Understanding the NEMT Insurance Market
Why NEMTAC's Training is Important to NEMT Providers
9 Bottom Line Reasons to Invest in Driver Training
22
5
43
NEMTAC Board of Directors
Creating a NEMT Business Plan is Your Roadmap to Success
NEMT Opportunities Within the PACE Program
Choosing the Right Partners for Your NEMT Business
Enhancing Your NEMT Operations with Scalable Technology
Letter from NEMTAC's President
NEMTAC Advisory Board Members
CTAA NEMT State Updates
38
How The Transportation Alliance is Working to Protect NEMT
12
Professional NEMT Driver Accidents
30
The NEMT Industry: Partners in Senior Care
3
33
41
8
27
16
18
Innovation is Just a Phone Call Away
Table of Contents
25
Three Things that will Shape the Future of NEMT
4
37
Why NEMTAC’s Training is Important to NEMT Providers
This is our third edition of NEMT Today, and follows the first NEMTAC annual conference, a success well beyond our expectations thanks to the tremendous support and commitment from those who attended, our sponsors and the broader NEMT community. We maxed out all the available vendor space and had nearly 400 attendees (100 more than we hoped) who enjoyed a wide range of presentations and perspectives about the current state and dynamic future of NEMT. And nearly 25% of those attending provided written feedback after the conference, offering both high marks and great suggestions about making next year even better. Thanks to all who attended and supported the conference. During the conference we unveiled the new NEMTAC Certified Transport Specialist (CTS) on-line training class, the first such nationally available training for the NEMT industry. Within 24 hours the first student completed the course, and its only grown since then with small providers, large organizations and individuals pursuing this important training. As NEMT advances as an industry, strong standardized national training is critical and a key element for any respected profession. This first offering from NEMTAC and the education to come in the future will help NEMT organizations achieve the quality, safety and reliability needed for success, as well as national accreditation with NEMTAC and competitive advantage. In keeping with our commitment to assure NEMTAC remains relevant, responsive and transparent, terms for 1/3 of the members of the Board of Directors expire at the end of each calendar year. As a result two Board members will be leaving the Board and one will seek a second term. A tremendous thanks goes to departing Board Members Robert Brown and Doug Allen, MD for their key contributions and dedication to founding and launching NEMTAC. The Board will be selecting replacements in the coming weeks and we will enter 2020 with both continuity of leadership and fresh energy, ideas and perspectives for NEMTAC's strategic direction. Please enjoy the many offerings of this new edition of NEMT Today from a range of authors, perspectives and roles in the industry. As always, we welcome feedback about our publication and ideas about making NEMTAC, NEMT Today and the coming 2nd annual NEMTAC conference even better! Thanks, Enjoy,
A Letter from NEMTAC's President
Steve Lewis Board President
Stanton Sipes Board Member
Melissa Jankowski Executive Director
Chris Kelly Board Member
David Marhoffer, Board Member , not pictured
Peter Hicks Board Secretary
Gail Bauhs Board Member
Michael Shabkie 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 Adonica Dawkins, Director of Operations, Chariot Transport, LLC Larry Dorsey, Regional Director of Business Dev., MedicOne Medical Response 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, 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 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 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 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 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
Emerald Sponsors
Contact us HERE to become a Corporate Sponsor!
Sapphire Sponsors
By Dan Reid, President, Grove Transit As the inaugural NEMTAC Conference sessions were ending last month, there was a common discussion among many of the NEMT providers in attendance. Essentially, the 400 participants had just attended a fantastic conference filled with informative content and vendors targeted to our industry. As positive as the remarks were, there were providers that were struggling to see how supporting the NEMTAC mission was going to benefit their NEMT company. Despite the many hours invested in NEMTAC this past year, I too was asking the same question. The crux of the issue came down to the recently announced Certified Transport Specialist (CTS) certification and the realization that the wheelchair securement training component was limited to the “awareness level” only. For those companies that provide both ambulatory and wheelchair services, I knew full well that without this essential piece of securement training, it would not be fully recognized by many States, and specifically, in Mississippi where we are based. Thus, I didn’t have a sufficient answer when the discussion about NEMTAC turned to the question, “What’s in it for me?” Training to a Higher Standard Throughout the last year the point had been raised during Advisory Board conference calls that unless NEMTAC could solve a need for provider training, we’d never get provider “buy-in” because they did not have the time or the money to spend on so called “high level national issues”. The greatest need noted and one of NEMTAC’s critical mission is to train and certify NEMT driver at the national level. I then did what I always do, begin looking for answers from the NEMTAC Advisory Board members. We discussed exactly what message was received by attendees versus what was intended to be delivered. So, what did this probing reveal? When it comes to certification, NEMTAC found a huge case of chicken and egg, which comes first? As we all know, there are no national training standards, each state and broker had their own concept of which training and certifications were required. NEMTAC gathered examples of various training requirements and determined it would select the highest standards and build the CTS program from there. Subsequently, the Certification Advisory Board was developed using stakeholder input from across the NEMT industry. The Board was tasked to review and craft the driver training modules. Once the curriculum was complete, the material was refined into a format that would be delivered through their Learning Management System (LMS) partner, CareerCert.
Why NEMTAC'S Training is Important continued ...
Although the CTS may not meet all the credentialing requirements set forth by each and every state, what it does do is to exceed the minimum standards of every state where standards were published. The next step is for the NEMT industry to push for adoption of these national standards wherever possible. Sharing NEMTAC training standards with NEMT brokers, and insurance carriers are the next steps for NEMTAC to further promote the adoption of nationally recognized and accredited training for the NEMT industry. Why Every NEMT Provider Should Embrace NEMTAC The current CTS program is the first step towards a standard that is recognized by all States, brokers, insurance companies, medical facilities and anyone contracting for NEMT services. Let’s clear up another question asked during the conference, while the CTS program offered through NEMTAC will meet the requirements for a CTS certification, it will not be the only training program that it will develop over time. NEMTAC’s Advisory Boards are developing a reciprocity program which will recognize training that meets or exceeds the curriculum included in the CTS course. Any NEMT provider with an internal training program can submit it to NEMTAC to be considered “substantially equivalent” and satisfy the requirements for a CTS certification, which leads us back into the discussion on wheelchair training certification. “We are moving quickly to identify standards which will be part of the CTS-Advanced Course”, advised Peter Hicks, NEMTAC Board Member. “Our role as the ANSI Standards Developer requires that we have an inclusive standard, preventing a single provider from being the sole source of training. We already have several nationally recognized organizations providing such training and processes already in place to certify those trainers” said Mr. Hicks. We expect the CTS-Advanced Program to be easily adoptable by all the payers across the country. The point to remember is that the current training you are already doing, whether from CTAA, TAPTCO, or even your own self-developed program, may already be sufficient to satisfy a CTS (ambulatory) or CTS-Advanced (ambulatory and wheelchair) certificate. The program will need to go through the reciprocity process to qualify. Once approved, the training program will be nationally recognized and the CTS certification will be portable from broker to broker, client to client, insurance company to insurance company or even State to State. Why is this important? Well let’s say you are an NEMT provider in Virginia where there are SIX statewide brokers operating in all counties. Once this training is in place, certified drivers will no longer have to meet separate (and possibly different) credentialing standards, because the brokers will recognize the CTS certification. However, that’s just the simplest example of the advantage of a NEMTAC certification.
