§ 365-H — Provision and reimbursement of transportation costs

New York § 365-H

• Jurisdiction: New York
• Law SOS: Social Services
• Title 11: Medical Assistance For Needy Persons
• Art. 5: Assistance and Care

Text

* § 365-h. Provision and reimbursement of transportation costs. 1. The\nlocal social services official and, subject to the provisions of\nsubdivision four of this section, the commissioner of health shall have\nresponsibility for prior authorizing transportation of eligible persons\nand for limiting the provision of such transportation to those\nrecipients and circumstances where such transportation is essential,\nmedically necessary and appropriate to obtain medical care, services or\nsupplies otherwise available under this title.\n 2. In exercising this responsibility, the local social services\nofficial and, as appropriate, the commissioner of health shall:\n (a) make appropriate and economical use of transportation resources\navailable in the district in meeting the anticipated demand for\ntransportation within the district, including, but not limited to:\ntransportation generally available free-of-charge to the general public\nor specific segments of the general public, public transportation,\npromotion of group rides, county vehicles, coordinated transportation,\nand direct purchase of services; and\n (b) maintain quality assurance mechanisms in order to ensure that (i)\nonly such transportation as is essential, medically necessary and\nappropriate to obtain medical care, services or supplies otherwise\navailable under this title is provided; (ii) no expenditures for taxi or\nlivery transportation are made when public transportation or lower cost\ntransportation is reasonably available to eligible persons; and (iii)\ntransportation services are provided in a safe, timely, and reliable\nmanner by providers that comply with state and local regulatory\nrequirements and meet consumer satisfaction criteria approved by the\ncommissioner of health.\n 3. In the event that coordination or other such cost savings measures\nare implemented, the commissioner shall assure compliance with\napplicable standards governing the safety and quality of transportation\nof the population served.\n 4. (a) The commissioner of health is authorized to assume\nresponsibility from a local social services official for the provision\nand reimbursement of transportation costs under this section. If the\ncommissioner elects to assume such responsibility, the commissioner\nshall notify the local social services official in writing as to the\nelection, the date upon which the election shall be effective and such\ninformation as to transition of responsibilities as the commissioner\ndeems prudent. The commissioner is authorized to contract with a\ntransportation manager or managers to manage transportation services in\nany local social services district, other than transportation services\nprovided or arranged for enrollees of managed long term care plans\nissued certificates of authority under section forty-four hundred\nthree-f of the public health law. Any transportation manager or managers\nselected by the commissioner to manage transportation services shall\nhave proven experience in coordinating transportation services in a\ngeographic and demographic area similar to the area in New York state\nwithin which the contractor would manage the provision of services under\nthis section. Such a contract or contracts may include responsibility\nfor: review, approval and processing of transportation orders;\nmanagement of the appropriate level of transportation based on\ndocumented patient medical need; and development of new technologies\nleading to efficient transportation services. If the commissioner elects\nto assume such responsibility from a local social services district, the\ncommissioner shall examine and, if appropriate, adopt quality assurance\nmeasures that may include, but are not limited to, global positioning\ntracking system reporting requirements and service verification\nmechanisms. Any and all reimbursement rates developed by transportation\nmanagers under this subdivision shall be subject to the review and\napproval of the commissioner.\n (b)(i) Subject to federal financial participation, for periods on and\nafter April first, two thousand twenty-one, in order to more\ncost-effectively provide non-emergency transportation to Medicaid\nbeneficiaries who need access to medical care and services, the\ncommissioner is authorized to contract with one or more transportation\nmanagement brokers to manage such transportation on a statewide or\nregional basis, as determined by the commissioner, in accordance with\nthe federal social security act as follows:\n (A) The transportation management broker or brokers shall be selected\nthrough a competitive bidding process based on an evaluation of the\nbroker's experience, performance, references, resources, qualifications\nand costs; provided, however, that the department's selection process\nshall be memorialized in a procurement record as defined in section one\nhundred sixty-three of the state finance law;\n (B) The transportation management broker or brokers shall have\noversight procedures to monitor Medicaid beneficiary access and\ncomplaints and ensure that enrolled Medicaid transportation providers\nare licensed, qualified, competent and courteous.