The Past, Present & Future of NEMT
Winter 2020
Lack of Transportation Leaves Millions on the Sidelines
Featured Articles:
Closing the Trap Door by Spotting the Red Flag
18
5
45
49
NEMTAC Board of Directors
Medicare is Wheeling Patients Towards NEMT Options
Maximize Reimbursement on "Not-at-Fault" Accidents
SDOH Opportunities for NEMT Providers
Letter from NEMTAC's Executive Director
NEMTAC Advisory Board Members
Top 10 Tips to Begin Contracting with Insurance Companies
48
38
Improving Patient Flow in the Next Decade
Leap into 2020 with Turnkey Accessible Vehicles
9
Cutting Medicaid NEMT Will Harm Public Transportation
28
Scaling Your NEMT Business in the New Decade
3
30
41
8
25
13
15
Medicare Advantage Plans Offering Transportation Benefits
Table of Contents
22
Medicaid-Funded NEMT Still at Risk in Washington
4
How to Provide Great Service as a NEMT Provider
34
NEMTAC Welcomes Eliot Kalter to Board of Directors
Welcome to the winter edition of NEMT Today. I would be remiss if I didn’t start by thanking Steve Lewis, our former NEMTAC board president for all the support and mentorship he has provided NEMTAC over the past 18 months. Steve’s term as board president ended at the end of 2019. It has been a tremendous honor to serve with Steve at the helm of the NEMTAC board of directors. We have accomplished some remarkable milestones under his leadership. I have been reflecting on our 2019 achievements and busy planning for our 2020 initiatives. The successful launch of the Certified Transport Specialist (CTS) training, publishing NEMT Today magazine and holding the Inaugural NEMTAC conference are just a few achievements the team has accomplished. Is it possible to top 2019 achievements? The answer is a resounding “yes”. As we look forward to 2020, our advisory boards are already hard at work implementing our new strategic goals. As you will notice in this edition, there are several articles addressing the integration of medical transportation into Medicare Advantage plans. There is an unprecedented opportunity for NEMT providers to become a critical partner within the healthcare continuum and we have rolled up our sleeves to support this important trend. I am excited about what the upcoming year has in store for our organization and hope you enjoy this edition of NEMT Today. Thanks,
A Letter from NEMTAC's Executive Director
Stanton Sipes Board Member
Melissa Jankowski Executive Director
Chris Kelly Board Member
David Marhoffer, Board Member, not pictured
Peter Hicks Board Vice President
Gail Bauhs Board Member
Eliot Kalter Board Member
Michael Shabkie NEMTAC Founder / Board Treasurer
Board of Directors
Header
Lorem ipsum dolor sit amet, consetetur sadipscing elitr, sed diam nonumy eirmod tempor invidunt ut labore et dolore magna aliquyam erat, sed diam voluptua. At vero eos et accusam et justo duo dolores et ea rebum. Stet clita kasd gubergren, no sea takimata sanctus est Lorem ipsum dolor sit amet. Lorem ipsum dolor sit amet, consetetur sadipscing elitr, sed diam nonumy eirmod tempor invidunt ut labore et dolore magna aliquyam erat, sed diam voluptua. At vero eos et accusam et justo. Lorem ipsum dolor sit amet, consetetur sadipscing elitr, sed diam nonumy eirmod tempor invidunt ut labore et dolore magna aliquyam erat, sed diam voluptua. At vero eos et accusam et justo duo dolores et ea rebum. Stet clita kasd gubergren, no sea takimata sanctus est Lorem ipsum dolor sit amet. Lorem ipsum dolor sit amet, consetetur sadipscing elitr, sed diam nonumy eirmod tempor invidunt ut labore et dolore magna aliquyam erat, sed diam voluptua. At vero eos et accusam et justo. Tota phaedrum sapientem vis ad, in illum habemus eum. Justo voluptaria ex sed, liberavisse delicatissimi usu cu. Illud legere vituperata ne vix. Quo ei noster omittam, stet molestiae consequuntur quo ad. Cu magna evertitur delicatissimi has, ludus noster pertinax est id. Mel et epicurei mediocritatem, dicunt iisque propriae ei nam. Brute vitae quidam sea in, ne per persius docendi. Probo omnium ullamcorper eos ne. Ne mei mutat omnes. Modus fuisset ad per, nam illud nihil eu, augue adipisci in vix. Pri no sumo forensibus philosophia. Fabulas signiferumque qui ea, simul insolens per ei.
Advisory Boards
Accreditation - Michael Shabkie, Co-Chair and Eric Lane, Co-Chair Carlos Ayestas, VP of Client Relations, Priority Transportation Services Dori Boyle, Medicaid Program Specialist, Idaho Department of Health & Welfare Paul Broussard, CEO, MediTrans, LLC Mindy Ginsberg, VP of Sales, FR Conversions Stan Gitin, Managing Director, Clarion Medical Sarah Hope, CEO & Founder, Vertical Identity Background Screening & Drug Testing Melissa Jankowski, Executive Director, NEMTAC Eric Lane, Commercial Risk-National Accounts, Bankers Insurance Jim Smith, President, JC Paratransit Solutions Michael Shabkie, Board Member, NEMTAC Roddrelle Sykes, Commercial Lines Producer, Frost Insurance William van der Linde, President, Old Dominion Transportation Group, LLC Scott West, CEO, NEMT Solutions, LLC Compliance and Regulatory - Michael Shabkie, Co-Chair and Dan Reid, Co-Chair David Aboudi, Partner, Aboudi Legal Group Maggie Adams, Owner, EMS Financial Services Michael Adelberg, Principal and Healthcare Strategy, Faegre Baker Daniels Gautam Aggarwal, MD, Medical Director, Arizona Complete Health Laura Fleet, CEO and Co-Founder, SendaRide, Inc Crystal Ford, Complaince Officer, Orange County EMS Melissa Jankowski, Executive Director, NEMTAC Martha Kendall, Network Oversight Manager, Tennessee Carriers David McDonald, President, QMAC Consulting Jennifer Place, VP Quality Assurance, Compliance & Policy, MAS Mark Porterfield, Owner, Careavan Transports Dan Reid, Owner, Grove Transit Michael Shabkie, Board Member, NEMTAC Kevin Teasdale, Managing Partner, Secure Medical Transportation Teresa Wilke, Owner / Principal, Silver Arrow Strategies
Advisory Boards continued ...
Certification - Peter Hicks, Co-Chair and Jim Adkins, Co-Chair Kelly Addy, Owner, Clear Choice Express, LLC Jim Adkins, Owner, SouthStar Emergency Medical Services Howard Berkowitz, VP Business Ops, H&S Personal Car Service & Consulting, Inc Tom Fairhurst, President, Highland Patient Transport Peter Hicks, Board Member, NEMTAC Melissa Jankowski, Executive Director, NEMTAC Miriam Manary, Sr Engineering Research Asso, Univ of Mich Transportation Research Inst Courtney Muchugu, President, United Transportation Group Ray Shanahan, Director of Sales, CareerCert Resource and Conference - Peter Hicks, Co-Chair and Travis Draney, Co-Chair Mike Chatelain, Commercial Sales Exec, Risk Services of Louisiana, a Leavitt Group Co Travis Draney, Owner, Nonpareil Care, LLC Peter Hicks, Board Member, NEMTAC Melissa Jankowski, Executive Director, NEMTAC Manuel Leon, VP of Business Development, Alivi Tammy Mihm, Managed Care Compliance Director, State of Tennessee Misti Mills, Co-Owner, Two M Insight Group Marcus Norton, National Sales Director, Mobility Support Solutions Jason Stempin, Commercial Business Development Manager, VMI Technology - Gail Bauhs, Co-Chair and Myron Hammes, Co-Chair Kyle Archer, Director of Sales, Passio Technologies Gail Bauhs, Board Member, NEMTAC Tony Bradshaw, Owner, Bradshaw Consulting Services (BCS) Sufian Chowdhury, Founder & CEO, Kinetik Healthcare Solutions, Inc Imran Cronk, CEO, Ride Health Mike Gonzalez, VP of IT, Alivi Myron Hammes, Managing Partner, Schedule Viewer Melissa Jankowski, Executive Director, NEMTAC Brendan McNiff, Director of Transportation, Roundtrip Anantha Rao, CTO & COO, Wellryde Robbins Schrader, Co-Founder and CEO, SafeRide Health
A Special Thanks to our Corporate Sponsors
Platinum Sponsors
Silver Sponsors
Bronze Sponsors
Contact us HERE to become a Corporate Sponsor!
Sapphire Sponsors Emerald Sponsors
Non Emergency Medical Transportation Accreditation Commission (NEMTAC) proudly welcomes Eliot Kalteronto its’board of directors. NEMTAC is a non-profit healthcare organization dedicated to championing standards and best practices for the provision of non-emergency medical transportation. “We welcome Eliot to the board of directors and look forward to the value his leadership will bring.”, said Melissa Jankowski, NEMTAC’s Executive Director. “As we continue our focus on developing national standards and supporting the NEMT industry, the depth of knowledge and relevant experience of Eliot will provide a valuable perspective for our organization. ”Eliot has emphasized that he became acutely aware of the importance of first-class non-emergency medical transportation that he could trust as his parents became dependent on these services.” Eliot Kalter has more than 40 years of experience in global capital markets. In 2007, he retired after 30 years from the International Monetary Fund, where he held various posts, including Assistant Director of the Capital Markets and Western Hemisphere Departments. He has also overseen surveillance and provided advice to the financial sectors in Brazil, Chile, Colombia, the Dominican Republic, Ecuador, Mexico, Peru, Russia, Turkey, Ukraine, and South Africa. In addition, he was responsible for management of the Public Debt Managers’ Forum. Since 2007, Dr Kalter has been President of EM Strategies LLC, which offers financial and investment services to institutional investors and private enterprises services. He is currently Co-Head of SovereigNet and Senior Fellow at the Council for Emerging Market Enterprises, The Fletcher School, Tufts University. Dr Kalter holds a PhD from the University of Pennsylvania. About NEMTAC – Non Emergency Medical Transportation Accreditation Commission (NEMTAC) was established as a non-profit organization to enhance and promote the quality of care in America's medical transportation system. NEMTAC standards represent industry best practices designed to ensure consistently high-quality customer care, safe vehicle operations and ethical business practices. In addition to accreditation, NEMTAC provides advanced education and training certificate programs to individuals seeking a career in the medical transportation industry. For more information visit: www.nemtac.org.
