Sneak Preview: CMS To Assess Medical Transportation Guidance

April 8, 2016 | By Jerry Ashworth | Post a Comment

xgran_bookshot(The following was excerpted from a recent article in the Federal Grants Management Handbook.) The Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) plans to review and potentially update its current Medicaid guidance on nonemergency medical transportation to help states comply with federal requirements, in response to a recent Government Accountability Office (GAO) recommendation.

Medicaid funding supports transportation services of Medicaid beneficiaries for scheduled nonemergency care. Such services are generally available for beneficiaries who have no other means of transportation to medical services. States, which have discretion on how they deliver such services, spent $1.5 million in nonemergency Medicaid transportation services in federal Fiscal Year 2013, GAO found.

States may contract with public or private transportation brokers to administer nonemergency transportation services. Transportation can be provided either: (1) on a fee-for-service basis, in which the state Medicaid agency pays transportation providers for each individual service trip; (2) on a managed care basis, in which the state contracts with health plans to provide covered health care services, including transportation, in return for a fixed monthly payment per enrollee; or (3) by contracting with transportation brokers to provide transportation services for beneficiaries who are not in managed care.

To oversee states’ operations of their nonemergency medical transportation programs, CMS:

  • reviews and approves state Medicaid plans and amendments to those plans:
  • periodically issues guidance on nonemergency medical transportation requirements;
  • conducts a range of program integrity activities, such as auditing claims and identifying overpayments, and determining risks and vulnerabilities in transportation services; and
  • provides technical assistance upon request.

GAO found that CMS guidance on nonemergency medical transportation is outdated. For example, CMS issued a guidebook in 1998 on designing and operating a Medicaid nonemergency medical transportation program, yet this guidebook noted that state Medicaid programs could use transportation brokerages only on a limited basis. Since then, the Deficit Reduction Act of 2005 expanded the number of states that could use transportation brokerages. CMS issued a letter to state Medicaid directors reflecting these changes, but it has not assessed its guidance to determine if further updates are needed in light of subsequent changes under the Deficit Reduction Act (Pub. L. 109-171) and other laws such as the Patient Protection and Affordable Care Act (Pub. L. 111-148), which has increased Medicaid enrollment in some states and necessitated more trips for medical services.

(The full version of this story has now been made available to all for a limited time on Thompson’s Grants Compliance Expert site.)


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