements that are to be applicable to the DHS, the non-emergency medical transportation broker, and the individual providers within the broker's network, under the non-emergency medical transportation brokerage program; and further establishes 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 clarifies that adult medical day care service centers, the non-emergency medical 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 to comply with the vehicle, staffing, and service delivery requirements specified therein. The DHS is required to designate an employee to engage in the ongoing monitoring and oversight of the non-emergency medical transportation brokerage program. In conducting a performance review, the department's designated evaluator is to 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.

AI Summary

Committee Categories

Carol Murphy (D)*,  Verlina Reynolds-Jackson (D)*, 

Introduced, Referred to Assembly Aging and Human Services Committee (on 11/14/2024)

Official Document