MO HealthNet NEMT & Statewide Managed Care Missouri Department of Social Services MO HealthNet Division August 22, 2018

Fee-for-Service broker is: Purpose of NEMT Program “to assure transportation to MO HealthNet participants who do not have access to free appropriate transportation to and from scheduled MO HealthNet-covered services.” – Section 22 of any provider manual CMS allows MHD to have one statewide transportation broker to coordinate transportation providers. Fee-for-Service broker is:

NEMT services are NOT available for: Services included under a 1915(c) Home and Community-Based Services Waiver Comprehensive Substance Treatment Abuse and Rehabilitation (CSTAR) programs unless authorized by DMH (with exceptions) Psychosocial rehabilitation services under the Community Psychiatric Rehabilitation (CPR) programs (with exceptions) Case Management Services DME provider services when it has a free delivery or mail-order services

NEMT services are NOT available for (cont’d): MO HealthNet-covered services provided in the home such as personal care, private duty nursing, home health, etc. Pharmacy Discharge from a nursing home

Fee-For-Service (FFS): Contract with Transportation Broker Delivery Methods Fee-For-Service (FFS): Contract with Transportation Broker LogistiCare Solutions, LLC 1807 Park Solutions Drive, Ste 518 St. Louis, MO 63146 866-269-4717

Delivery Methods (cont’d) Managed Care Organizations (MCOs): Arranged Directly Through the Health Plans Transportation Broker - MTM

Eligibility https://dss.mo.gov/mhd/providers/education/docs/NEMT.pdf

Eligibility Cont’d. These two slides are taken from our website. We have all programs out there with documents like these. Click on this link to take you directly to the NEMT doc, but if you want to see all other programs and who is eligible, do the following: Go to www.dss.mo.gov/mhd Click on “Information for Providers” on the right-hand side of the page Click on “Fee-for-Service” green box Locate the section titled “Education” Click on “Benefit Tables” https://dss.mo.gov/mhd/providers/education/docs/NEMT.pdf

Eligibility Cont’d. Must be receiving MO HealthNet benefits through a federal category of assistance Excludes: Blind Pension CHIP children over 150% of FPL State-only funded Child Welfare Services Women’s Health Services MORx only QMB only Gateway to Better Health

Eligibility Cont’d. Must NOT have access to any other transportation that is: Free Provided through a Public Entity (Public Transportation) NEMT through the Medicare program Locked into a Hospice provider Must be eligible on the date of service And have met SPEND DOWN requirements!

Arranging Transportation Reservations must be obtained at least 2 business days for urban counties or 3 business days for rural counties PRIOR to the medical appointment. Reservation Hotline: 1-866-269-5927 For the Hearing Impaired (TTY): 1-866-288-3133 In State Fiscal Year 2017, LogistiCare averaged 67,199 reservation calls/month! This groups’ population they serve will most likely fall into the rural areas/counties and it is a good idea to tell their clients and/or patients to arrange transportation 3 days in advance of the medical appointment if possible.

Travel Standards (Urban vs. Basic and Rural Counties) Established by the Missouri Department of Insurance Based on: Provider and Service Type Size of the County of Pick-Up Urban Counties – Population of 200,000+ Basic Counties – Population between 50,000 and 199,999 Rural Counties – Population < 50,000

Modes of Transport Public Transit / Bus Tokens* Multi-Passenger Van Taxi Para-Lift Van Stretcher Van Ambulance (for non-emergent transport only) Volunteer Driver (if approved by MO HealthNet) * Public Transit / Bus Tokens are prohibited in certain situations. See page 446 of any provider manual (Section 22 is for NEMT services). Situations where public transit is prohibit include: high-risk pregnancies, pregnancy after the 8th month, high-risk cardiac conditions, severe breathing problems, if the walk is more than three (3) blocks or more than one-quarter (1/4) of a mile, whichever is the least amount of distance, to the bus stop, and any other circumstance in which utilization of public transit/bus token/pass may not be medically appropriate. Gas Reimbursement

Gas Reimbursement Requirements The broker will verify that the participant actually saw medical service provider on the date of request for reimbursement. The broker will verify the mileage from the participant’s trip origin street address to the trip destination street address. If a street address is not available, the broker will use the zip code. Gas reimbursement is made at the IRS standard mileage rate for medical reason in effect on the date of service. Additional information regarding gas reimbursement: The broker will limit the participant to no more than 3 transportation legs (2 stops) per day unless the broker received prior authorization from MO HealthNet. The broker will also ensure that the transportation provided to the participant was comparable to transportation resources available to the general public.

Quarterly Trips Source: LogistiCare Solutions, Inc.

Transportation Assistance Curb-to-Curb Door-to-Door Requires statement of medical necessity from the medical provider Attendant provided by the transportation provider Only available to children Cannot take the place of a parent or guardian

Ancillary Services Meals and Lodging Only authorized if: Medical appointment requires an overnight stay Volunteer, community or other ancillary services are unavailable at no cost to the participant If a MO HealthNet-eligible child is inpatient in a hospital setting, ancillary services are provided for one parent/guardian when: Hospital does not provide ancillary services without cost to the participant’s parent/guardian, AND Hospital is more than 120 miles from the participant’s residence, OR Hospitalization is related to a MO HealthNet-covered transplant service.