of the advantage of a NEMTAC certification. You also need to recognize, and this is very important, TNC drivers credentialed under existing TNC requirements, do not meet the requirements for CTS certification. To be clear, any TNC driver can take the extra steps to get their CTS certificate or TNCs can decide to require their drivers to be trained, but absent that, TNC drivers won’t qualify for national certification. While Arizona and Florida seem to have decided to forego training standards for TNC drivers, providers in all the other states can get ahead of the game and point to the nationally recognized NEMT standard for potential rulemaking purposes. The Future of the NEMT Industry is in OUR Hands Upcoming initiatives of NEMTAC Include: developing a standardized national data set, a NEMT insurance initiative aimed at reducing insurance costs and a national credentialing database to help prevent duplicate submissions to the brokers, payers and states. Developing exceptional best practices, training and techniques is essential for NEMTAC. This process of continual improvement will take industry input and participation from key stakeholders. Much like our peers in emergency medical services, CTS certification of the future will be more advanced than the CTS of today. As drivers renew their credentials, they will receive updated and new training as techniques, best practices and standards evolve. Over time NEMTAC will continue to work with organizations to identify training programs qualifying for reciprocity so that if their program meets the requirements of the CTS program, they can continue to use their program and still be receive a CTS certification. In summary, not only should every NEMT provider be interested in what NEMTAC is doing, but it behooves every provider to stay attuned to NEMTAC’s progress and be willing to provide input where needed. This is an industry where just a few short years ago most providers scheduled trips, recorded trip data and submitted payment claims all on paper. We are quickly evolving from a low-tech paper driven industry to one where technology is the key to our existence, and we can also use that technology to make our industry a safer and stronger industry through nationally recognized credentialing programs. Just think of where we can be as an industry in as little as five years from now with nationally recognized and accepted standards
By Jim Cermack, Director of Training & Customer Experience Champion, Driverge Spend more money. Are you kidding me? Can that possibly be the solution? NEMT and other companies that transport wheelchair passengers are caught in what may seem like an unwinnable situation. Many companies have a revolving door of drivers who come on board, stay a few months and then leave. Add on top of this the challenge of any business to control costs, and you have executives and managers asking why would they invest more into a group of people who are going to quit within weeks or months. I propose that investing more in driver training can make a positive difference in overall customer experience and drive results right to the bottom line. In fact, I will give nine solid reasons to invest more in training. But before I get to that, let’s take a closer look at the situation of the “revolving door.” THE SITUATION As a trainer, I talk with drivers all the time. Quite often I sense a lot of frustration, and a key reason is low pay. On average, drivers can be amongst the lowest paid people in many companies. One factor can be a management mindset of them being someone who just drives the van. Someone who has a driver’s license and a clean driving record seem to be standard minimum – and sometimes only – requirements for the job. Another reason for driver frustration is a lack of training. They are given the responsibility of interacting one-on-one with and safely transporting people with disabilities and seniors – priceless assets. The problem is new drivers lack confidence. They don’t know if they are doing things right, and their passengers can grow frustrated with them. All this causes a tense work environment for drivers and passengers, and can lead drivers out the door. Here are a few of the negative business impacts of driver turnover: Seniors and people with disabilities want and need consistency. They do not do well with change. So a change in drivers can lower customer satisfaction and negatively affect your bottom line. Drivers not trained correctly can make mistakes leading to incident and accidents. These lead to poor customer service, bad press, and even lawsuits which can drive companies out of business. The costs of finding replacements can be high, including recruiting, training, efficiencies, and more. Some drivers leave because they see opportunities to make more money doing exactly the same job. So they leave to start their own business and become the competition. This causes a whole new set of problems. Turning things around takes a different mindset. Below are the nine reasons for investing more into driver training which will make a positive impact on the bottom line, and begin to change mindsets.
9 Bottom-Line Reasons to Invest in Driver Training
Reason 1: Investment in Training is minimal compared to the cost of accidents and lawsuits It has been shown defensive driver and wheelchair securement training can bring a dramatic reduction of accidents and incidents. One lawsuit or even bad press or word of mouth can ruin a business Reason 2: Having Professionally trained and certified drivers can lead to potential Insurance savings Conversations with insurance agencies that cover NEMT companies confirm that having certified drivers can lead to lowering insurance rates. There are no guarantees since driver certification is just one of many variables they consider, but a rate reduction can bring significant annual savings. Reason 3: Even the safest Wheelchair transport vehicles aren’t effective if the passenger isn’t properly secured At Driverge, we build some of the safest vans on the road today. They meet every safety requirement or don’t leave our factories. However none of that matters if the passengers aren’t secured correctly. Reason 4: Having certified drivers can set your company apart from your competitors When you are going after contracts or larger customers, having certified drivers can help you set yourself apart from the competition. This essentially lowers the level of risk of the customer. Reason 5: Professional training allows drivers to practice and ask questions before experiencing situations with actual passengers Many veteran drivers I have trained tell me they were never properly trained. The most common thing I hear is they rode with another driver for a day or watched videos. This is not enough because it’s typically only observation, and also does not prepare drivers for how physically taxing it is. In person training also allows drivers to ask more efficient.questions – especially why things are done certain ways. This is important for their confidence when responding to the questions of the passengers. Reason 6: Professional training can give your drivers knowledge of key parts of the ADA law Knowledge of applicable parts of the ADA law is critical for not
9 Bottom-Line Reasons continued ...
only your drivers’ confidence, but more importantly for protecting your company from possible fines or lawsuits. Knowing what is and is not allowed by ADA is critical. Reason 7: Trained drivers are more efficient and faster Not talking about drivers being faster because they’re rushing or cutting corners. Trained drivers have the confidence of knowing they are securing the right way which allows them to be more efficient. Reason 8: Improved customer service skills leads to happier passengers, a better riding experience, and greater loyalty Professional driver training isn’t just about securement. It’s about being a professional. Its taking pride in representing your company. More importantly, its about serving very special people and understanding the critical skill of Communication when interacting with people with disabilities to show respect, care and compassion. What they do matters! If your passengers truly feel like valued passengers rather than “cargo”, then they will remain customers! How important are regular customers to your business? Reason 9: Professional training goes beyond the “How-to” and gets drivers to understand the “WHY” This starts with customer service and adds a level of compassion. Getting to know your passengers and building a bond will lead to loyalty and consistency in revenue. To wrap this all up, know your investment in training can bring payback many times both in revenues and by avoiding other costs you DO NOT incur!