By Melissa Jankowski, Executive Director, NEMTAC
For many years, there has been a widening gap in the number of people needing substance abuse treatment and those who receive care. There are many reasons for this disparity, one of which includes lack of access to transportation. According to National Institute on Drug Abuse (NIDA) statistics compiled over a 12-month period, 21.6 million Americans aged 12 or older needed treatment for drug and/or alcohol abuse but, alarmingly, only 2.3 million received care. The simple lack of rides to the doctors’ offices, ambulatory care centers or other places for treatment has created a barrier for millions in need of lifesaving care. Substance abuse treatment is a viable long-term solution according to NIDA. Depending on the needs of the individual, a minimum three months of treatment is needed to significantly reduce or stop substance use. The longer a person is in treatment, the better the outcome and the lower the chance of recurrence. For example, NIDA reports that the minimum treatment period for methadone maintenance is 12 months but, depending on the individual, it could take years for an effective treatment plan. The most effective regimens focus on integrated delivery that includes mental health evaluations and therapy, medical care, education, counseling and other clinical interventions. However, proper treatment can’t be provided for those who can’t access regular appointments and interventions. Advancements in NEMT technology enhance capacity to address substance use disorder Reducing barriers to healthcare transportation for service providers and improving access for people in need via technology-enabled solutions that provide enhanced functionality and high overall system efficiency is essential. Digitally integrated transportation networks have set the stage for advancements in non-emergency medical transportation (NEMT). Emerging technology will enable automated administration of transportation benefits, simple ride scheduling and trip assignments by call centers, healthcare facilities, case managers, care givers and patients. Take a second to consider the way the system has worked traditionally. Now flip that on its head. Instead of a patient care coordinator or healthcare provider calling a cab company or transportation provider to determine when a patient will arrive, they will now have this information at their fingertips via a dashboard that provides the estimated time. Every ride will be digitized and include GPS tracking. Facilities and care coordinators will have a dashboard showing when a member is picked up or dropped off, and what happens throughout the trip. This real-time, actionable data is invaluable in helping care coordinators effectively navigate the many facets of their patients’ NEMT and provide the appropriate regimens of treatment.
Lack of Transportation Leaves Millions .... continued
Patients will have access to apps featuring technology similar to those utilized by Uber and Lyft. Users will be able to simply request a ride by swiping and selecting, rather than calling. What is perhaps most anticipated by patients is the ability to know the exact time they will be picked up for appointments. Additionally, patients will be able to rate their interactions and overall trip experiences using one to five stars to denote levels of satisfaction. The role of non-emergency medical transportation The nation’s NEMT networks are vast, more technologically advanced and effective than ever before, and provide a solution for a vital piece of the substance use treatment puzzle. First, let’s look at how NEMT can help solve an economic riddle of treatment cost versus societal and financial benefits of three primary medication-assisted treatment programs for opioid addiction: Methadone, Buprenorphine, and Naltrexone. Methadone is a very restricted treatment program and must be dispensed under the supervision of a physician in an Opioid Treatment Program (OTP) clinic, certified by the Substance Abuse and Mental Health Services Administration (SAMHSA). Methadone is typically administered on a daily basis and is part of a comprehensive treatment program including integrated services of medical and psychosocial support. The average cost of the medication alone is $6,552 annually according to NIDA. Buprenorphine can be administered in a physician’s office and is for more stable patients, but SAMHSA indicates it must still be part of a comprehensive, integrated program. Buprenorphine is administered twice weekly at office visits at an average annual cost for medication of $5,980. Naltrexone is also administered in a physician’s office. NIDA statistics show the once-a-month injectable has an annual cost for medication of $14,112. Clearly, the cost of medication alone in opioid treatment programs is expensive regardless of the regimen. Adding in other associated expenses such as physician and staff time would push costs even higher. However, NIDA reports the cost to society is far greater without treatments. Consider that substance abuse costs American taxpayers over $600 billion annually, a large portion of which is attributable to incarceration of tens of thousands arrested and charged with substance use offenses and/or related illicit activities.
Effective substance use disorder treatment is less costly than incarceration A comparative analysis conducted by NIDA shows a stark contrast in the government-funded cost of incarcerating substance-use offenders versus providing treatment. The study shows the average annual cost of incarceration for one year is $24,000 per inmate versus the highest cost for the noted medication, Naltrexone, at $14,112 per year. Simple math (cost of incarceration minus cost of medication) shows providing medication to one patient in year one versus incarceration saves taxpayers almost $10,000. Considering the average time sentenced for substance abuse related offenses is roughly 4.75 years, the expense of incarceration balloons to a per person average of $114,000 or $94,295 more than the cost of the most expensive one-year treatment regimen (Naltrexone). The savings are even greater when less expensive Methadone and Buprenorphine options are prescribed. According to Federal Bureau of Prisons statistics, as of June 2019, about 76,000 inmates in the federal system are incarcerated because of drug offenses. That represents 45.3 percent of all inmates in federal prisons. The Prison Policy Initiative reports that across local, state and federal systems, an average of 451,000 are locked up for non-violent drug offenses on any given day. READ MORE HERE This article was previously published in MobiHealthNews.com, digital health's publication.
Have you seen the television commercial? Joe Namath says that Medicare plans now include transportation to doctor’s offices and medical appointments. Of course he is not referring to traditional Medicare, he means commercial Medicare replacement plans, known as “Medicare Advantage”. But, since these Medicare Advantage plans have enrolled a large number of Medicare eligible patients (an average of more than 30% of total Medicare eligible beneficiaries nationwide and more than 50% in some individual states according to the Kaiser Family Foundation), this impacts a significant number of people. And these people are all potential customers of NEMT service providers. So, how do you tap into this market? Start with looking at what Medicare Advantage plans are popular in your state, then consider approaching these plans about what you can offer to their enrollees. Remember, from the insurance perspective, the point of offering this as a benefit to the patient is to keep the patient safe and healthy. Make sure you specifically address how your company intends to help the patient and get them to their medical appointments in a timely and safe manner. While traditional Medicare is not paying for these types of trips yet, it is in fact pushing patients toward NEMT options. A recent study, the Repetitive Scheduled Non-emergent Ambulance Transportation (“RSNAT’) Report, was conducted to look at the cost savings associated with the prior authorization requirement that is active in 9 states and the District of Columbia. This program requires ambulance services to get prior approval for scheduled, repetitive patients going for services such as dialysis treatment. The RSNAT report found that in some of the states where prior authorization is required, almost 70% of patients were removed from ambulance eligibility. This represents thousands of patients who now need transport by other non-ambulance, non-emergent medical transportation.
By Christopher Kelly, Attorney, Page, Wolfberg & Wirth
Medicare is Wheeling Patients Toward NEMT Options
According to CMS, the prior authorization requirement in the current states is being extended for another year, through 2020, while they “continue to work towards nationwide expansion.” So, even if prior authorization is not currently in your state, it’s coming, and now is the time to prepare. Whether you are in one of the current states or you are located in one of the other 41, you can take steps to assist these patients. Consider working with local ambulance service suppliers who may have patients that they need to refer out to NEMT providers, or perhaps with facilities that do not have their own NEMT vehicles. Working directly with the Medicare Administrative Contractor in your state may be another option. Keep in mind that any referring organization will be concerned about how you take care of their patients, so again be prepared to discuss your company’s credentials and what sets you apart from your competitors. Due to these changes, and the growing number of beneficiaries who are switching to Advantage plans, the volume of patients using NEMT services is sure to increase every year for the foreseeable future. Get ready to take advantage of these new avenues of business! Christopher Kelly is a lawyer with Page, Wolfberg & Wirth LLC, who focus on regulatory healthcare law as it relates to the EMS and ambulance industry. This article is not intended as legal advice. For more information or for assistance with any over-payment appeals, he can be reached at (717) 691-0100 or email to ckelly@pwwemslaw.com.