Waiver Services If a participant is going to a waiver-covered service, they must use waiver transportation (coordinated through the waiver program at DMH, but still uses LogistiCare). If a participant is going to a fee-for-service MHD-covered service, they may use NEMT for transportation.

Pick-Up / Drop-Off Requirements 15 minutes either side of scheduled pick-up Drop Off No more than 30 minutes prior to scheduled appointment Hospital Discharge Within 3 hours of request

Where’s My Ride Use when transportation provider is more than 15 minutes late Do NOT call the transportation provider directly – leave that to the transportation broker! Toll Free Number: 1-866-269-5944 When a participant contacts the transportation provider directly, LogistiCare is unaware of the problem. Plus, the transportation provider may promise things that they cannot fulfill. By calling the “Where’s My Ride” line, the transportation provider’s record gets updated to show a late arrival and/or no-show, which may impact their eligibility to continue being a transportation provider for MO HealthNet participants. It is a way to keep those transportation providers accountable for their actions and also alerts LogistiCare in case the broker made a mistake in their work and/or there’s a problem with their systems. It’s the hub, the coordinator, etc. Makes things cleaner.

NEMT Denials Participants have the right to request a State Fair Hearing within 90 days from the denial. Requests can be made by the participant, a family member, a clergy person, a friend or an attorney. Decisions are made within 90 days from the date the participant requested the hearing. To request a State Fair Hearing, participants may call the Participant Services Unit at 1-800-392-2161 (toll free) or 573-751-6527.

Participant Rights Participants have the right to be treated with respect and dignity. Participants have the right to privacy. Participants should be allowed to exercise their rights without being worried about how the NEMT program or its providers will treat them.

Complaints Types of Complaints: Driver Late / Did Not Show Up Condition of Vehicle Treatment by Driver Treatment by Call Center Staff Rider No-Show All calls to the Call Center are recorded! MHD staff also receive complaints through the Provider Communications line, Participant Services line, calls into the Director of Social Services’ phone line, Governor’s office, Legislature members, etc. Those are handled by MHD staff who work with LogistiCare to ensure the complaints and/or issues are resolved. MHD sees approximately 3 to 10 a week. In addition, LogistiCare is required to provide weekly, monthly and quarterly reports indicating complaint rates, trip rates, numbers, etc. MHD monitors those numbers closely and question any off-trend data. We also meet with LogistiCare executive and quality staff monthly via Webex (in person about every 3 months).

To Report a Complaint… Call LogistiCare Call Center Hotline: 1-866-269-5927 Where’s My Ride Line: 1-866-269-5944 MO HealthNet Stakeholder Services Unit (formerly Participant Services Unit): 1-800-392-2161

Champion Provider Program New program from LogistiCare – launched in 2018 Champion Providers must meet certain criteria to qualify Agreements with facilities to become the assigned transportation Facilities/providers targeted – a history of struggle for the patients in having on-time transportation to and from their appointments

Champion Provider Program (cont’d.) A dedicated transportation provider (with a history of quality and consistency) may be assigned to several facilities in close proximity to each other Allows transportation provider to take on more volume in a smaller coverage area. Provider has less empty-miles and ability to transport multiple MO HealthNet participants Transportation provider will be close by at all times since it is serving an assigned geographic location.

Champion Provider Program (cont’d.) Current Stats of Program: 44 facilities are in the program (Dialysis Facilities) 38 are in the process of joining Champion program is expanding to the whole state On-time performance has greatly improved which is vital for participants in receiving their full needed treatment. As we know, dialysis facilities have historically struggled in getting their patients to all of their appointments and on-time. That’s because they have appointments multiple times a week. This champion program is on-trend to improving the patients getting to their appointments. In fact, I have noticed a decrease in the amount of email referrals from dialysis patients stating they didn’t have a ride and/or got there late. Many times, the appointment times are flexible, so many plan their trips to the facilities for early in the morning just in case there are transportation issues. This aids the facility in patient processing and wait times as well. Eventually, the push to include additional provider types will increase. Dialysis was a specific need that LogistiCare identified initially. Champion program started out as a pilot project in the StL area. It has been so successful, that the company is looking at the program to expand to other states and areas in the country. LogistiCare is very hands-on with the transportation providers. They make site visits to potential Champion providers. Provide seminars and outreach about how it works. Coordinates meetings with the facilities and the transportation providers.

MO HealthNet Managed Care and NEMT MCOs must make NEMT available to participants to and from health care services for those who do not have the ability to provide their own transportation. MCOs must also make NEMT available to participants to and from health care services that are carved out of the MO HealthNet Managed Care contract (i.e., pharmacy, certain behavioral health care services).

MO HealthNet Managed Care and NEMT (cont’d.) The MCOs are required to follow all MO HealthNet Fee-for-Service policies and requirements in regard to eligibility for transportation. Ancillary Services are available to Managed Care participants the same as Fee-for-Service participants. Providers and participants should become familiar with each individual MCOs’ processes for obtaining transportation through their transportation broker.

To schedule a ride with Home State Health, call 1-855-HOME (4663). To schedule a ride with MissouriCare, call 1-800-322-6027. To schedule a ride with UnitedHealthcare Community Plan, call 1-866-292-0359.

Additional Information Contact: De’Nel Holliday Social Services Manager over NEMT Program Karen Pendleton Medicaid Specialist over NEMT Program (573) 751-6963 -OR- Ask.MHD@dss.mo.gov