Text
By Michael Shabkie, Founder/Board Treasurer, NEMTAC As a NEMT company owner, developing a multiyear business plan sounds like a daunting process and is often overlooked in the formation stages of the organization. Creating a robust business plan is equivalent to having a GPS or road map when you travel. As you can imagine, not having one is a sure-fire way to get “lost” and lose focus on your core NEMT business strategies. Developing a business plan is an easy component to overlook, especially when there are more pressing operational and financial pressures vying for your attention. The problem in not having a plan, is that as you address the daily challenges of operating the company, it is easy to spin out of control. I’d like to share a few tips for developing a business plan that I have found helpful over the years. 1. Remember that a business plan is meant to be a fluid document and that you are not writing anything in stone. Your plan will change and evolve as time goes on. As a foundation, the plan should outline your goals, challenges and where you want to be in 3 to 5 years. The plan should be updated annually to fit different economic circumstances or operational changes. We cannot truly see into the future, so, don’t panic about getting it exactly right. Concentrate on your market, your competitors and your growth strategies over this period. 2. As a rule, do not get caught up on the length of the business plan. Most owners think that unless a business plan is 30 pages long, that it is not of any worth. This is the wrong approach; the plan can be as long or as short as it needs to be. There is no need to pad the plan with unnecessary words or items that don’t need to be there. Keep it clear and concise. It is not the size of the plan that counts, it is the content. 3. Develop the outline for the executive summary. An executive summary needs to be succinct and should enable readers to know what the business is, what the business does and the objectives that you want the company to meet. This is the area of the plan to include your mission statement, if you don’t have one this is a good time to develop one. Business plans are often a way of attracting funding or are part of the loan process. The plan should showcase senior personnel; market differentiators and operational best practices. This approach is the best
Follow us!
way to sell potential investors or lenders on the intangible worth of your company. 4. It is critical to provide a detailed analysis of the markets you serve. A good plan analyzes the facilities or brokers who want to contract for services, analyzes the competition and examines the contracting behavior within the target markets. Be thorough in this section and do not simply assume that you have work in a market that is devoid of competition. All markets are vulnerable; the plan simply needs to show that the company can survive when times get tough. 5. The development of a strong marketing plan is essential. You will need to show that you can market your NEMT services and that you have thought about how to increase market share through an understanding of the basic principles of marketing. 6. It is important to include an analysis of all operating aspects of the business. This is the time to peel back the onion and examine all the layers of the company. Always remember; you are only as strong as the weakest link. This section should be an open and honest look at the organization. Most importantly, it demonstrates that you have thought everything through and that you are methodical in your approach. 7. Timing is everything. It is critical to consider the timing of your plan; don’t be overly optimistic, set realistic growth goals and identify achievable milestones. Taking a year over year approach and knowing the timing of contracts or other opportunities will assist in this process. 8. The plan will need to demonstrate that you have included a very methodical financial projection over this period. The financial plan should be based on your past financial performance and needs to be accurate. It is easier to project revenue, but all expenses need to be included, such as rent, any payroll, insurances, operating costs etc. 9. There is an old saying that a picture is worth a thousand words. This is especially true when developing a compelling plan. Take the time to develop graphics, graphs and insert pictures that tell the story. 10. Finally, include all relevant data such as bank statements, excel spreadsheets and data used to develop the plan. As a helpful tip, I have used an online business planning software called Live Plan to help me develop various business plans in the past and strongly recommend taking a look at the various products out there. As a final point, the sections outlined in this article should provide a solid foundation in the development of the business plan. Remember that the plan does not have to written in one day, take your time and work on each section over time. This approach will enable you to get to the end result in a way that is achievable and makes the whole process a whole lot less daunting.
Creating a NEMT Business Plan continued ...
By Alex King, Health Care and Transportation Associate, CTAA The non-emergency medical trip has long been a staple of community and public transportation operations. In fact, from its very inception, the Community Transportation Association of America (CTAA) has found itself developing training, research, technical assistance, resources and advocacy directed squarely at ensuring the safe and efficient transport of all Americans to non-emergency medical appointments. Non-emergency medical transportation (NEMT) requires an entirely unique vocabulary, policy complexity and operational specificity than nearly any other aspect of moving people. Today – as the transportation and health care industries face rapid change, innovative technology, and pressure from the private sector – CTAA remains committed to supporting its members in providing access to reliable mobility options for their community. CTAA, through its health care and transportation associate Alex King, is constantly reviewing resources, analyzing new trends, and providing technical assistance to communities working in the NEMT space. One such outcome of this work is CTAA’s newly launched Health Care and Transportation Resource Center, which creates a space to share resources, policy updates, and CTAA efforts focusing on the issues, opportunities and challenges impacting today’s NEMT professionals. At CTAA we have seen that while federal changes to NEMT can have nationwide consequences, most often changes to the Medicaid benefit occur at the state level. State’s often have an easier time making small- or large-scale changes to NEMT, whether through the way they provide the Medicaid NEMT benefit, to funding new or innovative NEMT programs for other populations such as older adults, or to access other social determinants of health. Below are highlights of a few recent state-led changes around NEMT.
CTAA NEMT State Updates continued ...
Sacramento, Calif. Earlier this month, Assembly Bill 970 passed the California State Legislature with bi-partisan support. Introduced by Rep. Rudy Salas (D-Bakersfield), AB970 will establish a grant program through the State Air Resources Board’s Clean Mobility Options program for disadvantaged and low-income communities to provide non-emergency medical transportation to and from health care appointments for seniors and persons living with a disability by utilizing zero-emission and near-zero emission vehicles. It will also require the California Department of Aging to hold a public workshop focused on addressing the barriers to providing transportation to and from non-emergency medical services for older individuals and persons with a disability. AB970 now awaits final consideration at the Governor’s office. Tallahassee, Fla. On Sept. 4, 2019, the Florida Agency for Health Care Administration (AHCA) released a notice of proposed rule (NPR) that would clarify policy updating the Florida Medicaid Non-Emergency Transportation Services Coverage Policy. The NPR would specify that transportation network companies are eligible to render Florida Medicaid NEMT services. AHCA found that this provision would not have an adverse impact on small businesses or increase regulatory costs more than $200,000 in aggregate over the year following the implementation of the rule. AHCA is no longer accepting comments, but the notice of proposed rule can be viewed here. This NPR is a required action under legislation (CS/HB 411) recently passed by the Florida State Legislature. CS/HB 411 (PDF) allows transportation network companies (TNCs) to provide NEMT to Medicaid patients if they are under contact with a Medicaid Managed Care plan or under contract/receiving referrals from a transportation broker who is under contact with AHCA or a Medicaid Managed Care plan. Additionally, the bill states that the requirements for TNCs providing NEMT may not exceed those already imposed under state law, except as necessary to conform with state and federal Medicaid Requirements. As other states look at similar legislation, Florida will be an example to watch regarding the outcomes of this change in NEMT policy. Farmington, Conn. A new model for NEMT has emerged in Connecticut through skilled nursing homes and housing facilities. Historically, most NEMT in the state is handled by for-profit companies that focus solely on transportation.
However, in this new model, in lieu of using the for-profit companies, these nursing homes and housing facilities are transporting their own Medicaid residents to health appointments. New Horizons, Inc., a nursing home that provides housing and support services for people with physical disabilities, is the first non-profit to use this model, providing its 200+ residents over 500 trips since the program’s launch in April. New Horizons’ program has a unique advantage in that it is already familiar with the specific needs of its residents, including their mobility and transportation needs. They have supplied wheelchair-accessible recreational transportation for more than 30 years, and have already received an outpouring of support from their clients regarding the expansion of these historical services into health care appointments. New Horizons has been working with the state’s Medicaid broker, Veyo, very closely throughout their expansion into the NEMT space. Read more about the program here. Interested in more information, technical assistance, or resources on these topics ? Sign up for CTAA’s FastMail Newsletter and check out our Health Care and Transportation Resource Center. Reach out to Alex King, CTAA’s Senior Program Associate, Health Care and Transportation at king@ctaa.org with any questions, updates, or comments.