Medicare is Wheeling Patients Toward ... continued
Owning an NEMT company today is often a tale reminiscent of David versus Goliath. As an owner or operator of a local NEMT company, you are faced with many challenges each and every day. Aside from ensuring you have the staff, the vehicles and the equipment to handle transportation requests, you are also responsible for growing your business by increasing market share. There are many sources for accessing trips, but none are more valuable than developing contracts directly with insurance companies and healthcare facilities. Navigating the contracting requirements with third party payers can seem daunting at first but once you master the process your company will have obtained a solid foundation for future growth. I would like to share 10 important tips you can use as a roadmap to securing these coveted types of contracts. Determine the Third-Party Payers You Want to Work With The important first step is to research the markets you wish to provide services and develop a target list of facilities and the insurance companies they contract with. Collect Information About Target Insurance Companies Call or visit the healthcare facilities you are targeting for new contracts. Ask them which insurance companies they are contracted with. Ask them for a contact name, staff person’s title, direct phone number or email address. Ask them about their experiences with the process and how long it took to obtain a contract. Call the insurance company’s “Provider Line” and ask how to become a provider. When contacting insurance companies, make sure they know you are a transportation provider. This will help you get connected to the right department. Initiate Contact with the Insurance Company Ask for the name and phone number of a contract person. Ask them to send you an application or if possible, how to download an application. Insurance companies often ask that your company sends a letter requesting to become a provider. Note: You may need to go through this process several times before you receive an application. Credential your Employees Collect and keep on file copies of all licenses, copies of driving records, drug screens, insurance coverage, company information, hours of operations, NPIs, Tax ID Number, and SSN of managing officer. Have all these copies available to you when you need to complete the application. Complete the Application Make copies of the application and all attachments for your records and in case the application is lost. Follow up regularly with each application.
By Sufian Chowdhury, Founder and CEO, Kinetik Healthcare
Top Ten Tips to Begin Contracting ... continued
Questions to Ask the Insurance Company Contracting Department The status of the application. How often the organization approves new applications. How long it will take after the application is approved to receive the fee schedule and contract. How long before you can start charging the insurance company for their covered patients. Depending on the insurance company this process can take up to six months. The key to obtaining an insurance contract is constant follow-up. Review the Terms and Rates of the Contract Know the cost of your NEMT services. Consider if the third-party contract will generate non-covered service expenses. If so, factor that into your financial analysis. Verify all contract terms and ensure that your company can meet the contract terms. Above and beyond the fee schedule, consider, licensing, quality assurance, site visits, and any other requirements that are stated within the contract. Violating the stated requirements can be grounds for lost reimbursement or contract termination. Negotiate any Objectionable Terms Check the contract for paragraphs that can restrict your ability to collect reimbursement. It is not uncommon for third-party payer contracts to include language that requires billing for reimbursement within 60 days post service and/or to have restrictions for corrected claims reimbursement. Read the entire agreement and ensure that it includes a description of covered services as well as a current fee schedule. Sign the Contract Identify the person in your organization who is authorized to establish contracts and keep them informed about your efforts to initiate contracts with insurance providers. Keep Contract on File for Renewal You will need to periodically access your contract for periodic renewal or the annual updating of fees. Keep your contract on file and readily available. Final Thoughts As a company owner it is vitally important to have a diverse mix of contracts and trip sources. A payer mix made up of private pay, third party payers, healthcare facilities and transportation brokers are an ideal way to set a solid foundation for future growth Sufian Chowdhury is the Founder and CEO of Kinetik Healthcare Solutions, a healthcare technology company based out of New York City. He serves as an advisor in various startups and organizations, including NEMTAC. Prior to Kinetik, Sufian worked as a financial analyst at Weill Cornell Medical College. For more information visit: https://www.linkedin.com/in/sufian-chowdhury/
www.nemtac.org/conference
Opportunities & Challenges of Industry Disruption On September 9, 2019, I delivered the keynote speech at the first annual conference of the Non-Emergency Medical Transportation Accreditation Commission (NEMTAC) held in Scottsdale, Arizona. Founded in 2018, NEMTAC’s mission is to create a high standard of care for the non-emergency medical transportation industry by distinguishing organizations that deliver high-quality customer service, ethical business practices, and safe vehicle operations. Any organization that receives NEMTAC accreditation will be able to indicate to its customers that it has exceeded the minimum requirements and achieved the Non-Emergency Medical Transportation (NEMT) industry standard of excellence. For my keynote address, the room was packed with a combination of industry professionals, including software providers, brokers, mobility companies, Transportation Network Companies (TNCs), industry trade group representatives, taxicab owners and operators, and paratransit operators. The NEMTAC conference made it clear to me that the next round of disruption in ground transportation is currently underway, with a unique combination of technology companies, TNCs, and even traditional taxicab operators looking to upend the broker system that has not been rattled since its inception. The stakes could not be higher, given the changes to the law and the kettle of subsidies available to companies that are either struggling to stay alive, or for new start-ups seeking a seat at the table, and for TNCs that desperately need to become profitable soon. This article will provide a brief history of the paratransit and NEMT industries, summarize my keynote speech findings and predictions about the future, as well as my observations at the conference.
By Matthew W. Daus, Esq., Partner and Chairman, Windels Marx Transportation Practice Group
I saw many divergent stakeholders at the NEMTAC conference interact for the first time with one another – they were sizing each other up, and not sure about whether a relationship should develop, or what the business model would look like. Nevertheless, it was clear that there was valuable networking as opportunities abound for many in the new NEMT universe. Finally, a plan of action on how to raise the duty of care and take advantage of business opportunities will be set forth, including plans by the International Association of Transportation Regulators (IATR) to develop model regulations for NEMT license, service delivery and safety. History of NEMT in the USA Non-Emergency Medical Transportation (“NEMT”) is a ground transportation service provided to individuals without access to public transportation who need to travel to medical appointments. Generally supported with Medicaid funds, NEMT service was launched as a joint federal and state program in 1966 to Medicaid beneficiaries. The program’s purpose is best described by Senior District Judge Clary inSmith v. Vowell (1974), a federal case from Texas that laid the foundation for NEMT services, as he describes the benefits of treating individuals for minor medical problems; many different studies have shown that paying for an individual’s transportation to the doctor’s office can prevent the condition from deteriorating into an emergency situation, which costs hospitals and insurance companies thousands of dollars. Since the inception of NEMT services, Medicaid has grown immensely; legislation expanding Medicaid enrollment has increased 52% alone, from 47.7 million beneficiaries in 2008 to 71.4 million in 2019, which means more people need rides every year. In 2005, Congress passed the Deficit Reduction Act that gave state NEMT programs enough flexibility for local governments to seek out cost-saving opportunities by outsourcing the day-to-day management of NEMT services to brokers. Studies have shown that these brokers, who operate on a fixed budget rather than a fee-for-service amount, have improved service quality and controlled costs. Most recently, the expansion of Medicaid eligibility under the Affordable Care Act (ACA) up to 138% above the poverty line has expanded the enrollment in Medicaid even further by creating a new adult group. NEMT Disruption Aside from legislative changes that increase Medicaid eligibility and enrollment, people are also living longer; as noted by a recent study commissioned by the United Nations, which projects life expectancy to rise on a global scale: As the pie continues to grow, transportation companies have sought to secure NEMT work as a staple of their revenue.Taxi companies, TNCs, and healthcare companies are all actively seeking to develop reliable NEMT services in order to survive in today’s over-saturated marketplace.
The Past, Present & Future ... continued
In an attempt to reserve a slice of the pie for themselves, NEMT brokers are hiring their own independent driver-providers (IDPs), in addition to contracting with local transportation providers. Using IDPs allows these brokers to realize more revenue from the state Medicaid program. Other organizations in healthcare are becoming even more creative.For example, Hennepin County Medical Center, located in Minneapolis, Minnesota launched Hitch Health, a new technology company. Hitch Health integrates with electronic medical records to determine a patient’s eligibility for NEMT service, then connects the patient with the nearest available vehicle once the patient is ready to be transported. In the TNC space, Uber is turning to NEMT services in an attempt to produce revenues, which may be especially important after Uber has posted record-high losses. Uber Health, which is Uber’s NEMT service, has grown 400% in the past year alone, topping more than 1,000 partners in Healthcare, including hospitals, primary care facilities, specialty clinics, and other organizations. Taxi companies have similar strategies. While traditional taxi companies typically only provided NEMT services to larger state contracts, many are now approaching local healthcare facilities in an attempt to procure private contracts as well. READ MORE HERE This article was previously published in Black Car News, digital health's publication.
By Gail Bauhs, NEMT Industry Solutions Consultant, TripSpark Technologies
Medicare-related trips are expected to rise in 2020 thanks to the recent expansions in non-medical benefits offered by Medicare Advantage plans. Changes in Law Regarding Medicare Advantage Plans Two changes to legislation enacted in 2018 are helping grow the Medicare NEMT market. The Centers for Medicare and Medicaid Services (CMS) adopted new rules that allow private health plans to offer extra health-related benefits that would maintain or improve health. Beginning in 2019, Medicare Advantage (MA) plans can offer limited personal supports and services such as home care, non-medical transportation, nutrition programs, and home modifications. The second legislative change was that Congress adopted the CHRONIC Act, which allows plans to tailor benefits to people with specific needs and to offer non-medical services to members with chronic conditions to help them stay in their homes. CMS estimates that 1.2 million chronically ill patients will be able to access supplemental benefits like meal delivery or transportation for non-medical needs like grocery shopping. Growing Market Good for NEMT Providers Open Enrollment began on October 15 and ended on December 7, 2019. Approximately 22 million Medicare beneficiaries were enrolled in Medicare Advantage plans in 2019, and CMS expects this to increase to over 24 million in 2020. More than 30% of Medicare beneficiaries have opted into this private plan alternative instead of the traditional Medicare program. The Kaiser Family Foundation looked at some preliminary data and estimates that one-third of Medicare Advantage plan beneficiaries will have access to some transportation assistance, on insurance plans offered by over 100 firms. But Services Still an Undiscovered Benefit While there may be more people eligible to receive NEMT services to doctors' appointments, pharmacies and such, most probably aren't yet using their benefits. A survey by HealthMine of consumers aged 65+ with a chronic condition, who are enrolled in a Medicare Advantage plan, found that the vast majority were unaware that plans may cover routine rides to medical appointments.
