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N0N-EMERGENCY MEDICAL TRANSPORTATION

N0N-EMERGENCY MEDICAL TRANSPORTATION

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N0N-EMERGENCY MEDICAL TRANSPORTATION

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  1. N0N-EMERGENCY MEDICAL TRANSPORTATION August 18, 2011 North Carolina Division of Medical Assistance

  2. Overview of Medicaid Transportation Policy • Title XIX of the Social Security Act does not specifically mandate provision of transportation as a Medicaid service. However, federal regulations and interpretations of the Act authorize states to cover transportation as either an optional service and/or as an administrative service. • North Carolina has federal approval to claim transportation as an administrative service reimbursement for transportation arranged and paid by the county department of social services (DSS) as an agent for the state. North Carolina Division of Medical Assistance

  3. Overview of Medicaid Transportation Policy • Medicaid only pays for transportation if the recipient receives a Medicaid covered service provided by a qualified Medicaid provider (enrolled as a NC Medicaid provider). Medicaid only pays for the least expensive means suitable to the recipient’s needs. • The county DSS must arrange for or provide transportation to Medicaid covered services for authorized recipients if the recipient is unable to arrange and/or pay for transportation. North Carolina Division of Medical Assistance

  4. Overview of Medicaid Transportation Policy • If the county DSS arranges transportation, the arranged transportation must meet the recipient’s needs. The transportation scheduler(s) must be aware of available transportation sources in the county and locality where the recipient lives. The scheduler must make use of the most appropriate and cost-effective method, including free transportation, for providing transportation services in each situation. North Carolina Division of Medical Assistance

  5. Overview of Medicaid Transportation Policy • Documentation must support expenditures and requests for reimbursement for transportation services provided to Medicaid recipients. The DSS may elect to maintain the documentation in the Income Maintenance case record, a transportation record for the recipient, or centralized system. North Carolina Division of Medical Assistance

  6. Overview of Medicaid Transportation Policy • DMA reimburses the county for the Federal and State share of certain transportation costs for direct services provided to recipients, or costs are reimbursed at the 50% administrative rate. • DMA-2055 Reimbursement Request Form, and DMA-2056 Medicaid Transportation Log, are to be completed and submitted for reimbursement. North Carolina Division of Medical Assistance

  7. Inconsistent Application of Policy Statewide • Some county DSS offices have on-site Transportation Coordinators. • Some county DSS offices have written transportation plans. • Some county DSS offices have contracts with transportation providers. • Counties have different ‘No Show’ policies, some have no policy. North Carolina Division of Medical Assistance

  8. Current Medicaid Transportation Costs • Approximately $43M for State Fiscal Year 2010 • Overall Medicaid Budget $9,450,000,000 • Required Budget Reductions • $356,151,356 (state) • 2% rate reduction • Reductions in utilization of services – limits on services • $90 m thru CCNC • Increased PI recoupments • Assessments • More Prior authorization • Must meet budget targets or additional cuts will occur such as • Additional rate cuts • Elimination of services North Carolina Division of Medical Assistance

  9. GAPS – 2007 Audit Findings • The Medicaid Quality Assurance Section of the Division of Medical Assistance conducted a review of the county reimbursements for Medicaid transportation costs. The purpose of the review was to evaluate the accuracy of Medicaid transportation reimbursements which fall outside the automated process for Medicaid claims payments. The focus of the review was to verify that recipients were authorized for Medicaid on the dates transportation services were provided and to verify that recipients received Medicaid covered services on the dates of the Medicaid transportation. • The Qualify Assurance staff requested from counties, Transportation Logs, DMA-2056 and Reimbursement Request forms, DMA-2055. North Carolina Division of Medical Assistance

  10. GAPS – 2007 Audit Findings • The Qualify Assurance Section reviewed 15,843 claims with Medicaid reimbursements totaling $397,892.52. • They found that 1,567 claims totaling $38,379.59 did not meet the criteria required by policy to claim reimbursement. • This resulted in an overall error rate of 9.89% based on the number of ineligible claims and a payment error rate of 9.65% based on the dollar amount of ineligible claims. • The individual counties payment error rates ranged from 0% to 41.41%. North Carolina Division of Medical Assistance

  11. GAPS – 2007 Audit Findings • 1068 incidents of No evidence that a medical service was received on the date of transport. • 164 - Transportation provided to non-allowable services such as WIC voucher pick up, after school care and employment. • 113 - Recipient was not authorized for Medicaid on the date transportation was provided. North Carolina Division of Medical Assistance

  12. GAPS – 2007 Audit Findings • 91 Reimbursements claimed for transportation provided for MQB and NC Health Choice recipients. • 77 Reimbursements claimed when recipient failed to keep transportation appointment or cancelled medical appointment. • 16 Transportation reimbursements claimed for lunches on trips that did not include an overnight stay. North Carolina Division of Medical Assistance

  13. GAPS – 2007 Audit Findings • 14 - Transportation was provided for Special Assistance recipients not participating in the SA In Home Program. • 13 -Transportation claimed when the only medical service provided was received at the recipient’s home as home health or personal care services. • 3 - Transportation was billed twice for same trip. North Carolina Division of Medical Assistance

  14. GAPS – 2007 Audit Findings • 2 - Medicaid identification number (MID) and corresponding recipient name did not match. Unable to determine if valid claim existed. • 2 - Transportation was provided for recipient residing in skilled nursing facility. • 2 - Medicaid reimbursement claimed when transportation provider was unable to transport recipient. North Carolina Division of Medical Assistance

  15. GAPS – 2007 Audit Findings • 1 - County paid provider directly for ambulance transportation rather than requiring ambulance provider to bill Claims Contractor. • 1 - County paid for attendant‘s “wait time”. North Carolina Division of Medical Assistance

  16. Goals/Objectives Timeline • Develop and write a comprehensive statewide Transportation Plan, to be provided to DMA no later than October 15, 2011. Transportation Plan will use existing DMA Transportation policy as the baseline. Transportation Plan will define how DSS and Transportation Providers will work together to achieve expected outcomes. • The Plan will set measurable parameters for reducing costs such as determining $amount of budget reductions to be achieved; will establish a timeline for reducing costs this FY; and will establish consequences for failing to reduce costs. North Carolina Division of Medical Assistance

  17. Goals/Objectives Timeline • The Plan will set measurable parameters for reducing the error rate such as requiring %reduction of error rates; will establish a timeline for reducing the error rate this FY; and will establish resulting consequences for failure to reduce errors. • The Plan will set uniform standards and requirements for Transportation Providers to use in claiming reimbursement including the use of standard logs, established codes, rates and provider requirements; and will establish consequences for failure to follow uniform standards and requirements. North Carolina Division of Medical Assistance

  18. Goals/Objectives Timeline • The Plan will establish reporting requirements and performance posting of quality indicators for DSS and Transportation Providers. • Establish a Medicaid Transportation Training and Communication Plan for county DSS that will address current policy requirements and provide State direction, oversight and expectations. The training plan will utilize the findings of audits to drive the curriculum content. North Carolina Division of Medical Assistance