Legislation creates new Possibilities for Medical Transportation Providers
Many Medicaid recipients and others who need help with medical transportation often struggle to obtain this vital service.
In an effort to improve access to care, The U.S. Department of Health and Human Services issued a federal “Safe Harbor” ruling for the provision of medical transportation, effective January 6, 2017.
What is the Safe Harbor Regulation?
The ruling opens the door for medical providers across America to provide or facilitate medical transportation for established patients. There are a large number of entities that are now able to get involved in medical transportation without fear of legal repercussions as long as they follow the new guidelines. Eligible medical providers include hospitals, clinics, physician’s offices, dialysis clinics, medical laboratories and physical therapists.
The Safe Harbor ruling protects health care entities from penalties related to a possible conflict of interest should they want to include medical transportation as part of their benefit package. Their involvement is allowed as long as they adhere to the guidelines. A summary of the guidelines are as follows. For detailed commentary on these guidelines, see the final rule.
- Established Patients - Transportation services are to be made available only to existing patients. Transportation cannot be used as an incentive or recruiting tool to induce patients to use a specific medical provider.
- Prohibition on Advertising - The service cannot be advertised in the media, on the healthcare entity’s website or be posted for public display.
- Promotes Access to Care - Transportation must be medically necessary as defined by Medicare or a State health care program including (but not limited to) Medicaid.
- Local Transportation – Patients may be transported a distance of no more than 25 miles for urban areas and no more than 50 miles for rural areas.
- Mode of Transportation - Private vehicles and public transportation are both allowed, however the ruling does not cover luxury, air or ambulance transports.
- Need for Transportation - The health care entity must have a written transportation policy in place that defines criteria under which patients are deemed “in need” of transportation. Specific insurance holders such as Medicare or Medicaid cannot be targeted.
- Per-Trip Billing – Payment must be based on mileage on a per-trip basis, not on a per-member basis.
The New Medical Transportation Landscape
There are several shifts in medical transportation that are likely to occur as a result of the safe harbor ruling:
- Volume of medical trips may increase – Healthcare entities may begin to offer transportation to members who are not covered by Medicaid and who previously did not receive a transportation benefit. Medicaid NEMT trips will continue to be provided.
- New types of providers may be chosen for non-Medicaid trips – Healthcare entities may choose any type of transportation provider to schedule and provide their non-Medicaid trips. They may contract with a taxi company, a TNC such as Uber or Lyft, or may even provide transportation in-house.
- NEMT brokers and providers may handle more non-Medicaid trips – Health care entities may choose to work with NEMT operators for all of their patient transportation – not just Medicaid-funded. This will result in more requests to link individual funding sources to various clients, programs, providers, vehicles, and drivers. Software designed for NEMT can help operators with claims management for multiple funding sources.
- NEMT brokers and providers have an opportunity to increase cost efficiencies – Adding multiple funding contracts, as well as shared booking and costing, can result in a lower average cost per trip.
- Will-calls and same day transport requests will increase – The increase of same-day schedule changes will increase the need for brokers to use a flexible-real time CAD/AVL and scheduling solution.
How NEMT Brokers and Providers can come out Ahead
With TNC providers and in-house transportation as options for non-Medicaid trips, Medicaid NEMT operators need to position themselves as experts who can mitigate risk to compete in this market. TNCs may not require their drivers to have basic safe driver and passenger assistance training or do fingerprint criminal background checks, without which their liability will increase. NEMT operators can bring this potential for liability to their medical and managed care organizations’ attention.
Providers may also say that by using a combined scheduling and notification system, their appointment no-shows will decrease. Additionally, operators may explain that scheduling transportation in-house is a complicated process without intuitive NEMT software to help. NEMT operators already have these systems in place, but medical providers may need to start from scratch.