Sponsored Content
Sometimes suppliers come and go, and it can be a series of one-hit wonders. More than likely, as a Non-Emergency Medical Transportation (NEMT) business owner or operations manager you’ve had that experience at one time or another. Maybe all too frequently. When your business is providing accessible transportation to those who depend on it to connect them with their medical care, and frankly, with the rest of the world, you can’t afford to partner with an unreliable supplier. Even more so, the success of your business relies in large part with relying on a supplier that’s at the ready with solutions beyond the widget they offer. The partner you choose to do business with should take the time to understand your business, become familiar with your unique needs and be able to offer a holistic approach to help solve your paint points. That’s what sets apart an exceptional supplier from others with similar products/service offerings. Take accessible vehicles for example. Over the last several decades, options in accessible vehicles have expanded and a handful of suppliers exist today, all offering variations of a minivan with a built-in wheelchair ramp or a full-size van with a platform lift. Depending on the application and the environment where your vehicles will be deployed, the options are fairly-well defined. How do you choose which supplier is the right partner for your operation? Choosing the right vehicle(s) is critical, but how your buying experience is in working with your supplier and what happens before and after your purchase are all just as important. Is your supplier providing financing/leasing solutions to help with your vehicle acquisition? Are they taking a consultative approach to help you identify the best vehicles that will meet your operational needs? How about the support you receive after your purchase? Will they stand by their warranty policy? And, are you getting the support you need to make sure your purchase will remain an effective investment and continue generating revenue for your business for the long haul? Sure, accessible vehicle manufacturers are in the business of designing and building the next best product in accessible transportation options. However, if they are capable of taking a birds-eye view of your needs, they will serve as an effective partner by helping to connect you with all aspects of your vehicle purchase, operation and ownership. Your vehicle supplier’s job should continue to help you maintain a healthy fleet of accessible vehicles for as long as you need, to maintain a profitable operation.
Choosing the Right Partners continued ...
One of the industry-changing solutions for NEMT customers was recently introduced by Revability, a VMI company, at the recent NEMTAC conference in Scottsdale, AZ. Revability offers a program called VMI Assurance—a program designed to help maintain NEMT accessible vehicles and provide roadside assistance if drivers are faced with mechanical failures while transporting passengers. There are two components to the VMI Assurance program: 1) Mobility Roadside Assistance (MRA), and 2) Wrench Fleet service. MRA is uniquely different from many of the leading roadside assistance service programs in the marketplace today because it’s dedicated to serving customers who require mobility assistance. Many of the other roadside assistance providers, such as AAA, do not accommodate passengers who use wheelchairs. MRA specializes in meeting the unique needs of wheelchair users. So, if a transportation provider finds themselves with an inoperable vehicle or accessible equipment, MRA will be there. A call to MRA will deploy a tow truck and paratransit transportation to ensure that the wheelchair user can continue to their destination safely. In addition to providing paratransit transportation, MRA also covers services commonly expected from a roadside assistance provider, such as: battery service, jump start, lock-out assistance, tire repair, towing, winching/vehicle extraction and emergency fuel delivery. Mobility Roadside Assistance is available throughout the U.S. and Canada. Another component of the VMI Assurance program is the Wrench Fleet service. Wrench has partnered with Revability with an exclusive agreement to service accessible vehicles put on the road by Revability dealers or commercial customers. What’s unique about the service through Wrench is not just the fact that expert, certified auto mechanics will service the vehicles. Wrench mechanics will go where the vehicles are located and service one vehicle or an entire fleet. This ensures that vehicles are maintained at the fleet owner’s convenience while maximizing vehicle utilization. Wrench mechanics will provide services such as brake adjustments and caliper replacement, oil and filter change, engine tune-up, vehicle parts replacement, A/C service, battery replacement, perform vehicle diagnostics and service the wheelchair ramp system, to name just a few. Wrench Fleet is currently available in select cities within the contiguous United States. Expansion of service coverage is planned in 2019 and will continue into 2020. VMI Assurance is the solution that has been much needed for those who provide service in mobility transportation. As the leading innovators in the mobility industry, Revability offers VMI Assurance to deliver a positive vehicle ownership experience for the life of the vehicle. Its objective is to help customers like NEMT operators keep their vehicles on the road, where they will continue generating revenue. In the spirit of providing a total solution, Revability offers a 1-year complimentary Mobility Roadside Assistance membership and 20% off first Wrench Fleet service with every new Revability conversion purchase. To sign up for MRA membership to cover existing vehicles, visit http://bit.ly/RevAbility. For more information about VMI Assurance, call Revability at (844) 864-4232.
Revability is located in Clarkston, Michigan, where it operates an expansive manufacturing facility. Its parent company, Vantage Mobility International, is located in Phoenix, Arizona and it also has a sister company located in Tucker, GA. NEMT customers are invited to take a factory tour to learn more about VMI’s Lean manufacturing process and warranty/technical support. Demand more from your suppliers. Those that are truly willing to partner with your business will engage and take a broader view to support you with solutions that add value to your operation.
By Ashley Berg, Head of Expansion, RedRoute For passengers that utilize NEMT services, the customer experience is paramount in allowing them to easily get to and from their medical appointments, all while living out their normal daily lives. From making a reservation to requesting will-call return rides, every step of the NEMT process is important in creating a smooth customer journey. This experience is unfortunately inconsistent across NEMT technology channels, as smartphone applications have received much of the attention over phone calls. Now, new developments in voice technology enable “automated agents” to assist a member through the entire call. A new age of customer transparency has evolved with the advent of smartphones and real-time tracking of rides via apps. While this is beneficial to the portion of the population that has access to smartphones, there is a significant demographic that is left to deal with antiquated technology. Many people rely on good old-fashioned phone calls for coordination of their NEMT rides. There are many who cannot afford smartphones, are visually impaired, or perhaps are not confident enough in their technology skills to use app-based or online scheduling. This leaves a service gap across the NEMT population - those with smartphones have access to faster booking and transparent ride information, while those who rely on phone calls are subjected to long wait times for scheduling and checking on the status of their ride. For members needing transportation to dialysis appointments three times a week, NEMT becomes a large part of their daily life. If they need to wait on hold for an average of 5 minutes each time they call to schedule a trip or release a ride, that’s a total of 2 hours a month spent on hold, just waiting to speak to someone about their transportation. This adds an extra hurdle to an already stressful medical situation and can make the relationships between NEMT programs and members unnecessarily tense. Fortunately, the recent development of speech recognition and natural language understanding (NLU) technology has allowed automated agents to bridge the gap. These automated agents can help a caller with their entire call, meaning they never need to wait on hold to speak with a human operator.
Innovation is Just a Phone Call Away continued ...