Medicare Advantage Plans Offering ... continued
Lyft Is an Early Winner Insurers are working quickly to find NEMT providers and to put together benefits packages. The ride-hailing service Lyft has seen early wins in this space and has Medicare Advantage partnerships with insurers Humana, Blue Cross Blue Shield and Cigna. Megan Callahan, vice president of healthcare for Lyft, told Home Health Care News that they "expect to be working with the majority of the largest Medicare Advantage plans by 2020." A senior director for Medicare Advantage plans at United Healthcare told CNBC that the roll-out of some enhanced services was still in progress as they were "building out the infrastructure" for some plans. Difference in Medicare vs. Medicaid Software Needs While Medicaid and Medicare Advantage-funded NEMT services are generally similar - with members calling in to arrange trips for qualifying purposes - the eligibility and funding pieces look very different.
Improving Customer Care for Better Star Rankings Medicare uses a Star Ranking System to measure how well Medicare Advantage plans perform and to allow the public to compare the performance of different plans. There are five different categories, primarily related to customer service and quality of care. While transportation isn't awarded any marks directly, it could help improve a plan's rating by making services more easily available, improving member experience and plan performance, and helping to better manage chronic conditions. Three additional ways to improve members' transportation experience are with driver training, in-vehicle technology, and online member portals. Driver training is essential for all NEMT trips, including those for Medicare Advantage. Many members may have chronic health conditions, mental illnesses or require mobility aids, so drivers benefit from passenger assistance training. Having a certification like NEMTAC's Certified Transportation Specialist – Advanced can help drivers more suitably handle vulnerable populations with care and compassion. In-vehicle technology that tracks the GPS location of your fleet and communicates it in real-time to your dispatchers can be invaluable when concerned family members or medical facility staff call looking for status updates on their loved ones. Instead of contacting a call center, an online passenger portal can allow individuals or their delegates to log in and check the estimated arrival/departure time and location of their rides. Delegates (who can be healthcare providers, family members or caretakers) can also book and schedule trips online on behalf of beneficiaries. Notifications remind people of upcoming medical appointments, which can also help improve customer service. Conclusion These new regulatory expansions are good news for healthcare organizations that want to provide transportation services to their beneficiaries to improve medical appointment attendance rates and access to care. The Medicare market will continue to grow as Medicare Advantage plan members become more aware of their new benefit and use it, and more plans offer non-medical transportation as a benefit. NEMT software used by Medicaid NEMT brokers and providers can be a great choice for Medicare NEMT providers, too. Be sure to check with your software vendor!
Leap Into 2020 with Turnkey Accessible Vehicles
Sponsored Content
Starting a Non-Emergency Medical Transportation (NEMT) operation from the ground up may seem daunting, but it’s very doable with the right resources to get you started. As a business owner, one of your biggest investments will be purchasing accessible vehicles—the main tools of the trade and source of income. While new and used wheelchair accessible vehicles can be found for sale from a variety of resources, there are a host of important points of interest to keep in mind in addition to price. For example, depending on the clientele you intend to service (e.g. government funded providers vs. private), you may need a vehicle that meets ADA compliance requirements. You will also want to think about who will drive the vehicle—yourself or a hired driver—maybe multiple drivers if your goal is immediate growth? Does the vehicle come with a warranty? What types of passengers will you transport—one or two wheelchair users and/or passengers in a gurney? Do you have cash on hand to purchase the vehicle or will the seller provide an option to finance, especially if you’re challenged with less than stellar credit? Sure, it’s tempting to sign your name away for the first accessible vehicle that appears to be affordable at face value. Afterall, that’s one major line item you can check off your list to get your NEMT operation up and running. Right? Well, not so fast… As with any business, there’s something to be said about taking a birds-eye view with a longer-term outlook. Having a reliable accessible vehicle that will get you started with the lowest possible purchase price, and, keep you on the road with a product that’s reliable with on-going support is very possible with the right supplier who can offer turnkey solutions. What does a turnkey solution look like when purchasing a wheelchair accessible vehicle (WAV)? FINANCING OPTIONS A seller that offers a turnkey solution will likely offer financing options. The ability to finance the least expensive wheelchair accessible vehicle for your business doesn’t have to be the sole influencer of your decision, requiring you to settle for less than what you want or need. Accessible vehicle manufacturers like AMS Vans work in higher volume sales than a smaller reseller or a private seller would, and they are able to access banks that are very well versed in financing modified vehicles, not to mention providing financing packages to small businesses that need a leg up to obtain an accessible vehicle or two to get their business started. CHOICES IN WAV TO MEET YOUR NEEDS Whether your vision is to become a transportation provider for local assisted living facilities where you might transport just one
Leap Into 2020 with Turnkey ... continued
or two wheelchair passengers at a time or signing on with a broker to facilitate high volume transportation services for area hospitals, you can find vehicles to fit your requirements from a comprehensive solutions provider. Not only is it valuable to review your options with an expert mobility sales consultant to understand the differences in the types of WAVs available, you’ll also acquire a good understanding of features that are critical to equipping your vehicle so that your business can hit the ground running sooner rather than later. Instead of going to multiple vendors for every component needed, a turnkey WAV solutions provider will get you set up with the equipment you need to start generating revenue for your business as soon as possible. If you plan is to serve passengers who utilize government funded fares, one of your top priorities should be to find a WAV that meets ADA regulation requirements. Many of the requirements are state specific, so, it’s imperative to work with a WAV seller that can outfit your vehicle with such requirements. For example, an ADA compliant package that’s commonly required is an interlock system. This feature ensures that the rear hatch door is locked and the lift or ramp is stowed before the vehicle can be put into gear. Additional ADA compliant features typically required are window breakers, belt cutters, fire extinguishers and roadside assistance tools such as reflectors and cones. If transporting passengers in a gurney is also on the horizon for your business, it’s super convenient if the WAV seller provides the option to purchase a complete securement kit to lock down the gurney so that you have it when you need it, and it’s easily removable when you don’t. Sellers like AMS Vans may even offer a refurbished gurney with a lockdown kit as a total package for your convenience. AFTER SALES SUPPORT Can you expect to receive after sales support following your accessible vehicle purchase? There’s a good chance this piece of the turnkey solution is missing when you purchase from a reseller or from private party. As a transportation service provider, putting on countless miles is expected to keep your operation profitable. Knowing that there’s a product warranty to lean on when there’s an issue with your vehicle is worth a serious consideration that should be part of the equation when you’re thinking about the total investment you’re about to make. Accessible vehicles are mechanical products that will see its share of wear and tear, and a solid warranty solution can save many headaches and your bottom line, especially if extended warranty is an option too.
In addition to warranty, there’s also a very unique service that you might want to think about. As a VMI company, AMS Vans offer VMI Assurance on every vehicle purchased. The nature of your business is being on the road and staying on it in order to maximize your revenue generating opportunities. VMI Assurance allows you to do that. All AMS vehicles come with a 1-year complimentary Mobility Roadside Assistance membership with an opportunity to extend the membership for up to 3 years. As with other roadside assistance memberships, common vehicle troubles that require towing, battery, fuel replacement and flat tire services are covered. However, what’s different about VMI Assurance is that if your driver was in the process of transporting a wheelchair passenger, a paratransit ride will be dispatched to provide your driver with backup. As part of the VMI Assurance program, NEMT operators also have access to Wrench Fleet Service where certified auto technicians will perform vehicle maintenance and repairs that range from routine services such as oil changes and tire rotations to more complex repairs. It will also provide service to help maintain the wheelchair accessible ramp system. With Wrench, auto technicians provide the convenience of coming to your place of business to perform the work anywhere where Wrench is available. Find out if Wrench is offered in your city: www.wrench.com/city. Wrench offers 20% off first service for AMS Vans customers. These are all value-added benefits that you won’t find from just any accessible vehicle seller. 2020 is a new year with many opportunities ahead for NEMT businesses. More resources are made available today than in any prior years to help support and foster the growth of independent NEMT owners and operators. The cost of starting your business can be carefully measured to provide the greatest return on investment when you partner with a seller that will stand by you and offer turnkey solutions, starting with when you initially buy your wheelchair accessible vehicle and for many years following your purchase.For more information on any of the products or services offered by AMS Vans, visit https://www.amsvans.com/wheelchair-vans/commercial or call 800-775-8267. For information on fleet purchases, please contact Jason Stempin at jasons@vantagemobility.com or (314) 396-9322.
