Non-Emergency Medical Transportation (NEMT) Broker Model Community Forum

Non-Emergency Medical Transportation (NEMT) Broker Model Community Forum

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Purpose of Forum• Provide information on Non-Emergency

Medical Transportation (NEMT) changes and NEMT Broker Model.

• Seek input regarding the Broker Model• Listen to and document concerns• Many specifics of the Broker Model are

still under development, (i.e., member choice, rate and operational structure).

Reaching across Arizona to provide comprehensive quality health care for those in need

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Today’s AgendaWhy the NEMT Changes? What are the Changes?

Has There Been Outreach to Tribes? What is a Broker?

What Does the Broker Model Look Like? What is the Expected Outcome? What are the Benefits to Tribes?

What is the RFI and RFP Timeline?


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Why the NEMT Changes?


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Issues


“We have been inundated with non-tribal NEMT providers operating on our reservation without tribal authority.” (Tribe)

“The NEMT company I work for closed their office and left town without paying me.” (Provider)“I was left in the middle of town in my wheelchair by an NEMT driver who refused to drive me home because he didn’t want to drive onto the reservation.” (Member)

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Background• Quality of service concerns • High error rate during CMS audit and tribal

concerns around member safety and labor issues

• Prompted program integrity and oversight changes

• Workgroup formed May 2013 - AHCCCS & tribal representatives

• Workgroup submitted recommendations for change

NEMT Implementation PlanReaching across Arizona to provide comprehensive quality health care for those in need

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Background Cont.• Several Providers suspended by

AHCCCS for credible allegations of fraud.

• Tribe has issued Cease & Desist orders against non-tribal Providers.

• Tribe has stopped issuing tribal business licenses to Providers.

• Providers not licensed or authorized by Tribes to operate on tribal lands.


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Background Cont.• Approximately 175 NEMT Providers are

registered with AHCCCS.• NEMT services account for an annual spend of

$65M: NEMT Provider Type 28 (NEMT) accounts

for $43M of this total NEMT Provider Type 77 accounts for $6M

of this total• Other Provider types billing for this service:

Attendant care agencies and mental health clinics


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Current NEMT Providers by County

List of registered NEMT Providers:http://www.azahcccs.gov/commercial/NEMTProviders.aspx


Apache - 24 Mohave - 4

Cochise – 2 Navajo – 15

Coconino – 13 Out-of-State – 7

Gila – 1 Pima – 25

Graham – 1 Pinal – 3

La Paz – 2 Yavapai – 3

Maricopa – 86 Yuma - 1

http://www.azahcccs.gov/commercial/NEMTProviders.aspx

http://www.azahcccs.gov/commercial/NEMTProviders.aspx

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What are the NEMT Changes?


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2013 NEMT Changes Per the NEMT Implementation Plan:• 7/1/2013

o Companies submit copies of insurance for each vehicle. Upon expiration, updated insurance copy submitted to AHCCCS.

o Proof of vehicle insurance required for individuals not employed by a company.

o For metered vehicles required copy of licensure from the Department of Weights and Measures.


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2013 NEMT Changes Cont.• 7/1/2013

o New or re-enrolling Providers must complete online training module and submit training certificate for applications to be processed.

o Trip tickets required o Copy of registration for each vehicle

required.


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o Claims denied if submitted without trip tickets.

• 11/1/13o Notice posted prohibiting the issuance of

gift and snack cards as enticement (Federal law).

o Date-of-Birth added to trip tickets.


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2014 NEMT Changes• 2/12/14

o Registration for federal vehicles accepted (internal policy update).

• 4/1/14 o Tribal business license required of NEMT

Providers. (IHS/638 Providers exempt)o Logo or company name on each vehicle

required. o Federal database check for driver criminal

activity/traffic violations.o AHCCCS will verify Tribal business licenses with

Tribes.Reaching across Arizona to provide comprehensive

quality health care for those in need

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o Re-certification of existing NEMT Providers.

o Site visits will begin in July and are conducted to ensure AHCCCS requirements are being met.


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2013 NEMT Changes 2014 NEMT Changes7/1/13:• New or re-enrolling Providers must complete on-

line training and submit training certificate.• Trip tickets required• Copy or registration required for each vehicle• Companies submit copies of insurance for each

vehicle. Updated insurance copy submitted to AHCCCS by Companies.

• Proof of vehicle insurance for individuals not employed by a company.

• Metered vehicles provide copy of licensure from Dept. of Weights & Measures.

2/12/14:• Registration for federal vehicles accepted (internal policy

update)

8/1/13:• Claims denied if submitted without trip tickets.

4/1/14:• Tribal business license required of NEMT Providers• Logo or company name required on each vehicle• Federal data base check for driver criminal activity/traffic

violations.• AHCCCS will verification Tribal business licenses with Tribes

6/1/14:• Recertification of existing NEMT Providers.

