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 White Paper Examines Medicaid Benefit for Non-Emergency Transportation

A white paper by Leavitt Partners examines Medicaid’s non-emergency medical transportation (NEMT) benefit and makes recommendations on how to improve the integrity of the benefit by ensuring access to qualified transportation providers, harnessing technological tools, and utilizing ride-sharing platforms in an appropriate manner, among other steps federal and state policymakers could take.

Titled, “Moving Forward Together: Opportunities to Improve Program Integrity in Medicaid Non-Emergency Transportation,” the white paper authored by two Leavitt advisors said NEMT offers many Medicaid beneficiaries—on their own or via providers—access to transportation that otherwise would not be forthcoming.

“NEMT enables Medicaid beneficiaries who lack reliable sources of transportation to use a benefit that will ensure they can access their primary care provider, dialysis appointment, child wellness check-up, addiction treatment, and other forms of non-emergent care,” the authors said.

The report noted that patients who are low-income, who have multiple chronic conditions, or who face challenges related to the social determinants of health are too often challenged in accessing reliable transportation to and from health care providers.

This makes the transportation benefit all the more important, the authors said, as NEMT “helps to remove transportation barriers to needed health services, improve health outcomes, and reduce utilization of more expensive emergency services.” This also can have a role in home- and community-based services, managed care plans, and at the facility level, they said.

In the white paper, the authors also call for “vigilance through strong program management and risk management strategies to protect the program from those who would exploit or defraud the program and could cause harm to Medicaid beneficiaries.”

The delivery of Medicaid NEMT services has evolved in the past decade or so, they said, as new opportunities have placed new expectations on the program.

“Abundant research and program audits show the need for additional federal and state actions to improve the program integrity of Medicaid NEMT services,” the authors said. Moving forward, they said it is essential that Medicaid leaders across Medicaid state programs, brokers, managed care plans, and delivery systems work together to improve the integrity of the program for the benefit of patients and the program itself.

To meet these demands for integrity and smooth access for beneficiaries, the authors list the following main recommendations for the Centers for Medicare & Medicaid Services to undertake:

--Update NEMT program integrity review;

--Facilitate collaboration on leading practices;

--Provide technical assistance to states;

--Require basic program integrity; and

--Analyze the Transformed Medicaid Statistical Information System data for insights.

At the state level, the authors said state Medicaid programs should:

--Require public transparency of key Medicaid NEMT data;

--Leverage existing data to continually improve program integrity;

--Position state systems to detect and prevent known fraud schemes;

--Use prior approval strategically;

--Ensure robust complaint and Medicaid appeals processes for beneficiaries;

--Use contracting arrangements to incentivize program integrity and quality; and

--Transition to or between transportation brokers with careful planning.

The white paper can be found at www.leavittpartners.com.

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