This is called “automating” a call. An automated agent serves as a next-generation IVR (Interactive Voice Response), adding on a layer of conversational artificial intelligence (AI) to traditional touch-tone inputs. While legacy IVRs assist with call routing and manual entry of customer identification numbers, this new technology goes a step further. NLU is used to better understand the caller in the context of the conversation, taking into account what has already been said, as well as what questions the caller is likely to have at that stage in the phone call. The technology can also learn from past calls to determine what the customer is saying with greater accuracy. These AI agents can assist members with every step of their call, from verification and eligibility to scheduling and cancelling trips. To handle all of these steps, the system must be able to understand fields such as names, ID numbers, locations, dates, medical reasons, and more. Additionally, there are more nuanced factors such as accommodating callers who speak slowly, make mistakes, or speak with an accent or regional dialect. The automated agent should also be carefully calibrated for a certain number of retries if it doesn’t understand the input the first time - there is a balance between optimizing the use of the automated system and frustrating a customer by asking them to repeat themselves too many times. If all of these features work in tandem, the automated agent can act in the same manner as a live operator. The result? A system that can assist the caller immediately, with no wait time. This solution allows a caller to interact with the automated agent on the first ring, regardless if there are 50 other callers at the same time. This is a scalable solution with no cap on the number of calls handled at any one time. There are certainly benefits for the business, as well. The call center can now focus on more complex calls, increasing employee happiness by taking away the routine calls in favor of handling more interesting inquiries that require critical thinking. An automated agent also significantly reduces call center expenses by streamlining operations. Phone calls continue to serve as an important interaction point for many NEMT riders. An automated agent can greatly reduce the amount of time spent scheduling a ride, allowing members to more seamlessly fit NEMT into their busy lives. As an added bonus, this enhancement in customer experience actually comes with a corresponding decrease in call center expenses. As technology continues to permeate the NEMT sector through smarter routing systems and smartphone apps, let’s bring innovation to the oft-forgotten telephone system.
By Brendan Helt, AVP, Research Underwriters The NEMT industry is in the midst of a serious transformation. Already a multi-billion dollar industry that provides roughly one million trips per day, the space is poised for significant expansion in the coming years. An aging population and increased scrutiny over healthcare costs and outcomes have forced lawmakers and key stakeholders to recognize the vital importance of well executed non-emergency medical transportation services. Due to these and other factors, the NEMT industry is expected to grow annually by 7% moving forward. While NEMT is still primarily represented by small businesses, this projected expansion has attracted significant attention and investment from larger corporations. New vendors focusing on every facet of the NEMT business have emerged, and transportation network companies like Lyft and Uber have dramatically increased their focus on this space. A multi billion dollar industry forecasting aggressive growth presents opportunity for all stakeholders, large and small alike, but the future of NEMT is not without its challenges. Broad concerns regarding customer service and wait times persist, and a national shortage of qualified drivers has caused many issues. Chief among the challenges facing the NEMT industry, though, is the startling lack of affordable insurance options. Due to wider market trends as well issues specific to NEMT risks, the insurance marketplace’s appetite for insuring non-emergency medical transportation companies has nearly disappeared in recent years. Like many industries, the insurance marketplace goes through cycles of rising and falling rates, known as hard and soft market cycles. Hard markets are characterized by higher premiums, strict underwriting practices, less competition among insurance companies, and reduced insurance availability. Conversely, soft market cycles generally bring lower premiums, increased competition, relaxed underwriting guidelines, and capacity for insurance companies to write more policies. While the broader commercial insurance marketplace has remained relatively stable, the commercial auto product segment has been in the midst of a prolonged hard market cycle. There are many factors that have caused this shift to a hard market, including historically underpriced rates, increases in claims frequency and severity, and increased litigation expenses. The commercial auto market experienced its eighth straight year of underwriting losses in 2018, leading Fitch Ratings to categorize it as “…a chronically underperforming product segment.” Industry experts believe that commercial auto rates have been underpriced for the last 5-8 years, leading to inadequate claims reserves and a pool of underperforming risks. The results of this underpricing can be seen in insurer’s combined ratios. The combined ratio is a measure of profitability used by insurance companies, and is calculated by taking the sum of incurred losses and expenses and dividing them by earned premium; a combined ratio under 100%
Understanding the NEMT Insurance continued ...
indicates a profit, and anything over 100% indicates an underwriting loss. The commercial auto combined ratio was 110.4% in 2018, meaning that for every $1.00 of premium insurers collected, they lost $1.14. The severity of these underwriting losses is a direct cause of hardening market conditions. Another primary factor has been the issue of increasing claims severity, caused by rising medical costs and a challenging legal environment. It has been reported that the persistence of injuries from a car or truck accident have been longer than average, leading to more lost days and a longer duration of time needed to settle a claim. This has led to higher claims payments and increased expenses for insurers. Claims frequency has also been impacted by things like distracted driving and increased activity on the roads due to lower fuel prices. It has also become much more costly to defend against lawsuits, as plaintiff’s attorneys have become more aggressive in going after for-hire motor carriers. All of this leads to a commercial auto insurance landscape that requires insurance companies to raise rates in order to return this line of business to profitably. Market surveys and insurer filings indicate rate increases this year have been in the high single digits, and double digit increases are likely to be common in 2020. Simply put, passenger transportation providers, and especially NEMT businesses, should expect to pay significantly more for their insurance moving forward. Business owners should also be prepared to provide much more detailed information on their operations, including detailed safety plans, driver screening and training materials, vehicle maintenance procedures, and financial statements. Unfortunately, the days of receiving a quote in exchange for a short application, vehicle, and driver information are likely over.
While business owners should be prepared for challenging renewals, there are several things you can do to help minimize the impact of this hard cycle. As underwriting guidelines become more restrictive, it is extremely important that you review your safety programs and ensure that they are updated, implemented, and monitored throughout your business. This includes taking a more comprehensive approach to managing your business risks and tracking claim activity closely. NEMTAC and it’s partners can be a vital resource for transportation providers seeking to implement or enhance safety and risk management practices. While there isn’t much to be optimistic about in the near future, these hard market cycles do not last forever. Prior to the start of this cycle in 2011, the U.S. experienced eight straight years of commercial auto profitability that began in 2003. Although 2020 will likely be the ninth consecutive year of combined ratios above 100%, the prospect of rate adequacy and improved claims practices, coupled with improved technology and safety practices, point to a possible end in sight. Until then, it is important to work with a capable broker during these periods to ensure that all options are available to you. Be proactive and invest in safety and technology, and take advantage of the tremendous resources available through NEMTAC, it’s vendors, and the larger NEMT community.
By John Kuder, Senior Instructional Designer, Avatar Management Services IMAGINE YOURSELF AS THE OWNER OF A NEMT TRANSPORTATION COMPANY Just like with any transportation company, it’s time-sensitive. All professional driver accidents cost you money on claims, extra time between trips, and an opportunity cost not being available to handle additional requests. They might even cost you a contract. You set aside a certain amount of revenue to new driver training every year to avoid losses. While that’s money that could go into marketing to find new business, you rest easier knowing you’re doing the best you can to protect your drivers. But guess what? Despite the training, your drivers still have accidents. When NEMT companies spend money on training and their drivers still have accidents, it’s frustrating, even if the training paid for itself twice over. Sometimes we hear people ask why even bother if drivers still crash. The fact is, even trained professional drivers might have accidents. Training still matters, though. There are steps you can take beyond the initial training, so your drivers have less accidents. The “Why” before the “How” If you want to stop professional drivers from having accidents, you have to ask yourself why they happen at all. There are a lot of reasons, but one of the biggest, and the one we’ll talk about here, has to do with the five levels of learning a skill: Awareness Initial modeling Cognitive Performance Enactive mastery Automaticity Our answer lies in automaticity, but first let’s talk about what each level means.
