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Wednesday, October 18 2017

Orlando, Fla. —2017 has brought a complete new game for Non- Emergency Medical Transport businesses.

•New brokers
•New competition and
•New political inputs that will shake up markets and businesses across the country.

NEMT companies that can provide efficient, reliable and scalable services will thrive, as will those that can use change to grasp more market share. New entrants can always be an opportunity for other providers to realize that their service could be performed in new ways.

Through 2016 there was a high flow of technology companies entering the NEMT market. Large technology companies like Uber, Lyft, and other start-ups have partnered with providers, state governments and hospital systems to leverage the growing fleets of Transportation Network Companies (TNCs) to provide NEMT service.

Medicaid playing a key role in reshaping NEMT services.

Despite the expansion of NEMT services and of brokerage as the preferred model for delivering NEMT, the benefit has drawn increased scrutiny within Medicaid.

Program integrity lapses have damaged NEMT’s reputation. Like other parts of the Medicaid program, NEMT is not free from fraud and abuse. Over the past few years, investigators have uncovered bad conduct by some NEMT drivers and vendors.

Then came the brokerage model, designed to address and mitigate these problems through capitated arrangements that insulated Medicaid budgets from fraud losses and encourage brokers to root out abuses. To address program integrity concerns, Congress could require states to manage the NEMT benefit by contracting with brokers, incentivize states to choose the broker option, or require states that do not use brokers to use utilization management tools commonly used by brokers, such as prior authorization.

NEMT is one of many parts of the Medicaid program that will likely be subject to experimentation in the coming years. A March letter from HHS secretary Tom Price and CMS administrator Seema Verma promises to “empower” states seeking flexibility in any of seven listed areas, one of which is NEMT.

Its importance and benefit to the bottom line has been proven by several studies which noted that missing routine, preventive care can lead to unnecessary costs and hospitalization. Although it is difficult to isolate the impact of transportation on health outcomes, a study conducted by Florida State University concluded that if only 1 percent of the medical trips funded resulted in the avoidance of an emergency department hospital visit, the payback to the State would be 1108 percent, or about $11.08 for each dollar the State invested in its medical transportation program. According to the study, “Overall, the State of Florida invested $372,264,302 in these transportation disadvantaged programs in 2007. These funds generated benefits of $3,172,813,246.31, which is a payback of 835%, or $8.35 per each dollar invested in these programs.”

Research also shows that transportation is one of the most common barriers faced by low-income populations in accessing timely and necessary medical care, and NEMT fills this access gap by providing the appropriate and least costly method of transportation. Given the high needs of the Medicaid population and the trend across health insurance toward greater use of non-medical benefits, including NEMT, to improve the efficiency of medical care, we are confident that NEMT will continue to be an important part of Medicaid.


Posted by: Annie Rodriguez AT 01:29 pm   |  Permalink   |  0 Comments  |  Email

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