By Michael Adelberg, Scott Bogren, Alexandra King
For the fourth time in three years, an NEMT-focused essay appeared on the Health Affairs Blog, the most prestigious forum for essays and short pieces on health policy topics. The most recent essay, published on January 14, was co-authored by Michael Adelberg of the Medical Transportation Access Coalition, Scott Bogren of the Community Transportation Association of America, and Alexandra King, also from CTAA. Link to the essay. The authors argue that non-emergency medical transportation (NEMT) is interwoven into the services provided by our nation’s local transportation agencies, which often serve as key NEMT ride providers. The authors further note that curtailing Medicaid NEMT would have significant negative consequences on local transportation services beyond Medicaid. Local transportation agencies, in the four states that they examined, depend on NEMT as a steady source of revenue (sometimes more than 50% of total funding) to provide transportation to vulnerable and rural populations. Without NEMT riders, existing fixed route lines would become financially untenable, resulting in diminished transit services for all populations and services – including trips for employment and vocational training, healthcare (for people not covered by Medicaid), social services, and community engagement. The essay arrives at an important moment for the future of NEMT. In the coming weeks, the Trump Administration is expected to release a Request for Information from which it will seek input on whether NEMT remains “administratively necessary given the delivery of healthcare both in terms of technological advances and the commercial market design.” The Administration has previously stated its intent to convert NEMT from a mandatory to optional benefit in the Medicaid program – a move that would likely lead some states to curtail the benefit. To learn more about the RFI, contact Michael.adelberg@faegrebd.com. Health Affairs publishes “Cutting Medicaid Non-Emergency Medical Transportation Will Harm Community-Level Public Transportation”
2020 is more than a new year; 2020 marks the beginning of a new decade. The enormity of this new decade has all of us here at RoutingBox thinking about long term goals rather than just a“New Year’s Resolution.”We are asking more honest questions about what our goals are and figuring out where we truly want to be at the end of this decade. It turns out, as a company, we want to grow our software to be a much wider reaching and more effective solution for NEMT businesses. If you’re anything like us, you want also to spend the next ten year’s growing and improving upon your business. But how do we get from where we are now to where we want to be in ten years? There is no short answer here. We must solve the scalability problem. Are our businesses scalable? How do we find out? If they’re not, can we make them scalable? This is truly a daunting problem. At the end of the day, all businesses are scalable if you are willing to put in the work and make the necessary changes for your business to be compatible with growth. Perhaps the most important thing to keep in mind as you begin scaling your business is-- that this takes time. You cannot expect to see the results you want overnight – scaling is truly a long-term goal. Before you can begin making changes, you will need to take a deep dive into your company as it stands today. Look at every tiny little detail of your business – current trips, current staff, current expenses. Where you stand today, could you handle it if your trips doubled or even tripled tomorrow? Would you miss trips? Would drivers be left without a clue of whom they’re picking up or where they are supposed to be? Could billing staff keep up? If the answer is no, it’s time to make a growth plan. Start by planning for the numbers you want to see. For example, if you want to go from 100 rides a month to 500 what do your expenses begin to look like? How many more drivers and vehicles will you need? Do you need to do more than just livery trips? Try to account for every expense in as much detail as possible. This exercise will show you what additional assets you’ll need to achieve the growth goal you’ve set for yourself. It will also show you exactly what that’s going to cost you. Start figuring out how to generate that additional cash flow – whether you take a small business loan, apply for a couple of grants, or just pull yourself up by your bootstraps and grind until the money is there. After additional cash flow has been generated, you can start working toward your goal of additional trips. To do this, you’ll need to acquire new contracts with brokers and/or additional trips from your current brokers. Start reaching out to your current brokers and brokers you would like to work with and sell to yourself! Remember that you do not need to,
Scaling Your NEMT Business ... continued
nor should you, jump from where you are right now to your long-term “number of trips” goal. Make the increase slowly over time to ensure your infrastructure can handle the additional workload. When you start to see an increase in overall trip-volume and revenue, you have reached the perfect time to begin investing in new technology to streamline your operations. Here to discuss how technology is integral to scaling is RoutingBox’s in-house Scaling Expert, Gabriel Lullo. Gabriel has experience in owning his own firm, as well as working in firms that specialize in scaling. He has been instrumental in expanding companies by focusing on the culture, environment, customer success, and sales through implementing new technologies.His specialty is growing a handful of employees to a large organization. When we spoke to Gabriel, he had this to say about scaling your NEMT business,“In order to scale your business, you need to have the right partners in technology. Spending the time and energy on technology will be an essential ingredient in your effort to scale your business. The right technology will provide you with more effective costs savings and maximize your output. Systems, networks, and automation are all areas that will help minimize your manual workload and, as a result, lower your labor expenses. The beginning of the year is typically the best time to evaluate your need for new software, new systems, and new hardware. Putting in the time upfront to find the right tools, as well as putting in place the right people to support those tools, will pay off significant dividends in the long-term. This will help you scale into your 4th quarter goals and beyond. Done correctly, you will be able to ride that growth for many years.” Continue to revisit your growth plan on a regular basis – monthly, quarterly, etc. Check your progress toward your goal, adjust any numbers that may be differently than you had initially forecasted them to be, and add in any additional needs you have encountered since putting your plan into action. As we mentioned earlier, remember that scaling your business is a long-term goal. Celebrate the small wins and be willing to adjust as needed. Current RoutingBox user, Bryan Daparma of Hometown Taxi located in Long Island has had great success in scaling his NEMT business. He has been using RoutingBox software since 2016 and to him-- that has made all the difference. When Bryan was going through chemotherapy, he started to notice the real problem with NEMT. “When I’d leave chemo with my wife,” he said, “I’d see the same people waiting outside for their ride home as I saw on my way in over an hour earlier.”The thought of having just gone through chemo and then having to wait over an hour to go home shook him to his core. Now, Bryan was going into work with a new mindset. He started asking more honest questions about how transportation, and NEMT specifically, is run. He learned that dispatching for NEMT operated on a “first come, first serve” basis. “What do you mean we just pick everyone up in the order they call?” Bryan asked in disbelief. He knew they could do better at Hometown Taxi. Doing better became his mission.
In 2016, when Bryan had just begun trying to bring about real industry change at Hometown Taxi, he was doing pretty much everything by hand with pen and paper. They had a variety of phones, radios, and in-car GPS systems, but something was always falling short. Again, he knew they could do better. Bryan, being the kind of person who is open to trying any and all new solutions, made sure his team knew that they could go to him with their ideas. Team members would come by his office and recommend a solution they had heard about one way or another and Bryan, true to his word, would try all of them. Four or five dispatching solutions in, it became obvious to Bryan that none of these applications had been created by people who understood the transportation industry from a driver’s standpoint. Needless to say, when RoutingBox came to Hometown Taxi, Bryan was cautiously ready to give it a try. He had low expectations but, nevertheless, he agreed to try the basic version of RoutingBox. Immediately, he felt the impact. They were better organized which meant more trips were being completed, which in turn kept customers happy and calling into Hometown Taxi rather than their competitors. He approximated that it only took 30-45 days for him to completely buy into RoutingBox. Since upgrading his RoutingBox, Bryan has been able to triple his revenue. To him, while his revenue growth may be impressive, it’s the fact that his overhead only doubled when his revenue tripled that has truly made the difference. “RoutingBox allows us to have minimal overhead and office staff, which lets us pay our drivers better and even give them vacation time – something totally unheard of in this industry!” Bryan said. When Bryan began his mission to improve NEMT, he knew he’d eventually need to invest in a worthwhile technology that would help him to achieve the industry altering goal he’d set for himself. His “give everything a try” nature meant he would end up investing in multiple technologies – most of which fell just short. “Everything else I tried was good, but nothing was great until I got RoutingBox.” Bryan’s story means so much to us, here at RoutingBox. While, of course, we are proud to have helped Hometown Taxi’s revenue triple since 2016, it is truly Bryan’s mission that makes our work so worthwhile. We do not take lightly the mission he is on to improve NEMT; in fact, we are on the very same mission. NEMT can be better, and we are proud to be working diligently on being an integral part of that change. As you enter this new decade, with lofty goals in mind, ask more honest questions, be as open to solutions as our friend Bryan Daparma, and be willing to put in the hard work required to reach your goals. Slow progress is still progress, a mission that fills you with passion is enough to get you started and a great partner in technology will make all the difference.
By Al LaGasse, CEO, The Transportation Alliance
Rep. Sanford Bishop (left) and President Tom Arrighi
In late December, operators of Medicaid-funded non-emergency medical transportation (NEMT) received a legislative gift whose magnitude sent a collective wave of applause—and a sigh of relief—throughout the industry, when this vital transportation service was saved from a potential budget axe. The effort to save NEMT had been the top legislative priority for The Transportation Alliance for over a year. As the premier trade association of the for-hire passenger transportation industry for more than a century, a large number of TTA member fleets now provide NEMT to the millions of Americans who rely on this vital lifeline to medical appointments. In a recent survey of attendees at the TTA’s most recent annual convention, more than 50 percent said their fleets now provide NEMT, evidence of the ever-changing landscape and growing opportunities within the transportation industry. The legislative fight boiled down to this: Throughout 2019, TTA became increasingly concerned when it heard in the halls of Congress that a movement was afoot to curtail funding for NEMT services. At the White House, President Trump had expressed a desire to cut supposed waste and abuse of this $3 billion service that allows millions of low-income Americans to have their trips to life saving medical appointments—from kidney dialysis to substance abuse treatments and more—by allowing states the option to no longer provide Medicaid funds for NEMT. In short, a legislative rulemaking was being floated that would have allowed states to opt-out of this critical lifeline, hurting millions of Americans who depend on this transportation to medical appointments, as well as potentially devastated many TTA members businesses. The TTA leapt into action. At its annual legislative fly-in in Washington, DC in June, members fanned out across the halls of Congress to deliver a singular message: NEMT saves lives, and without it, the ramifications of missed medical appointments will cost billions more. One study found that for $1 spent on NEMT, $11 is saved in costlier treatments. In other words, as Ben Franklin famously said, “An ounce of prevention is worth a pound of prevention.”