Professional Driver Accidents – Awareness is Key Awareness, also known as receptivity, means that you want to learn a new skill. You know about it and think it’s worth the time and effort to learn it. Next, in the initial modeling level, you can watch someone perform the skill and slowly copy what they do. You might make mistakes, but with help, you start getting better. Once you reach cognitive performance, you can complete the skill on your own with a lot of focus. When you reach the fourth level, enactive mastery, you are able to do the skill without error or much focus. You can do it at the same time as another easy task like talking. The Danger of Automaticity Professional drivers are at their best sitting around enactive mastery or even cognitive performance. The line graph shows that there is even a diminishing return on training right around this point. The danger comes when drivers enter the fifth stage: automaticity. Automaticity means that you can perform the skill without any thought. You’ll likely start focusing on something else. Ever drive home without remembering how you got there? Automaticity is why that happens. Automaticity is dangerous because we don’t drive in a bubble. For skills like throwing a football or painting, automaticity saves us time and energy. With driving, automaticity means drivers go into auto-pilot and can’t react based on what’s happening around them. Not paying attention to changes on the road puts drivers at risk of having an accident. Automaticity comes from doing a task over and over again, and as a result, professional drivers are especially likely to reach this level. How Do We Combat Automaticity? You have to make drivers think about the training they went through when they first started, even if they’ve been driving for a decade. We call this making the training “sticky.” The best way to do it is with Monthly Safety Initiatives (MSI), focusing on one defensive driving aspect every month that they learned about in their training. Use posters, videos, blogs, and meetings to remind them of what they already know. In our experience, accidents that an MSI focuses on will significantly decrease that month. When a driver has been at the job for too long without additional training, they become complacent. That’s unacceptable when lives are on the line. Take action to prevent it today!
Professional NEMT Driver Accidents continued ...
By Akhil Yadav, Consultant, AgileSAS With the Annual Enrollment Period (AEP) 2020, on the horizon, and Medicare Advantage (MA) plans responding positively to supplemental offerings that include medical transportation, the NEMT industry finds itself centerstage for improving the delivery of care for millions of Americans. Even though the concept of achieving “Care for Patients across the Care Continuum” has been around since 1998, it has gained practical momentum since the introduction of the Affordable Care Act (ACA). Solving the challenges of Methods to Identify at Risk Populations, Interoperability of Health Records, Discharge Planning, Care-Coordination, Rx Reconciliation etc., all have been aimed at bridging the care gaps and improve patient outcomes. With that context, let us examine where the Social Determinants of Health (SDOH) driven transportation benefits fit into a Health Plans’ objectives and how the NEMT Industry can play leading role in enhancing service delivery. Payer’s Goals and the NEMT Industry To examine the goals from the Payer’s eyes, we have a look at how their performance is measured and reported. A few sources to look at and to better understand NEMT’s enhanced role in healthcare would be: CMS Star Ratings NCQA – HEDIS Measures
CMS Star Ratings The CMS Star Ratings are based on nearly fifty measures that include how well the plans provide for screenings, immunizations, and health check-ups. Additionally, the ratings depend on, how well the plans manage members’ chronic conditions, deliver on member satisfaction and respond to member calls and queries. The ratings drive a rebate system which enables Plans to get paid additional sums from 50% to 70%. The rebate dollars enable Plans to offer additional benefits for attracting additional MA members. Will NEMT organizations have a role in contributing to the Plan’s financial performance for the year 2020? The answer would be a resounding yes, as the Non-Emergency Medical Transport benefits are directly aimed at enhancing the rates of preventive screenings, immunizations, follow-up visits to the doctor and increased adherence rates for health promoting therapies. HEDIS Measures Performance for Medicare Advantage Plans Healthcare Effectiveness Data and Information Set (HEDIS) is a tool that measures health plan performance on dimensions of care and service. HEDIS makes it possible to compare the performance of health plans on an ‘apples-to-apples’ basis. Time and again, various reports have put, low preventive screening rates among the MA plans’ provider networks, as one of the limiting factors in Health Plans’ ability to improve their HEDIS Scores.
The NEMT Industry: Partners continued ...
A closer look would reveal that, HEDIS scores are reported for Effectiveness of Care and Access & Availability of Care, amongst other performance dimensions. Mostly the sub-measures under these categories are, preventive screenings and annual visits. While every health outcome is dependent on the patient visiting the doctor, the preventive screenings, annual visits, follow up visits are the most critical in enabling positive, proactive outcomes for senior patients. By enabling NEMT rides for the qualifying patients (criteria set by Plans) NEMT organizations enhance the delivery of better performance outcomes for Plans/Payers on these and other critical measures. Thus, being an integral contributor to the health plan’s performance against its peers in the market. The three recurring themes of the HEDIS and STAR ratings driven MA Goals are: Focus on Preventive Care Better Care Management Enabling better care in a low acuity patient’s home Beyond Daily NEMT Operations We will be able to meet and exceed expectations of the payers if we were to model our NEMT operations around a few key considerations: All NEMT business processes designed and executed with patient well-being, safety, quality and service as foremost Aim at personal relationship-oriented interactions with members other than being merely transactional Acknowledge and train our staff on the emotional dimensions of the patient experience that are the largest drivers of patient satisfaction Enhance our role in customer care through human connection, respect and compassion Develop a mindset that the NEMT Industry is an essential healthcare partner in the delivery and maintenance of healthy patient outcomes
Align NEMT Training and Performance Measurements With a better understanding of the role we are to play enabling the payer goals, we would better serve our purpose, by aligning our NEMT training and measurement systems beyond the traditional. For example, we could better serve the needs of a SNP (Special Needs Plan) member, if our staff are trained to adapt the appropriate communication style and service delivery approach. As the new Medicare Advantage benefits kick in on January 1, 2020, the role of the NEMT industry should be viewed that of partners in the evolving value based healthcare ecosystem. 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 teams work alongside the HC industry leadership to help shape service strategies, take their services and products to the audience. About AgileSAS: Akhil & Steve Massey are consultants with AgileSAS and their areas of interest lie in the MA, and Commercial Plans related Healthcare Initiatives. They have worked in the areas of Sales and Market Development for Vendors who partner with Payers to provide business support services across the Member Enrollment, Premium Billing and Recon, Claims, Member and Provider Services, Medical Management and Fraud & Abuse.
