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Analysis

Medicaid Leaders Should Improve NEMT Services, Study Urges

By Jack O'Brien  
   July 24, 2019

A white paper released by Leavitt Partners Wednesday offers recommendations for improving NEMT.

Medicaid leaders and healthcare industry stakeholders are advised to consider actions that could improve program integrity for non-emergency medical transportation (NEMT), according to a white paper released by Leavitt Partners Wednesday.

The paper provides specific recommendations for both the Centers for Medicare and Medicaid Services (CMS) as well as state Medicaid programs in order to "protect the program from those who would exploit or defraud the program and could cause harm to Medicaid beneficiaries."

The white paper acknowledges that NEMT services have changed dramatically since the program debuted in 1966, especially with the rise of ridesharing companies like Uber and Lyft in the healthcare space. 

Related: More People Using Uber, Lyft to Take Cheap Ride to Emergency Room

Couathors Josh Trent, principal at Leavitt Partners, and Charlene Frizzera, senior advisor at Leavitt Partners, wrote that NEMT assists Medicaid beneficiaries who "lack reliable sources of transportation" and ensure that at-risk patients do not forgo treatment and improve health outcomes. 

Despite highlighting the benefits associated with NEMT, Trent and Frizzera pointed to issues with program integrity, including lacking oversight audits and improper payments that can "erode public support for Medicaid services.”

For CMS, the authors urge the agency to update NEMT program integrity review, "facilitate collaboration on leading practices," and implement the open recommendation issued by the Government Accountability Office in 2016.

Related: Uber Health Head on NEMT Competition: 'This is Not a Winner-Take-All Market'

Trent and Frizzera argue that state Medicaid leaders should position their respective systems to "detect and prevent" known fraud schemes, ensure the complaint and appeals process for beneficiaries is consistent, and consider the role of transportation network companies like Uber, Lyft, or Veyo. 

"The delivery of Medicaid NEMT services has evolved in the last decade or so, as external forces have created new opportunities and placed new expectations on the program,” Trent and Frizzera wrote. "It is essential that Medicaid leaders across Medicaid state programs, brokers, managed care plans and delivery systems work collaboratively to improve the integrity of the program for the benefit of patients and the program itself."

Related: Lyft Exec on Mission: 'Get Patients Everywhere They Need to Go'

In addition to Leavitt Partners, members of Congress have recently spoken out on CMS' plans for NEMT, pushing back on a recent regulation put forward in the Trump administration's fiscal year 2020 budget proposal. 

In mid-June, three congressmen authored a letter to CMS Administrator Seema Verma expressing concerns about proposed regulations to allow state Medicaid programs to drop NEMT coverage. 

The letter, written by Reps. Sanford Bishop, D-Ga., Buddy Carter, R-Ga., and Tom Graves R-Ga., urged Verma to support state flexibility without "overturning a Medicaid policy in place for over 50 years" in a move that they said could affect "our most vulnerable beneficiaries."

On June 11, the Trump administration publicly expressed its opposition to H.R. 2740, a bill aiming to prohibit CMS from allowing state Medicaid programs to make NEMT benefits optional. The bill passed the House on June 19. 

Related: Ford GoRide CEO on Medical Expansion: 'We're Not Just In It to Move People Around'

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.


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