The following are topics from questions and answers of industry professionals. This is a follow up to a Medicaid Roundtable at the Community Transportation EXPO 2007 in Reno, Nev. The participants were providers, brokers, and Association staff.
One especially significant statement out of this gathering of information came from a broker who said that providers should do what they do best which is to provide transportation that is professional, safe, and reliable. Many of the national brokerages have no desire to be direct providers. The national brokerages who participated in this information concurred.
Coordination of services: Providers found that providing non emergency Medicaid transportation was a positive addition to other services. It provided for expansion of service and increased revenue to match other programs. Brokerages are willing to work with transit providers and their existing schedules if transportation can be provided at a lower coordinated cost to the broker.
Fuel cost increase: Providers and brokerages found that working together using the political process to educate legislators about the need for additional funds to cover increase in the cost of fuel had been a positive experience. This effort must be joined by those needing the increased reimbursement. In most cases, the increase is done as a 100% pass through of increased funds to providers through fuel adjustments and a mileage formula.
Client no shows: With the increase of transportation being provided for behavioral health clients, client no show rates have increased. This is extremely costly to the transportation provider since in most cases, Medicaid does not cover no shows. Some strategies to combat the increasing no shows were offered by providers and brokers alike. Some Medicaid contracts require that the transportation provider call the client/rider the day before the service to confirm the ride. This is helpful but time consuming to the provider. Some systems have a policy that after three no shows the client must call in to the transit provider the day of service to verify the trip or the trip will not be scheduled. It is also helpful to work with the client's case manager to educate the client about no shows. It was also advised that the managing department for Medicaid in the state be notified of habitual abusers. Some states have instituted a one month suspension policy for habitual no shows if the client is not attending life-sustaining treatment. Whatever the strategy, it must be approved by Medicaid.
Broker vs. Provider: There is a disconnection between what the provider understands about the broker and what the broker understands about the provider. Transportation providers often do not realize that many of the restrictions and demands placed on the provider by the brokers come directly from the contract the broker signs with Medicaid. Liquidated damages, on time performance levels, and other requirements are often not broker driven but are included as specifics in the Request for Proposal (RFP) the broker responds to. The broker is often subject to fines for substandard performance by the transportation provider.
Brokers however do not take into account that in the case of the provider, Medicaid is likely not the only contract and does not operate independently of the other services. Vehicles and drivers are used for multiple contracts at the same time and therefore, it is difficult if a broker attempts to set up routes that do not include other contracts.
Certainly good communication between the provider and broker is essential but often not a reality.
Brokers and Medicaid Need to Reduce Cost: Brokers work with Medicaid to reduce costs. This can have the perception of being at the expense of the provider. Brokers strive to assign the appropriate mode of service for the client's needs. The broker utilizes public transit and public transit fare structure wherever possible. The broker uses trip verification of covered Medicaid services. Each trip may be required to be verified by a signature of the client in order for the transportation provider to receive payment for services. Enforcement of no show policies can decrease cost. Sometimes, however, Medicaid will not allow for restricted services as a result of client no shows. Brokers may levy fines or penalties for provider no shows or lack of on time performance. They may penalize for trips the provider turns back to them due to the fact that the trip will then have to be reassigned usually at an increased rate.