\n (C) The transportation management broker or brokers shall be subject\nto regular auditing and oversight by the department in order to ensure\nthe quality of the transportation services provided and adequacy of\nMedicaid beneficiary access to medical care and services.\n (D) The transportation management broker or brokers shall comply with\nrequirements related to prohibitions on referrals and conflicts of\ninterest required by the federal social security act.\n (ii) The transportation management broker or brokers may be paid a per\nmember per month capitated fee or a combination of capitation and fixed\ncost reimbursement and the contract shall include, but not be limited\nto, responsibility for:\n (A) establishing a network of high-quality Medicaid enrolled\nproviders; provided, however, that in developing such network the\ntransportation management broker shall evaluate the qualifications of\ncurrent Medicaid transportation providers on a priority basis for\nparticipation in its network, and leverage reputable transportation\nproviders with a proven record of serving Medicaid beneficiaries with\nhigh-quality services;\n (B) continuing outreach to Medicaid enrolled providers to assess and\nresolve service quality issues;\n (C) developing mandatory corrective actions for any Medicaid enrolled\nprovider that falls under quality performance standards;\n (D) establishing a prior approval process which shall include\nverifying Medicaid eligibility and reviewing, approving and processing\ntransportation orders;\n (E) managing the appropriate level of transportation based on\ndocumented patient medical need to ensure that Medicaid beneficiaries\nare using the most medically appropriate mode of transportation,\nincluding public transportation, which shall be maximized statewide,\nincluding in rural areas; provided that when determining the appropriate\nlevel of transportation, the transportation management broker shall\nensure that patients have reasonable and timely access to medically\nappropriate transportation services;\n (F) implementing technologies to effectuate efficient transportation\nservices, such as GPS, to improve match to mode of transportation;\n (G) establishing fees to reimburse enrolled Medicaid transportation\nproviders;\n (H) adjudicating and paying claims submitted by enrolled Medicaid\ntransportation providers;\n (I) reporting on performance encompassing all aspects of the\ntransportation program, including but not limited to Medicaid\nbeneficiary complaints including the length of time to make a compliant,\nwait times related to the receipt of services by a recipient, and\ntracking medical justifications to modes of transportation provided;\n (J) collaborating with Medicaid beneficiaries and consumer groups to\nidentify and resolve issues to increase consumer satisfaction;\n (K) auditing cancellation data on a quarterly basis to ensure\naccuracy;\n (L) coordinating medical benefits and transportation with Medicaid\nmanaged care organizations, including development of value based\npayments for transportation services; and\n (M) such contracts shall include penalties for incorrect denials,\nunresolved complaint rates, unfulfilled trips, and any other criteria\ndetermined by the commissioner and specified in the competitive bidding\nprocess.\n (iii) A transportation management broker with which the commissioner\ncontracts shall file with the commissioner a bond issued by an insurer\nauthorized to write fidelity and surety insurance in this state, in an\namount and form to be determined by the commissioner. The purpose of the\nsurety bond shall be to provide the sole source of recourse to providers\nof Medicaid transportation services, other than the transportation\nmanagement broker, that cannot receive payment for services properly\nprovided if the transportation management broker becomes insolvent. To\nthe extent permitted by law, the surety bond shall provide that any\nfunds that remain after such provider liabilities are satisfied shall be\npaid to that state.\n (iv) A transportation management broker with which the commissioner\ncontracts shall provide to Medicaid enrolled providers annually a\nconspicuous written disclosure that states the following: "The New York\nState Department of Health has contracted with this transportation\nmanagement broker to arrange non-emergency transportation for Medicaid\nbeneficiaries who need access to medical care and services and is paying\nthe transportation management broker a per member per month capitated\nfee or a combination of capitation and fixed cost reimbursement. This\ntransportation management broker is not licensed by the New York State\nDepartment of Financial Services as an insurer and is not subject to its\nsupervision as an insurer. This transportation management broker is not\nprotected by New York security funds and there will not be any right to\nrecover against the department of health, department of financial\nservices, or this state in the event of the transportation management\nbroker's insolvency.