Medicaid-Funded NEMT Still at Risk ... continued
During the fly-in, TTA members were fortunate to hear remarks Rep. Sanford Bishop (D-GA) at a breakfast, in which the Congressman expressed his unwavering support for NEMT. Recognizing the champion its members have in Rep. Bishop, TTA remained in close contact with the Congressman, even sending an industry delegation to visit with him in his home district, including then TTA President Terry O’Toole, TTA Past-President Rick Hewatt and TTA Legislative Counsel Paul Miller. The association’s members then engaged in a coordinated letter-writing campaign to members of Congress, while Miller worked the halls for one-on-one meetings.When the Trump administration signaled its imminent plans to issue a year-end rule-making that would have made it easier for states to opt out of providing some NEMT service, newly elected TTA President Tom Arrighi made a strategic visit to DC in November reiterating the importance of this crucial service to Americans. He was accompanied by Miller, as well as TTA CEO Al LaGasse and TTA Executive Vice President John Boit, in that last-minute series of appeals calling on Congress to act swiftly to save NEMT. Those efforts, along with the efforts of other concerned organizations, paid off. In late December, Congress directed the Trump administration not to make any regulatory changes to the availability of non-emergency medical transportation (NEMT) in the Medicaid program for 2020. On Dec. 17, The House took action to pass an omnibus package of appropriations bills that included report language directing the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) not to publish any regulation restricting NEMT until a study to examine the impact of such restrictions on beneficiaries is completed. The package was approved by the Senate on Dec. 19. President Trump signed the legislation into law on Dec. 20, 2019 as part of the federal appropriations bill.
Rep. Bishop (left) and Past President Terry O'Toole
While the report’s language is not law, this action taken on by Congress is about as strong as it could be and will likely delay publication of any rule-making to restrict NEMT funding in the Medicaid program during 2020 as the Medicaid and Chip Payment and Access Commission (MACPAC) completes its report. The joint House/Senate explanatory statement attached to the bill reads: "Non-emergency Medical Transportation (NEMT).—The agreement directs HHS to take no regulatory action on availability of NEMT service until the study described under the Medicaid and CHIP Payment and Access Commission" header of this joint explanatory statement is complete. MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION (MACPAC) "Non-Emergency Medical Transportation (NEMT).—Within the amount provided, the agreement provides $300,000 for MACPAC to examine, to the extent data are available, the benefits of NEMT from State Medicaid programs on Medicaid beneficiaries, including beneficiaries with chronic diseases including end stage renal disease (ESRD), substance abuse disorders, pregnant mothers, and patients living in remote, rural areas, and to examine the benefits of improving local coordination of NEMT with public transportation and other Federally-assisted transportation services. The agreement directs HHS to take no regulatory action on availability of NEMT service until the study is completed." Vigilance is needed year-round to protect the rights of our passengers and our industry. Thankfully, TTA was well positioned to present a case and receive swift action. Rep. Bishop has been one of the key Congressional leaders working with TTA to protect NEMT. He has proven to be a tireless ally in this effort, and our members engaged in NEMT most certainly owe him thanks for his tireless protection of this life-saving transportation benefit.
Miller, Hewatt, Bishop and O'Toole (left to right)
Before Congress adjourned for the recent holiday, TTA and its allied partners worked with key members of the House Energy & Commerce Committee on a strategy to have the committee hold a hearing on H.R. 3935, the Protecting Patients Transportation to Care Act, early in the new session. On January 9, the House Energy & Commerce Subcommittee on Health held that hearing, titled Legislation to Improve Americans’ Health Care Coverage and Outcomes.”This hearing addressed seven healthcare related bills, including H.R. 3935. This hearing was yet another crucial step in protecting NEMT, as members on both sides of the aisle were shown that providing NEMT services to constituents in their communities literally saves lives while also saving taxpayers from having to pay more in delayed healthcare costs when previously treatable illnesses send people to expensive emergency care. This hearing was a great way to kick off the year, but we still have lots of work to do. Now is the time for the NEMT industry to get involved. What can you do? Forewarned is forearmed. If your company provides NEMT services, there is simply no more informed voice in Washington than The Transportation Alliance. Get involved and know what you can do to help save NEMT funding by becoming a member of TTA today. Memberships start as low as $395. Open up a range of networking, educational, informational and business opportunities for your fleet today. Together, we can continue to present a strong and unified voice to protect the vital services of NEMT. We are now continuing our legislative efforts and the next step is to get H.R. 3935 passed by the House of Representatives. For TTA, the NEMT fight continues to be a very high priority, and will be one of the very top agenda items during our annual Capitol Hill fly-in this summer, as well as during the Spring Conference & Expo in Boston, March 18-20. Space is limited for the Spring conference, one of our smaller and more intimate TTA gatherings of the year, so be sure to register today!
By Alex Theoharidis, Co-Founder and CEO, Acuity Link
We all know that patient flow is a problem, but why is no one talking about it or addressing it? Frankly, patient flow issues are falling by the wayside because there is still so much to be smoothed out when it comes to the ABCs of your run of the mill inpatient care process. As a patient, caregiver or provider, we are left asking ourselves so many questions every day in our roles: When will the physician begin rounding? Do I have time to go grab a cup of coffee before the nurse or doctor comes in to talk to my dad? Excuse me, nurse, can you bring me up to speed on the patient Dr. Smith saw yesterday? Has a CT scan been ordered for Mrs. Green? Communication is the ultimate lynch pin in our healthcare system. Great communication leads to desired outcomes, while poor or lacking communication leaves results up in the air, leaving many in the situation feeling a loss of control. I am here to tell you that the light is visible at the end of the dark, antiquated healthcare communications tunnel as we head into a new decade. It is important to remember that a computer cannot replace the role of human touch in care delivery, but a digitally enabled healthcare workforce provides limitless potential to the industry. The Consumer is Always Right We have witnessed a shift in healthcare from one where the system called the shots to one where patients are now former marionettes free of the strings that once determined their care delivery decisions for them. The consumerization of healthcare is real and will only increase in the next decade, especially as the Baby Boomer population continues to age and increasingly require more care services. This means that the quality of patient-to-provider and provider-to-provider communication has nowhere to go but up. Today, healthcare providers are not syncing up with how their patients prefer to communicate and it’s impacting patient satisfaction scores. It’s been found that communication issues contribute to troublesome bottlenecks in moving patients through the system including: Delayed discharge (50%) Consult delays (40%) Emergency department wait times (38%) When asked about their top frustrations with their stay, patients cited: Slow discharge and transfer times (31%) Limited time with their doctor during the visit (22%) Long waiting room time (22%) Something’s Gotta Give It is evident that inpatient healthcare cannot go on like this and something has to change. As we enter the third decade of the 21st century, expect all healthcare delivery and process issues to come to a head. To that end, we should expect to see state and federal government respond robustly. 2019 saw a record number of bills introduced surrounding patient rights to reliable and appropriate non-emergency medical transportation (NEMT) as well as state regulations and oversight. One should expect to witness more and more state Medicaid programs signing on with NEMT providers and in turn see an increase in privatization of those services.
This past summer, Lyft announced that Arizona’s Medicaid program would cover its services, marking the first such agreement between a state Medicaid program and a national ride-sharing program. As we look toward the inpatient flow portion of the care journey, we should expect to see providers and care teams pushed out of the realms of their comfort zone; not because they want to, but because hospital and health system bottom lines demand it. A survey finds that healthcare organizations are still heavily reliant on 1970s technology, with 89% using fax machines and 39% using pagers. While there is a physician shortage overall – some specialties hurting more than others – that supports health systems providing generous contracts to providers, they also have to balance those asks with fast moving federal regulation implementations against increased costs for procedures with less in reimbursement from insurance providers. According to an August article from Becker’s Hospital Review, 113 rural hospitals closed between January 1, 2010 and August 21, 2019. This list only includes hospitals that ceased providing inpatient services. For rural areas, a hospital closure can mean a bleak outlook for the healthcare of those in the area. While physicians today are in a unique position to bargain for more, hospital CFOs and CMOs will more than likely have their hands tied financially and federally when it comes to how far they can go to hire and retain the best talent and continue to provide access for the country’s most vulnerable populations. Looking Ahead The picture painted above may seem bleak, but it’s important to look at it from the perspective that these circumstances are pushing healthcare beyond its comfort point and into a new era that is more patient-centered. It’s time we toss the fax machines and pagers and put the phone down. It’s time to realize that patient flow and NEMT is a concern at all levels of healthcare, not just for the unit secretary. It’s time to make the full transition to patient-centered care models and communicate with patients on a level they prefer, not what’s best for the facility and the antiquated modems it clings to. 2020 to 2030 will be the decade that sheds archaic patient flow support systems and processes in favor of the advanced technology, AI and machine learning just begging to jump into the American healthcare system to improve outcomes and experience. About the Author Alex is the co-founder and CEO of Acuity Link. Previously he was the founder/CEO of Coastal Medical Transportation Services, an ambulance service company. There, Alex identified a need to bridge the gap in interaction between healthcare institutions and medical transportation companies, leading to the creation of Acuity Link. For more information visit. www.acuity-link.net.
