While federal changes to non-emergency medical transportation (NEMT) can have nationwide consequences, most often changes to the Medicaid benefit occur at the state level. State’s often have an easier time making small or large scale changes to NEMT, whether through the way they provide the Medicaid NEMT benefit, to funding new or innovative NEMT programs for other populations such as older adults, or to access other social determinants of health. This blog highlights recent state-led changes around NEMT.

Sacramento, Calif.

Earlier this month, Assembly Bill 970 passed the California State Legislature with bipartisan support. Introduced by Rep. Rudy Salas (D-Bakersfield), AB970 will establish a grant program through the State Air Resources Board’s Clean Mobility Options program for disadvantaged and low-income communities to provide non-emergency medical transportation to and from health care appointments for seniors and persons living with a disability by utilizing zero-emission and near-zero emission vehicles. It will also require the California Department of Aging to hold a public workshop focused on addressing the barriers to providing transportation to and from non-emergency medical services for older individuals and persons with a disability. AB970 now awaits final consideration at the Governor’s office.

Tallahassee, Fla.

On Sept. 4, 2019, the Florida Agency for Health Care Administration (AHCA) released a notice of proposed rule (NPR) that would clarify policy updating the Florida Medicaid Non-Emergency Transportation Services Coverage Policy. The NPR would specify that transportation network companies are eligible to render Florida Medicaid NEMT services. AHCA found that this provision would not have an adverse impact on small businesses or increase regulatory costs more than $200,000 in aggregate over the year following the implementation of the rule. AHCA is no longer accepting comments, but the notice of proposed rule can be viewed here.

This NPR is a required action under legislation (CS/HB 411) recently passed by the Florida State Legislature. CS/HB 411 (PDF) allows transportation network companies (TNCs) to provide NEMT to Medicaid patients if they are under contact with a Medicaid Managed Care plan or under contract/receiving referrals from a transportation broker who is under contact with AHCA or a Medicaid Managed Care plan. Additionally, the bill states that the requirements for TNCs providing NEMT may not exceed those already imposed under state law, except as necessary to conform with state and federal Medicaid Requirements. As other states look at similar legislation, Florida will be an example to watch regarding the outcomes of this change in NEMT policy.

Farmington, Conn.

A new model for NEMT has emerged in Connecticut through skilled nursing homes and housing facilities. Historically, most NEMT in the state is handled by for-profit companies that focus solely on transportation. However, in this new model, in lieu of using the for-profit companies, these nursing homes and housing facilities are transporting their own Medicaid residents to health appointments. New Horizons, Inc., a nursing home that provides housing and support services for people with physical disabilities, is the first non-profit to use this model, providing its 200+ residents over 500 trips since the program’s launch in April. New Horizons’ program has a unique advantage in that it is already familiar with the specific needs of its residents, including their mobility and transportation needs. They have supplied wheelchair-accessible recreational transportation for more than 30 years, and have already received an outpouring of support from their clients regarding the expansion of these historical services into health care appointments. New Horizons has been working with the state’s Medicaid broker, Veyo, very closely throughout their expansion into the NEMT space. Read more about the program here.

National

The Center for Medicaid and Medicare Studies (CMS) on Sept. 16, 2019, announced a one-year extension of the prior authorization demonstration for repetitive, scheduled non-emergency ambulance transportation. The program will now run through Dec. 1, 2020. The demonstration applies to D.C., Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia and West Virginia. The demonstration started in 2014, and Monday’s announcement is CMS’ third extension. Read more about the program here.

Did I miss something going on in your state? Share your updates via email with king@ctaa.org.