\n (v) To the extent practicable, the competitive bidding and contracting\nprocess maybe completed by April first, two thousand twenty-one;\nprovided, however, such contract may be effective at some date after\nApril first, two thousand twenty-one, if the process takes longer to\ncomplete.\n (vi) Responsibility for transportation services provided or arranged\nfor enrollees of managed long term care plans issued certificates of\nauthority under section forty-four hundred three-f of the public health\nlaw, not including a program designated as a Program of All-Inclusive\nCare for the Elderly (PACE) as authorized by Federal Public law 1053-33,\nsubtitle I of title IV of the Balanced Budget Act of 1997, and, at the\ncommissioner's discretion, other plans that integrate benefits for\ndually eligible Medicare and Medicaid beneficiaries based on a\ndemonstration by the plan that inclusion of transportation within the\nbenefit package will result in cost efficiencies and quality\nimprovement, shall be transferred to a transportation management broker\nthat has a contract with the commissioner in accordance with this\nparagraph. Providers of adult day health care may elect to, but shall\nnot be required to, use the services of the transportation management\nbroker.\n 5. Notwithstanding any contrary provision of law, and subject to\nfederal financial participation, the commissioner of health shall make\nadjustments to payments under this section, for the purposes of\nproviding increased access to Medicaid non-emergency transportation in\nrural communities. Up to two million dollars shall be available for such\npurposes.\n 6. (a) The commissioner of health shall require transportation\nproviders enrolled in the Medicaid program and specified by the\ncommissioner pursuant to regulation, to report the costs incurred in\nproviding transportation services to Medicaid beneficiaries pursuant to\nthis section; provided, however, this requirement shall only apply if\nthere is no transportation management broker contract authorized in\nsubdivision four of this section. The commissioner shall specify the\nfrequency and format of such reports and determine the type and amount\nof information required to be submitted, including supporting\ndocumentation, provided that such reports shall be no more frequent than\nquarterly. The commissioner shall give all transportation providers no\nless than ninety calendar days' notice before such reports are due.\n (b) If the commissioner determines that the cost report submitted by a\nMedicaid transportation provider is inaccurate or incomplete, the\ncommissioner shall notify such provider in writing and advise the\nprovider of the correction or additional information that the provider\nmust submit. The provider shall submit the corrected or additional\ninformation within thirty calendar days from the date the provider\nreceives the notice.\n (c) The commissioner shall grant a provider an additional thirty\ncalendar days to submit the original cost report, or corrected or\nadditional information required pursuant to paragraph (b) of this\nsubdivision only when the provider submits a written request to the\ncommissioner for an extension prior to the due date and establishes to\nthe satisfaction of the commissioner that the provider cannot submit the\ncost report or corrected or additional information by the due date for\nreasons beyond the provider's control.\n * NB Repealed 16 years after the contract entered into pursuant to\nthis section 365-h is executed\n * § 365-h. Provision and reimbursement of transportation costs. 1. The\nlocal social services official shall have responsibility for prior\nauthorizing transportation of eligible persons and for limiting the\nprovision of such transportation to those recipients and circumstances\nwhere such transportation is essential, medically necessary and\nappropriate to obtain medical care, services or supplies otherwise\navailable under this title.\n 2. In exercising this responsibility, the local social services\nofficial shall:\n (a) make appropriate and economical use of transportation resources\navailable in the district in meeting the anticipated demand for\ntransportation within the district, including, but not limited to:\ntransportation generally available free-of-charge to the general public\nor specific segments of the general public, public transportation,\npromotion of group rides, county vehicles, coordinated transportation,\nand direct purchase of services; and\n (b) maintain quality assurance mechanisms in order to ensure that (i)\nonly such transportation as is essential, medically necessary and\nappropriate to obtain medical care, services or supplies otherwise\navailable under this title is provided and (ii) no expenditures for taxi\nor livery transportation are made when public transportation or lower\ncost transportation is reasonably available to eligible persons.\n 3. In the event that coordination or other such cost savings measures\nare implemented, the commissioner shall assure compliance with\napplicable standards governing the safety and quality of transportation\nof the population served.\n * NB Effective 16 years after the contract entered into pursuant to\nthis section 365-h has been executed\n