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

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

Today’s Agenda Why 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? Reaching across Arizona to provide comprehensive quality health care for those in need

Why the NEMT Changes? Reaching across Arizona to provide comprehensive quality health care for those in need

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

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

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

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

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

What are the NEMT Changes? Reaching across Arizona to provide comprehensive quality health care for those in need

2013 NEMT Changes Per the NEMT Implementation Plan: 7/1/2013 Companies submit copies of insurance for each vehicle. Upon expiration, updated insurance copy submitted to AHCCCS. Proof of vehicle insurance required for individuals not employed by a company. For metered vehicles required copy of licensure from the Department of Weights and Measures. Reaching across Arizona to provide comprehensive quality health care for those in need

2013 NEMT Changes Cont. 7/1/2013 New or re-enrolling Providers must complete online training module and submit training certificate for applications to be processed. Trip tickets required Copy of registration for each vehicle required. Reaching across Arizona to provide comprehensive quality health care for those in need

2013 NEMT Changes Cont. 8/1/13 Claims denied if submitted without trip tickets. 11/1/13 Notice posted prohibiting the issuance of gift and snack cards as enticement (Federal law). Date-of-Birth added to trip tickets. Reaching across Arizona to provide comprehensive quality health care for those in need

2014 NEMT Changes 2/12/14 Registration for federal vehicles accepted (internal policy update). 4/1/14 Tribal business license required of NEMT Providers. (IHS/638 Providers exempt) Logo or company name on each vehicle required. Federal database check for driver criminal activity/traffic violations. AHCCCS will verify Tribal business licenses with Tribes. Reaching across Arizona to provide comprehensive quality health care for those in need

2014 NEMT Changes Cont. 6/1/14 Re-certification of existing NEMT Providers. Site visits will begin in July and are conducted to ensure AHCCCS requirements are being met. Reaching across Arizona to provide comprehensive quality health care for those in need

2013 NEMT Changes 2014 NEMT Changes 7/1/13: 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

Has There Been Outreach to Tribes? Reaching across Arizona to provide comprehensive quality health care for those in need

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

Tribal Outreach Webpage: Regional Tribal Broker Forums 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 Reaching across Arizona to provide comprehensive quality health care for those in need

What Is A Broker and What Does the Broker Model Look Like? Reaching across Arizona to provide comprehensive quality health care for those in need

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

Broker Model Implementation Year 2015: Implementation Year 2016: Provider type 28 (NEMT) will be included in the Broker process. Implementation Year 2016: Provider type 77 (BH Clinics) will be rolled into broker process. Other Provide types will be added at future dates. Reaching across Arizona to provide comprehensive quality health care for those in need

Broker Model Broker 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 quality health care for those in need

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

Just Call the Broker! Reaching across Arizona to provide comprehensive quality health care for those in need

What is the Expected Outcome and What Are the Benefits to Tribes? Reaching across Arizona to provide comprehensive quality health care for those in need

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

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 quality health care for those in need

What is the Broker RFI & RFP Timeline? Reaching across Arizona to provide comprehensive quality health care for those in need

Step 1:NEMT Request for Information (RFI) RFI published August 2013 6 Vendors responded: Medical Transportation Management (MTM) Logisticare Total Transit Veolia Transportation Access2Care National Medical Transport 3 Vendor presentations March 2014 Reaching across Arizona to provide comprehensive quality health care for those in need

NEMT RFI (cont.) Sample questions from the RFI: What types of vehicles are used for general and special populations? How would you operationalize transportation services? Are different approaches utilized for urban vs. rural populations? How would the vendor ensure appropriate billing and tracking of mileage? Describe the workflow of an approval for transportation Describe the population and widely utilized services in rural area and on Tribal lands Reaching across Arizona to provide comprehensive quality health care for those in need

Step 2: NEMT RFP Timeline July 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 Reaching across Arizona to provide comprehensive quality health care for those in need

Step 3: Transition Implementation Plan Member education/outreach Data exchange Transition timeline Continuous tribal consultation Member notification Reaching across Arizona to provide comprehensive quality health care for those in need

AHCCCS Contact: Rebecca Fields: Fee-for-Service Management, rebecca.fields@azahcccs.gov Patricia Garcia: Provider Registration patricia.garcia@azahcccs.gov Bonnie Talakte: Tribal Relations bonnie.talakte@azahcccs.gov Reaching across Arizona to provide comprehensive quality health care for those in need

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

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