Improving Patient Flow... continued
With the close of the 2019 annual enrollment period, the Medicare Advantage (MA) industry is slated to beat the membership growth rates that it has experienced in the recent past. As a warm and promising welcome to 2020, most payers have started on the SDOH journey and show signs of being at different deployment curves. The Medicare Advantage market looks forward to a year of innovation and action. This is largely because current payer initiatives are based on their sample studies over the past few years. What we see emerging is the first wave of SDOH initiatives based on the insights developed from these studies and a strong belief in the goals of “Whole Person Health” outcomes. SDOH today, is about acting on the “known-knowns” pertaining to Social Determinants in relation to healthy outcomes. The SDOH puzzle helps us identify, Who specifically is at a higher risk of not being able to meet health outcomes, and Why. Based on this information, it would be easily ascertained, What social support could be provided to help achieve best health outcomes. The first wave of SDOH is all about taking these initiatives forward and help complete the CLINICAL+ SDOH picture at a patient level. This, by nature is expected to be a dynamic and ongoing activity. Value of such a large-scale effort lies in continuity and ability to generate longitudinal and multi-dimensional Social Data. This calls for long term partnerships with flexible and scalable service providers. SDOH Goals: Usable SDOH Data At the patient level Multi-dimensional (covering all 5 types of Social Determinants) Has high correlation to health risk
By Akhilesh Yadav, Director of Client Success, AgileSAS
Time for SDOH Innovation, Creativity and Expanded Partnerships To meet these objectives, SDOH initiatives are perfectly suited for innovative approaches. Some payers are deploying creative, multi-faceted strategies to engage with the patients, where they are. Some of these strategies include transportation as a key component of their offerings, through NEMT partners. These approaches could present opportunities for partnerships and diversification of related services. One such example is the possible deployment of non-clinical staff to address the social needs, such as isolation, transportation, house-keeping, home assessments etc. This opens up possibilities for NEMT companies to address such needs through diversification of their Driver Networks and retooling of their customer interfaces with members (Website, Smartphone-Apps, and even Call Centers) and ancillary services providers. Organizations that decide to respond to the opportunities for diversification, should invest time in exploring and learning. Ones who have identified them and are open to expanded role in the Payer and Provider initiatives should make every effort to signal their intentions to the markets of interest, through Account Based Marketing. Each encounter you have with plan’s members, presents you with a unique opportunity to engage them and promote your consumer brand and to add value to your relationship. A few ideas, for possible ancillary service offerings that provide long term value to the payers are: Social Risk Assessments and data aligned to integrate into their data infrastructure. Communication Initiatives promoting healthy behavior Breast Cancer Screening Colorectal Screening Pneumonia Vaccinations Flu Vaccinations etc. Patient engagement efforts to educate and encourage sharing of social and environmental data
SDOH Opportunities for NEMT ... continued
Providers Need SDOH Experience and Insights 80% of the Health Delivery organizations currently do not use socioeconomic data in care planning or do so only based on patient reported data. The challenges are presented by: Prevalence of current low rates of SDOH screenings at the level of physicians. (currently providers screen for average of only 1 element of SDOH) Time and Resource limitations of a provider to help achieve a reliable and multidimensional SDOH assessment Some elements of SDOH assessments are truly more physical in nature, for example an assessment of in-home living conditions Therefore we see merit for NEMT Players to increasingly look for partnerships with the healthcare system who are already entering into Value Based Contracts with payers. Hospital systems have a unique need to perform on their MIPS, MACRA and HRRP performance goals, thus making NEMT Service or NEMT Management offerings a strategic tool to help improve administrative and quality performance. Health Systems can benefit from high performing NEMT services that help them improve upon metrics such as: Efficient fleet utilization (in cases where they already own and manage the fleet) Reduce Appointment-no shows Improve on-time arrivals Improve patient experience (example post hospitalization discharge) Improve patient outcomes Better insights around the SDOH and SDOH supported care management outcomes is also a great imperative for them to be best informed and experienced while negotiating value-based contracts. Above all, health systems have been the biggest source of referrals for all ancillary medical and non-medical services and would continue to play that role. Increasingly NEMT operators would have to interact with the healthcare system, and closely work to achieve smooth patient handovers. That call for early stage partnerships and experience working in close collaboration in an incredible opportunity for the NEMT industry.
As we scanned the Medicare Advantage market in the build-up to 2020, we found there were 13 companies that launched new Medicare Advantage plans. 9 were Health Systems, Physicians and Pharmacists owned. Health Systems would increasingly prove be the source of Medicare Advantage Plan partnerships when they enter the MA Markets. Partnerships between NEMT Organizations & Healthcare Delivery Systems would be a great place for start-up collaborations and acquisition of MA clients. The NEMT industry should look forward to these exciting opportunities for collaboration through the rest of 2020. It is already a great start with a few national players reporting satisfactory to exceptional financial results for their government businesses in particular. We wish all the members a very successful year ahead, and look forward to many conversations in the times to come. About Author: Akhil is a seasoned healthcare industry professional, having worked across the spectrum of Providers, Payers, and Pharmaceutical Companies. He is currently actively engaged in following and reporting on the SDOH related developments from CMS, and MA Plans. He and his team work alongside the HC Technology and Services industry leadership. The team helps shape products and service strategies, and take them to markets. He can be contacted at Akhilesh@agilesas.com and Ph: 910-378-4949
Maximize Reimbursement on “Not-at-Fault” Accidents
"Even if you have spare units available, you're entitled to the Loss of Revenue/Use while the unit is out of service".
When your vehicles get hit by a third party, their insurance is liable not only for the physical damage, but also the Loss of Revenue (LOR) or Loss of Use (LOU) while the unit is being repaired. We have found that many fleet owners and managers don’t know this recovery is available, have great difficulty recovering it, or not recovering what they are equitably entitled. This article will help you understand the who, what, why and when for not at fault accidents. Let’s begin with the steps that should be taken to help recover the maximum from your “not-at-fault” accidents. Educate and equip drivers with the tools necessary to collect key information at the scene. Taking lots of pictures is the single best advice we can give. A picture may be worth 1,000 words, but when it comes to accidents, a picture can be worth thousands of dollars. Take pictures of: The accident scene, damages to both units, license plates, skid marks, debris, path of final resting place of the vehicle, third-party driver’s license and insurance information. Gather as many witnesses as possible and statements from both drivers. On board videos and some GPS systems capture speed, braking, and other data that may help with a disputed claim. Get an accurate and thorough estimate. Insurance adjusters are motivated to pay out the least amount possible and are typically not trained to accurately determine the damage to specialty vehicles. Using a damage recovery expert with strong commercial fleet experience is critical for accurate damage assessment. What am I entitled to from a “not-at-fault” accident? Essentially you are entitled to your physical damage, cost for transporting the damaged unit, Loss of Revenue (LOR) or Loss of Use (LOU) and Diminution of Value (DV). How much you are entitled to depends on several factors are the subjective negotiations that damage recovery firms engage in hundreds of times each day. You can go back up to 6 years depending on your state to recover these items on old claims. Pursuing Loss of Revenue or Loss of Use The following are steps you can take to help maximize recovery: Pursue all possible recovery sources. Besides the at fault driver’s primary policy, there may be other coverage from an umbrella policy, a secondary policy by the vehicle owner, a company policy, or personal assets. Know your opponent. Understanding insurance regulations, standards, and the law are key to move the carriers to action.
By Brian J. Ludlow, EVP, Alternative Claims Management
Mitigate your losses. You have an obligation to mitigate your losses. So even if the insurance carrier is dragging their feet you must do what you can to keep the process going and not incur more costs, such as storage. Supporting income records.Loss of Revenue is the hardest item to recover.Proper documentation supporting the income that the unit generated prior to the accident in a format that satisfies the insurance companies, is critical. Buckle up for a long ride. Even after the carrier has accepted liability and you have provided them all the information they requested, be prepared to make a lot of follow-up calls, emails and dozens of voicemails.Carriers often drag out the claim hoping you will either give up or accept less; essentially wearing you down.What we see most often with new clients is they had other essential priorities, such as running their business, so the claim fell off the radar and LOR was not recovered. Diminution of Value (DV), is the loss of market value a vehicle suffers even after it is repaired.The age of the vehicle, miles, condition and other factors determine this amount. The key here is strong data which supports your valuation or using a firm that has extensive experience and a successful track record for recovering DV. Getting accurate value when a vehicle is a total loss. The term “Total Loss” is an insurance term lacking legal definition. Carriers have often used title branding laws to determine if a vehicle is a “Total Loss”. While each state has different criteria for "branding" titles, vehicles can and have been paid as total losses with damage percentages well below the title branding statutes. Carriers often tout statements such as “Federal Guidelines” or “State Statutes” when attempting to settle claims. More accurately, legal entitlements are based upon what is called the Restatement of Torts and defined by case law in each state. Typically, property and casualty insurance adjusters don’t understand these laws and again are motivated to pay out the minimum possible. Engaging a firm that specializes in commercial fleet claims can provide an arm’s length transaction necessary to be proactive on the front side in setting the claim up properly, which usually results in a higher recovery.
