SUBJECT: NEMT Vendor Obligations and Policy Implementation Timeline
DISTRIBUTION: County Directors of Social Services
Medicaid Eligibility Staff
Change Notice 01-12, Non-Emergency Medicaid Transportation (NEMT), revised NEMT policy in order to provide more consistency and oversight of the transportation program. Federal regulations place additional reporting obligations on individuals and entities that contract to provide Medicaid Services. These additional obligations are outlined below and must be included in all NEMT vendor contracts.
Furthermore, in September 2011, the Centers for Medicaid and Medicare Services’ Medicaid Integrity Group conducted a comprehensive program integrity review of the North Carolina Medicaid Program. As a result of that review, North Carolina was cited for noncompliance with 42 CFR 1002.3(b)(3) for failure to ensure that adverse actions against Non-Emergency Medicaid Transportation vendors and providers for program integrity reasons are reported to the Department of Health and Human Services Office of Inspector General (DHHS OIG). This letter provides a procedure for counties to report adverse actions against transportation vendors and providers and a form to do so (see Attachment 1).
Included as attachments to this Administrative Letter are the county contract template (see attachment 2) and contract transportation rider (see attachment 3), which are revised to include federal and state Medicaid vendor reporting requirements. The Local Business Liaisons have shared the revised contract template and transportation rider with the counties. The DMA-5024, Medicaid Transportation Vendor Documentation, form is revised to include the business ownership, control and location information specified in II. below (see Attachment 4 for revised form). Attachment 5 is the DMA-5125B, Medicaid Transportation Suspension Notice, which is revised to indicate that the individual is entitled to transportation to a critical service (where applicable) during the period of their suspension. In addition, the NEMT Grid, containing implementation timelines, is appended as “attachment 6.”
Disclosure is due at any of the following times:
Contracts with NEMT vendors must obligate the vendor to furnish DMA or HHS, within 35 days of the date on a request, full and complete information related to business transactions about:
Before the county enters into or renews an NEMT vendor agreement, or at any time upon written request by the county, the vendor must disclose to the county the identity of any person who:
Effective immediately, counties must notify DMA Quality Assurance when they take an adverse action against a NEMT vendor for program integrity reasons. Adverse actions include denials and terminations of enrollment or contracts. Program integrity reasons include fraud, integrity, or quality.
Examples of program integrity reasons include but are not limited to:
• Conviction of a criminal offense related to the delivery of an item or service under Medicare or under any State health care program
• Conviction under Federal or State law, of a criminal offense relating to neglect or abuse of patients in connection with the delivery of a health care item or service
When an adverse action is taken against a transportation vendor or provider, complete the attached DMA-5142, Office of Inspector General Adverse Action Reporting Form, and submit via fax or mail to Division of Medical Assistance, Quality Assurance Section, 2501 Mail Service Center Raleigh, NC 27699-2501 at 919-814-0036 within five work days.
DSS contract template and contract “Addendum J, Certification Regarding Transportation” is revised to obligate NEMT vendors to perform the regulatory and policy requirements contained in NEMT policy. The Local Business Liaisons have shared the revised contract template and transportation rider with the counties. The use of the contract template is optional, but the information required by it must be contained in every NEMT contractual agreement the county enters into with an NEMT vendor. See Attachment 1, contract template and Attachment 2, Certification Regarding Medicaid Transportation.
The DMA-5124, Medicaid Transportation Provider Documentation form is revised to include the contractual requirements added in II.C. above. See attachment 3.
MA-2910/3550, Medicaid Transportation, VII.G.2. states that critical needs recipients, such as those receiving dialysis or chemotherapy, cannot be denied transportation to critical services, no matter how many transportation appointments they miss. However, transportation to non-critical services, such as routine doctor visits, can be suspended for these individuals. Indicate on the revised DMA5125B, Medicaid Transportation Suspension Notice, that the individual can still receive transportation to a critical need medical service during the suspension.
On March 15, 2012, a “Dear County Director of Social Services” letter included a “NEMT Grid” which contained implementation timelines for the revised NEMT policy. The identical NEMT Grid is appended to this Administrative Letter as Attachment 6.
If you have any questions regarding this information, please contact your Medicaid Program Representative.
Craigan L. Gray, MD, MBA, JD,
(This material was researched and written by Shara Britt, Assistant Chief, Quality Assurance Section and William Appel, Policy Consultant, Medicaid Eligibility Unit.)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.