11/1/13:• Notice posted prohibiting issuance of gift and snack

cards as enticement (federal law)• DOB added to trip tickets

7/14:• Site visits begin and are conducted to ensure requirements are

being met

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Has There Been Outreach to Tribes?


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Tribal Outreach• Tribes informed and input received via Tribal

Consultation meetings. May 30 2013 January 22, 2014 April 17, 2014 June 12, 2014

• Information distributed by Tribal Relations Office

• NEMT Workgroup Meetings held each month from July to December 2013.


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Tribal Outreach• Webpage:

o http://www.azahcccs.gov/commercial/NEMTBroker.aspx

• Regional Tribal Broker Forums July 21, 2014: 1-3 pm, Phoenix July 24, 2014: 10-12 pm, Tucson July 31, 2014: 12-2 pm, Flagstaff

• Continue to update and obtain input from tribes


http://www.azahcccs.gov/commercial/NEMTBroker.aspx




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What Is A Broker and What Does the Broker Model Look Like?


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What is a Broker?

• “One who works as an agent for others in negotiating contracts, purchases or sales”

• “A person who buys and sells goods or assets for others” Merriam-Webster

• A Broker is not an NEMT Transportation Provider.


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Broker ModelImplementation Year 2015:

o Provider type 28 (NEMT) will be included in the Broker process.

• Implementation Year 2016:o Provider type 77 (BH Clinics) will be rolled

into broker process.

• Other Provide types will be added at future dates.


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Broker ModelBroker will:• Operate statewide • Coordinate NEMT transportation for Fee-for-

Service members as appropriate to meet member needs.

• Will not provide NEMT services • Contract with Providers to complete

services.• Be required to have a Tribal Liaison

(representing an Arizona Tribe) on staff.Reaching across Arizona to provide comprehensive


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Broker Model Cont. Broker will:• Serve as single point-of-contact to request

transportation. • Ensure NEMT Providers meet AHCCCS &

Broker requirements to be considered for inclusion into the NEMT Provider Network.

• Be in compliance with AHCCCS oversight standards

• Ensure that Providers have tribal business licenses


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Just Call the Broker!


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What is the Expected Outcome and What Are the Benefits to Tribes?


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Expected Outcome• Improved accountability and

oversight of NEMT Providers.• Better transportation service to

AHCCCS members.• Culturally competent Broker• A “one-stop shop” for AHCCCS

members. Member will just call the Broker.

• Tribal enforcement of licensing procedures


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Benefits to Tribes• Opportunity for Tribes to select new

Providers to operate in their communities.

• Tribes can determine which Providers will receive Tribal business licenses.

• Strong tribal input, in collaboration with Broker, will result in appropriate Provider network.

• Tribe/member issues quickly resolved with assistance of Broker and AHCCCS.Reaching across Arizona to provide comprehensive


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What is the Broker RFI & RFP Timeline?


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Step 1:NEMT Request for Information (RFI)• RFI published August 2013• 6 Vendors responded:

o Medical Transportation Management (MTM)o Logisticareo Total Transito Veolia Transportationo Access2Careo National Medical Transport

• 3 Vendor presentations March 2014


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NEMT RFI (cont.)• Sample questions from the RFI:

o What types of vehicles are used for general and special populations?

o How would you operationalize transportation services?

o Are different approaches utilized for urban vs. rural populations?

o How would the vendor ensure appropriate billing and tracking of mileage?

o Describe the workflow of an approval for transportation

o Describe the population and widely utilized services in rural area and on Tribal lands


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Step 2: NEMT RFP TimelineJuly 1, 2014 – August 29, 2014 RFP/ scope of work development

August 29, 2014 RFP document final

September 1-30, 2014 CMS approval of RFP (30 days)

October 1, 2014 Publication of RFP

October 23, 2014 Questions from Offerors due

October 23-October 30 AHCCCS gathers answers to questions

October 31, 2014 Solicitation Amendment posted with answers

December 3, 2014 Proposals Due

December 4 -31, 2014 Evaluation of Proposals

January 5-16, 2015 Vendor Presentations

January 19-30, 2015 Final scoring and Recommendation for award

February 1-28, 2015 Send to CMS for Review and Approval of Award

March 1 2015 Award

March - August Implementation Period

September 1, 2015 Contracted NEMT services begin


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• Member education/outreach• Data exchange• Transition timeline• Continuous tribal consultation• Member notification


Step 3: Transition Implementation Plan

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AHCCCS Contact:

• Rebecca Fields: Fee-for-Service Management, [email protected]

• Patricia Garcia: Provider Registration [email protected]

• Bonnie Talakte: Tribal Relations [email protected]


mailto:[email protected]




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Questions?


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Thank You.


Documents

Non-Emergency Medical Transportation (NEMT) Broker Model Community Forum