Maximize Reimbursement on ... continued
So how do you win at the recovery game? Unfortunately, you are in a game where the opponent is highly motivated to deny or delay your claim and defend their insured. Persistence, knowledge of the law and industry, plus proper supporting documentation is key to winning. There are essentially three routes for recovering “not-at-fault claims”. Handle the claims yourself. Unless you have extensive knowledge of the law and insurance industry, plus have ample time to talk to the voicemails of insurance carriers this option may not be ideal and detract from your core business. Let your insurance company handle the claim. They will pay your Physical Damage, less your deductible, but they can only recover what they pay out and is on the policy. Therefore, LOR, LOU and DV are typically not recovered. Hire a Damage Recovery Firm to handle the claims for you.If this is the route you select, look for a firm with a long track record, experience with specialty vehicles, adequate technology, legal resources, and specializes in Loss of Revenue/Use recovery. Their fees should be performance-based, so they only win if you do. Brian J. Ludlow is Executive Vice President for Alternative Claims Management. He is an entrepreneur and consultant to the insurance, financial, and transportation industries. His firm has transformed the fleet damage recovery process. bludlow@AltClaim.com| 231-330-0515
By Claire Burgdorf, Marketing and Branding Strategist, RouteGenie
If you work in the transportation industry, specifically the Non-Emergency Medical Transportation Industry, great service is one main aspect that will set you apart from your competitors. Not only will it make your company stand out above the rest, but it is absolutely vital for the growth of your business. One key aspect to ensure great service in NEMT is utilizing all of the resources available to you. There are many software programs designed specifically for the industry that will help manage your on-time performance from start to finish. You will want to have a resource that allows you to import your trips directly into the system. This will guarantee accuracy for the day ahead and ensure that your customers have a great experience from the moment their trip is scheduled,to the moment they are dropped off safely back at home. If problems do arise,you will want your dispatchers to be customer service oriented instead of focused on the logistics of the day. The right tool can help you handle the real-time changes and challenges that come up throughout the day,like add on trips, will calls, no shows, cancellations, driver call offs, vehicle breakdowns, etc. This will allow your dispatchers to spend less time on fixing errors and will allow them time to provide better service to your passengers and drivers. Another way to impress your customers and medical facilities that you deal with, is by being proactive and staying on top of “what’s next.” One way to do this is by interacting with your passengers in advance of their trip to minimize the likelihood of a no-show. Many times, this will happen because your client either doesn’t know how to get a hold of you, forgot about the appointment entirely, or simply doesn’t want to go. Use a software that will let you send reminders to your clients about their upcoming trip and give them the opportunity to confirm or cancel. Once they confirm, continue to give them live updates on their trip when the driver is on the way and when they have arrived at the pick-up location. This will also keep your payers happy as they will know exactly what is happening with their clients and can prepare accordingly. Providing accurate information to your payers, and in a timely manner, is another key step to having great service as a NEMT provider. Don’t spend the time trying to manage the billing on your own. Utilize technology to help maintain the financial health of your business by making it easy and fast to generate all of your billing. This would include broker billing, 837P files, CMS 1500 forms, paper invoices, and more. Putting the right resources in place for your team puts them in a position to shine as customer service experts instead of logistics experts that are always stressed and under pressure. Making that change is what separates the NEMT companies that are trying to grow from those that are able to successfully do so!
By Joseph M. Rubino, President, J.M. Rubino Transit Consulting
Christopher did everything right. He had transported Mrs. Peterson many times; in fact, he was her regular driver. Christopher had transported this elderly woman about 30 times, and they had their routine down pat. This morning, he parked his van at the same spot in her driveway he always did. First, he opened the minivan's tailgate and let the ramp down. He then assisted Mrs. Petersen and her wheelchair up into the vehicle, and he made sure he navigated her into the exact spot for proper securement. Christopher made sure the wheelchair's brakes were applied. He attached the links at the rear of the wheelchair at a perfect 45° angle. He then exited the van, closed up the ramp and the tailgate, and went around to open each side door, in turn, to secure the floor restraints in the front of each of the chair's wheels. Finally, he attached the combination shoulder belt and lap belt with perfect precision. Christopher then checked all the restraints to make sure there was no play in any of the securements, then closed the side doors. Finally, he moved into the driver's seat, started the van, put it in gear and proceeded on his route. Driving down the road, Christopher felt pretty good about things. As always, he felt he had done everything perfectly. Plus, he liked transporting Mrs. Peterson, and it was a short run today, as he only had a 6 mile drive to her appointment. And, like I said, he had done everything perfectly. Then, 2 miles into the trip and without warning, a car cut Christopher off, he tapped his brakes, the trap door opened, and Mrs. Peterson fell through. She slid downward, and forward, onto her knees and out of her wheelchair's seat. The lesson here? If you transport wheelchair riders for an NEMT or ADA service, remember this: your wheelchair accessible vehicle has a trap door. You just don't know it yet. Since 2008, I have worked as an Expert Witness more than 200 times. Most of these cases involve personal injuries in a for-hire vehicle, and too many of those cases have involved a passenger sliding out of their wheelchair. The fact is, no securement in the world can guarantee that a passenger will not slide forward out of the wheelchair given the right combination of circumstances. Or should I say, the wrong combination of circumstances. Accidents and/or incidents will sometimes happen if certain conditions are present, as they were in this case described above with Christopher and Mrs. Peterson. Those circumstances are the following: 1. an elderly or disabled passenger, 2. who has weak or non-functioning legs, 3. who has limited mobility, if any, 4. slumping low in their wheelchair, 5. sitting on cushions, pillows and/or blankets, 6. with no companion or aide present to monitor him or her, 7. as the vehicle braked quickly, 8. while the roadway was on a downward slope. When you have the presence or 3 or 4 of those circumstances, you are at risk. When you have 5 or 6, you are likely to have an unfortunate event. When you have 7 or 8 occur at the same time- the trap door will open.
Closing the Trap Door ... continued
Although the type of situation described above can happen with a wheelchair rider at any time, it is most likely to happen during the conveyance of an NEMT Medicaid rider. Many times it occurs due to the fact that companies like yours must do what you are ordered to do by your contacting broker who, in turn, has the responsibility of determining the proper Level of Service (LOS) for the rider. Under most circumstances, providers have little input into the process which determines the LOS, since a rider's LOS, including any special needs, is determined based on the data provide by the rider and/or the rider's advocates during the rider certification process, combined with the subsequent evaluation made the broker. To repeat, that process starts with the rider and/or the rider's advocates (family, personal aide, attendants, medical providers, case managers, etc.) providing as much information as possible about the rider's physical condition and transportation needs to the broker. Far too often, the NEMT rider's family and caregivers do not convey a complete and accurate picture of the rider's physical condition, and physical capabilities to the broker. In many of the cases I have worked on, family members and caregivers are fully aware of problems related to mobility in riders like Mrs. Peterson but simply do not relay this information to the broker, and yet you are expected to provide the proper service to the rider without the proper information. Some passenger advocates, particularly family members, live with the optimism that their loved one will get better and improve physically, and this causes them to sometimes not possess a realistic view of the passenger's condition as it relates to their transportation needs. In addition, families usually do not understand the limited role of your company, and of your NEMT driver. In 2011, I wrote a column in which I discussed a personal injury case where a NEMT passenger fell out of her wheelchair during the discharge process. The rider's family subsequently sued the NEMT provider. The driver (let’s call her Ms. Smith) was referred to dozens of times in the court documents as “Medic Smith.” While I first thought it was merely posturing on the part of the plaintiff attorney, it soon became clear to me that the family of the passenger thought the"NEMT" driver was actually an "EMT." Obviously, an NEMT driver is not a medical technician, has no medical trailing, and cannot act as a passenger's aide or attendant. And that is the problem: many of your riders need attendants and don't bring them nor do they request them.
As an expert witness, I often learn that patients like Mrs. Peterson are monitored by aides, attendants, or caregivers 24/7/365 while they are in the safety of their home or living facility. Yet, these same riders are sent unaccompanied while traveling to a medical appointment. And your company is at risk when that happens, because, unknowingly, you are not carrying with you in the van the person who watches that rider around the clock. Here is a list of red flags and problematic situations that NEMT or Paratransit drivers need to be trained to identify, deal with, avoid, or act accordingly: Riders who are transported while sitting in motorized chairs or scooters W/C Riders who sit on pillows, cushions and/or blankets W/C riders who keep their feet on the ground and/or do not use the w/c footrests Riders with home aide/attendants who do NOT accompany that rider in your vehicle Riders with breathing issues Young passengers multi-loaded with older riders Ambulatory passengers who disembark while walking in the van past a W/C rider Disabled, ambulatory riders who choose to walk up and down steps by themselves W/C Riders with no ramp at their home who insist they can walk up their front step(s) Passengers left unattended outside a building, even for one minute, even at their own request Driving away from the destination before the rider is safely inside Allowing a rider to change their seat while in transit, even if the vehicle is stopped Trying to move a W/C rider, or letting the W/C Rider move themselves, when on a W/C lift
In addition, your drivers must always report red flags to you so you can either deal with the issue, or report it to the broker or the transit agency in the case of a paratransit passenger. Drivers must report the slightest sign of a red flag,even if it has not yet developed into a problem. Your driver cannot assume that your company management, the Medicaid broker's staff, the transit agency, or even the rider's own family are aware of what they (the driver)has seen. Drivers must assume nothing. If something looks like it might be a problem today,next week or next month, report it NOW. Finally, your drivers need to listen to their passengers and their passengers' advocates when they talk. If a family member states "my mother keeps sliding out of her chair," or "my mother has trouble breathing" the driver cannot assume that is a well-known fact.Your driver must assume he is the only person in the world who knows this fact.Drivers must report such information to your management so you can report it to the Medicaid broker or to the transit agency. It is possible this rider has not been provided the most appropriate level of service. Joe Rubino is the President of J.M. Rubino Transit Consulting and has worked on transit projects in 47 states. He also works extensively as an Expert Witness. Contact him at jmrubino@aol.com, or at www.jmrubinoconsulting.com. This article originally appeared in The Transportation Leader, the magazine of The TransportationAlliance (TTA)
SUBMIT HERE
Submit Content for the Spring 2020 Edition of NEMT Today!
NEMT Today magazine is a quarterly publication with editions in the Winter, Spring, Summer and Fall. We are interested in receiving articles that highlight educational topics related to Non-Emergency Medical Transportation (NEMT) business operations, industry trends, compliance & regulatory, technology and customer service. Article Specifications: Furnish content with Word files with 1000 word maximum or less preferred. All font will be Open Sans 9pt. Submission Deadlines: Final copy is due on the following dates: Winter issue - January 15th Spring issue - March 15th Summer issue - June 15th Fall issue - October 15th
Ad Specifications: Furnish press ready pdf files. All fonts must be embedded, and all images must be 200dpi minimum (300 dpi preferred.) The publication is an 8.5 x 6 interactive digital publication. Prices and Specifications listed below:
Advertise in the Spring 2020 Edition of NEMT Today!
www.nemttoday.com