Three Things That Will Shape the Future of NEMT
Co-authored by Roudtrip and WellRyde Integrating 21st-century technology has been a game-changer in non-emergency medical transportation (NEMT). NEMT providers and care coordinators now have access to more invaluable tools to schedule and monitor patient rides than ever before. These tools are having a tremendous impact on the industry, increasing access to care, and leading to better health outcomes. As we look to the future, the next wave of technological advancements will undoubtedly continue to change NEMT for the better. Here are three things we see that will shape the future of NEMT: Complete ride digitization Technology has progressed to a point where anyone operating a ride has multiple touchpoints. Soon, all NEMT rides will be completely digitized — a benefit that will change the industry for the better, particularly when it comes to combating fraud, waste, and abuse (FWA). Introducing the latest route-building and GPS capabilities to the process means that there will be higher transparency to enforce accountability. Ride digitization also bodes well for the overall quality of NEMT service. Key ride quality metrics like driver on-time performance, ride quality based on driving parameters (like speeding, braking, deviation from routes, etc.), and rider feedback can be easily tracked at the ride level and aggregated at the transportation provider level. For transportation providers, it will make the entire process more efficient, decreasing missed connections while ensuring enough transportation supply to meet patient demand. Major shifts in care delivery With the increasing popularity of telehealth, nurses and physicians are exiting traditional settings and entering homes and other care locations. With the rise of new health care roles like community health workers, primary healthcare services, and patient education is now done in the setting of the patient’s home. As such, there will be a decrease in the total number of people who need to be physically present for an appointment. This new reality means that NEMT will be used to benefit those who need it most, such as those with behavioral health needs, or those who need treatment for chronic illness. The assimilation of autonomous vehicles into society Plenty has been said about autonomous, or “driverless,” vehicles, and there are currently many challenges that need overcoming as they’re introduced into society. With many companies emerging in the space, such as Alphabet’s Waymo, many predict that we will begin to see autonomous vehicles on the road in about 10 years. As a result, more people will be using autonomous vehicles to get to and from medical appointments. Autonomous vehicles will likely work as a complement to NEMT, with drivers transitioning to attendants in vehicles to assist patients. Ultimately, autonomous vehicles have the potential to make NEMT better by making rides safer, coordination simpler, and ensuring patients remain at the center of care. In closing, it’s safe to say that the future of NEMT looks to follow its current trend. New and innovative technology will undoubtedly continue shaping the future of the industry, and every new stride will focus on improving the patient experience and delivering better health outcomes.
By Alfred LaGasse, CEO, The Transportation Alliance A core mission of The Transportation Alliance, the nation’s oldest and largest trade association of the for-hire passenger transportation industry, is to help the industry thrive by keeping an eagle eye on federal legislation in Washington, DC that affects the association’s member fleets. Such vigilance is crucial, especially today, as Medicaid-funded Non-Emergency Medical Transportation (NEMT) is under threat. Thanks to the hard work of the association’s government affairs team, members and other supportive groups, a new bill has been introduced in Congress protecting Medicaid-funded NEMT for those in our communities who need it the most. This effort was a front-and-center topic at Mobilize 2019, The Transportation Alliance’s annual convention and expo, that was held Oct. 16-19 at the newly renovated Bally’s Las Vegas. Mobilize 2019 offered educational sessions on innovation, business diversification, and operational excellence, as well as 30,000 square feet of Expo hall where vendors showcased their latest products and services for today’s fleet, from vehicles to software to insurance products and more. Just a few weeks prior to Mobilize 2019, The Transportation Alliance proudly participated in NEMTAC’s first ever annual conference, where the issue of protecting Medicaid-funded NEMT and expanding opportunities in the industry was also a topic of discussion. Terry O’Toole, the 2018-2019 President of The Transportation Alliance, presented a well-received session titled “The Transportation Alliance Works to Protect & Expand NEMT Opportunities.” Following on the heels of Mobilize 2019 and NEMTAC’s exciting inaugural event, here’s a helpful recap of where things stand right now in Congress following a flurry of action led by The Transportation Alliance in Washington, DC. 2019 Legislative Fly-In Recap In June, transportation leaders from around the country held more than 50 policy meetings with Congressional members on Capitol Hill to call attention to one of our industry’s top priorities: protecting Medicaid-funded NEMT. With Medicaid-funded NEMT serving the 3.6 million low-income Americans who depend on it for lifesaving medical appointments and treatments, our members knew the stakes were high and got to work.
Before attending their individual meetings with lawmakers, members met with Representative Sandford Bishop (D-GA), who serves on the House Appropriations Committee, where they discussed efforts to protect Medicaid-funded NEMT funding. Rep. Bishop, a proven ally of the transportation industry, delivered prepared remarks emphasizing the brass tacks of the legislative process and recognizing The Transportation Alliance as an important partner in the recent legislative success protecting Medicaid-funded NEMT. Earlier this year, Rep. Bishop sent a letter to Representative Rosa DeLauro (D-CT), the chair of the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies, and to Ranking Member Tom Cole (R-OK) opposing changes to Medicaid regulations that would have allowed states to eliminate NEMT. The letter received bipartisan support from lawmakers in both chambers, the entire House Congressional Black Caucus and over 60 NEMT stakeholders including The Transportation Alliance. “This change would have wreaked havoc on the delivery of healthcare, especially in rural areas,” Bishop said. “Ending Medicaid coverage would literally have been a matter of life and death for these individuals.” The result of Rep. Bishop’s effort was legislative language in the appropriations bill to block funding of the implementation of this rule change. Following the inclusion of this language, Rep. Bishop’s office received word that the Centers for Medicare & Medicaid Services would not promulgate the rule until at least after 2020.
How The Transportation Alliance continued ...
"When we act, together, we can delay and stop bad policy and protect our most vulnerable citizens,” Bishop said. During our session, Rep. Bishop also announced that he intends to propose legislation that would provide Medicare NEMT—modeled on Medicaid’s managed transportation care benefit—for individuals who qualify due to end-stage renal disease and who lack transportation alternatives (other than an ambulance) to travel to dialysis appointments. The Transportation Alliance celebrated in the success of the Legislative Fly-In’s efforts to defend NEMT for our most vulnerable populations while providing a vision for the future of transportation as it intersects with government. A Bill is Introduced On July 24, Congress took another step toward protecting Medicaid-funded NEMT. Representatives Buddy Carter (R-TX), Tony Cardenas (D-CA), Tom Graves (R-GA), and Sanford Bishop (D-GA) introduced this critical legislation, H.R. 3935, which follows efforts earlier this year to prevent the administration from promulgating a new rule allowing states to discontinue this program for Medicaid recipients. The Transportation Alliance supports this effort and will work with the bill’s sponsors on ensuring this vital healthcare benefit is protected by lobbying members of the House and Senate. We will continue to work to ensure this legislation becomes law. Getting Involved These are just a few examples of how The Transportation Alliance ensures our industry’s voice is being heard. Every year, we advocate for the top priorities facing our industry. Today, our industry’s voice is again being heard with this bi-partisan introduction of H.R. 3935 protecting Medicaid-funded NEMT. The members of The Transportation Alliance have a seat at the table in Washington DC when it comes to legislative measures. We don’t intend to leave any of our transportation allies, or the 3.6 million Medicaid-funded NEMT passengers, behind in this fight.
Sponsored Content Every non-emergency medical transportation (NEMT) provider has a similar goal: provide the highest quality transportation services in the most efficient manner possible to positively impact your bottom line. A comprehensive dispatch software solution can help you achieve this. There are two key features that NEMT software platforms should have to offer full benefits to transportation providers: flexibility and scalability. Ideally, routing, scheduling, and dispatching (RSD) technology platforms should be developed specifically with NEMT services in mind. Platforms developed specifically for NEMT offer a full, wrap-around suite of NEMT-tailored software solutions customized to meet the needs of transportation providers who offer community transportation options. When researching software technology to fit your needs, features like optimized scheduling and dispatching, GPS functionality, enhanced visibility, streamlined claims and billing, and mobile app technologies are key components that will benefit your business. What Benefits Does Reveal RSD Technology Offer? While each software is different and has its own unique benefits, Reveal’s RSD platform was developed for NEMT services. Simply put: Reveal offers NEMT providers end-to-end benefits and operational enhancements. Through cutting edge technology, NEMT providers have the improved ability to deliver premium transportation service to passengers. Reduced Costs On average, Reveal helps NEMT providers reduce overall costs by 20%. How do they achieve that? The Reveal platform improves the efficiency of trip entry and scheduling, and offers real-time service monitoring to allow for timely adjustments. Flexibility and Scalability Whether your operation has five vehicles or 500, Reveal is completely tailored and scalable to the size of your company. With this level of flexibility and scalability, large and small organizations alike can take advantage of the features most important to you. Optimized Routing and Scheduling To best insert trips into your schedule, Reveal analyzes your daily routes—including any standing order trips—to identify where single-reservation trips, will calls, or last minute pick-ups fit into existing schedules, allowing for optimized route efficiency.
Mobile App Technologies With intuitive in-vehicle technology and smartphone applications for both drivers and passengers, Reveal increases transparency and trip management capabilities for all stakeholders, improving the overall transportation experience and increasing satisfaction. Real-Time Visibility With real-time visibility into route performance, dispatchers can see how individual trips and routes are performing. Using this analysis, dispatchers can quickly make changes and adjustments as necessary to improve service delivery and overall performance. Improved Data Integrity and Reporting Reveal’s unparalleled reporting, dashboards, and oversight tools allow you to quickly facilitate data retrieval to better determine the root cause of performance issues. With this ability, Reveal helps you proactively prevent recurrence of service issues. GPS Capabilities Reveal interfaces with Google Maps to hold drivers accountable to schedules and allow for real-time traffic updates for route changes, pick-up and drop-off geocoding to improve location accuracy, and immediate trip reassignment when a dispatcher is alerted that a driver is running late for a pick-up. Who is Reveal? Reveal Management Services, Inc. is a technology and operations management firm that specializes in improving transportation efficiencies, performance, and productivity while reducing operating and labor costs. Reveal provides technology solutions for transportation agencies and private companies like NEMT providers who offer passenger transportation services. Since 2008, Reveal has provided a reliable platform for transit agencies to use to better manage fixed route and Americans with Disabilities Act (ADA) paratransit services. In 2017, MTM, Inc.—one of the nation’s largest NEMT brokers—acquired Reveal, and has since customized the Reveal RSD platform to specifically meet the needs of NEMT providers. How Do I Learn More? Interested in learning more? Contact Reveal for a free demo! Visit www.reveal-solutions.net to schedule your demo today.
Enhancing Your NEMT Operations continued ...
By Gail Bauhs, NEMT Industry Solutions Consultant, TripSpark Technologies The Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to seniors over 55 who qualify for nursing home care, but who can still live safely in the community. PACE was created to give individuals and their families, caregivers, and professional health care providers the flexibility to provide the most appropriate health care needed. An interdisciplinary team of professionals works together with participants and their families to develop an effective, coordinated plan of care. These professionals are also experts in working with older people. Most participants are dually eligible to receive both Medicare and Medicaid covered services, but PACE may also provide additional care and services not otherwise covered. Examples of covered services include: prescription drugs, physician care, transportation, home care, check-ups, hospital visits, and even nursing home stays whenever necessary. The heart of the PACE program is the PACE day center, a centralized facility that offers meals, socialization, routine medical tests and check-ups, therapy and more. Participants receiving these services require transportation to take them back and forth between their home and the center. PACE Transportation Services A significant benefit of the integrated care seniors receive through PACE is transportation to and from the PACE center and to all medically necessary appointments. What makes this more complicated than standard non-emergency transportation is that in addition to transportation, PACE centers may also need to manage and coordinate home health care visits. The focus of every PACE organization is to help individuals live in the community for as long as possible. To meet this goal, PACE organizations focus on preventive care that requires both transportation to and from medical services and home visits by medical professionals. Scheduling and routing routine pick up and drop offs of individuals from their homes to the PACE center is easily handled by most NEMT software. However, scheduling home visits by medical professionals using their own vehicles means cross referencing multiple schedules. To help address this issue, some NEMT software offers two types of scheduling: trips and home health care visits. Why Invest in PACE Transportation Management Software? According to the National PACE Association (NPA), participants make an average of 8 visits per month to the PACE center or 16
NEMT Opportunities Within the PACE continued ...
trips overall per month. Multiply that by the number of program participants (51,000 as of September 2019), and that's 9.7 million trips a year and growing. Estimates for the capital funding required to set up a new PACE facility come in at up to $12 million. The NPA estimates that a used van costs up to $40,000 to purchase, while a new one rolls off the lot for $60,000. With this much money invested in transportation and infrastructure, combined with the need for comprehensive routing to meet growing transportation demand, it makes sense to choose a PACE software program that can accommodate both trips and home care visits. Single System for Dual Scheduling Unlike trip scheduling, home health care visits can be set up as an individual visit or as a group of visits to be performed by an individual provider. For example, Gerry’s trips can be scheduled, as well as a visit from his home health provider. Additionally, Gerry’s home health provider could also schedule all the home visits he has with his participants to help manage his own schedule. By viewing both Gerry’s trip schedule alongside the home heath care provider's schedule, one can see when Gerry will be at home and available for a visit. With the aid of technology, staff can avoid mismatched transportation and home visit bookings that can result in participant no-shows and lost revenue. Customizable fields also allow PACE organizations to assign contracted costs to modes and trip types, as well as to visit types and duration. Users can select from a predetermined menu of options to help track the medical reason for a trip or the type of home health service delivered. Each contracted providers' details are entered into the software so only current and appropriate providers are considered for scheduling assignments. For example, a provider coded as a home health care aid would not be assigned to an in-home physiotherapy session. Having a single system that can manage both types of diverse scheduling can optimize resource use, reduce scheduling conflicts, and simplify record keeping and reporting. Safety and Security with Staff Credentialing PACE transportation and home care workers are considered direct care workers under PACE regulations, so they must meet all health requirements and background checks. Having a credentialing module embedded into your PACE software helps ensure only staff with current and up-to date credentials are assigned to perform trips and home care services, and that their background checks are up to date. HIPAA and Data Security Since both PACE programs and their contracted transportation providers are considered to be health care providers, they are subject to audits from their respective funders.
NEMT software can help PACE program and transportation providers meet HIPAA requirements for secure data storage, backup and access; proper handling of health records; and prevention of security breaches. Specifically, NEMT software can provide the following tools to meet HIPAA standards surrounding technical safeguards: Unique user identification and authentication Encryption and decryption of information Audit controls to record activity and provide reports. Conclusion With the expected nation-wide growth of PACE programs and the potential for cost-saving and scheduling efficiency, it makes sense for organizations to invest in an NEMT software platform that offers innovative solutions for both PACE transportation and home health visits.
SUBMIT HERE
Submit Content for the Winter 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 Winter Edition of NEMT Today!
www.nemttoday.com